Introduction W.T. McNicholas*,# and M.R. Bonsignore",+ *Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Dublin, and # Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland. " Dept of Medicine, Pneumology, Physiology and Nutrition, University of Palermo. + Institute of Biomedicine and Molecular Immunology, National Research Council, Palermo, Italy. Correspondence: W.T. McNicholas, Pulmonary and Sleep Disorders Unit, St. Vincent’s University Hospital, Elm Park, Dublin 4, Ireland, Email: S leep-related breathing disorders, particularly obstructive sleep apnoea (OSA) syndrome (OSAS), are highly prevalent and represent an increasing part of clinical respiratory practice. OSAS is now recognised to be one of the most common chronic respiratory disorders, with only asthma and possibly chronic obstructive pulmonary disease having a higher prevalence. Thus sleep apnoea represents an important topic for the European Respiratory Monograph, and the present volume provides a comprehensive overview, with chapters ranging from basic mechanisms to clinical practice. This issue provides an update of a previous Monograph on Respiratory Disorders during Sleep published in 1998 [1]. Humans spend up to a third of life asleep, and yet surprisingly little is known about the biological role of sleep. There is general agreement that sleep is beneficial. William Shakespeare’s Macbeth described sleep as the ‘‘chief nourisher in life’s feast’’, and the age-old remedy for the sick person is to get ‘‘plenty of sleep’’. Some classical writers, however, have viewed sleep with deep suspicion. Sir Thomas Browne wrote ‘‘Sleep, in fine, is so like death, I dare not trust it with my prayers’’, and Alfred, Lord Tennyson described sleep as ‘‘death’s twin brother’’. There have been many references to presumed sleep apnoea in the classical literature and throughout history, including several kings of ancient Greece, and a detailed review of the historical aspects of OSAS is provided in the previous Monograph on Respiratory Disorders during Sleep [2]. Furthermore, the giant in the tale of Jack and the beanstalk very probably suffered from OSAS, and Charles Dickens’s description of Joe, ‘‘a wonderfully fat boy’’, in The Posthumous Papers of the Pickwick Club, clearly demonstrates features of OSAS. Dickens noted that Joe snored heavily, ‘‘as if the roaring of cannon were his ordinary lullaby’’. He was plethoric, ‘‘red-faced’’, had dropsy (peripheral oedema), cognitive dysfunction (‘‘the fat boy’s perception being slow’’) and ‘‘divided his time into small alternate allotments of eating and sleeping’’. These descriptions strongly indicate that Joe suffered from the sequelae of untreated OSAS, with excessive daytime sleepiness, intellectual impairment and cor pulmonale. The term Pickwickian was first used by William Osler, in 1905, to describe similar patients with hypersomnolence and obesity, and was used to describe many early cases of sleep apnoea reported in the medical literature [2]. However, this term is rarely used today, as there may be different causes of obesity and hypersomnolence. Although sleep apnoea was first described as a specific clinical entity in the late 1950s, there are several descriptions in earlier clinical journals that clearly refer to the disorder. The sleeping characteristics of obstructive apnoea were clearly described by BROADBENT [3] in the late nineteenth century: ‘‘there will be perfect silence through two, three, or four respiratory periods, in which there are ineffectual chest movements finally air enters with a loud snort, after which there are several compensatory deep inspirations’’. The practice of modern sleep medicine and the investigation and diagnosis of sleep-related breathing disorders owes much to the development of appropriate diagnostic tools and techniques. The pivotal discovery of electroencephalography by BERGER [4], in 1930, demonstrated clear differences between wakefulness and sleep. The use of the electro-oculogram by Eur Respir Mon 2010. 50, vii–ix. Printed in UK all rights reserved, Copyright ERS 2010. European Respiratory Monograph ISSN: 1025-448x. DOI: 10.1183/1025448x.00026409 vii W.T. MCNICHOLAS AND M.R. BONSIGNORE
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