Who was the first to use the term Pickwickian in connection with sleepy patients? History of sleep apnoea syndrome.

The symptoms and characteristics of sleep apnoea syndrome--excessive daytime sleepiness, loud snoring, restless and non-restorative sleep--are so impressive that it is difficult to understand why its recognition was delayed until the 1970s. The Centennial book of the American Thoracic Society credited Sidney Burwell for the discovery of Obstructive Sleep Apnoea Syndrome. This is only one of the many mistakes and misattributions regarding the history of sleep apnoea syndrome. The earliest descriptions of patients who presumably suffered from sleep apnoea were made in the 19th century. The term "Pickwickian" in connection with sleepy patients was introduced in 1889. The first electrophysiological sleep recordings of Pickwickian patients and the understanding of the syndrome as disordered breathing in sleep, were made during the late 1950s and 1960s. Its recognition as a public health problem was facilitated by Young et al.'s [Young T, Palta M, Dempsey J, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230-5] seminal paper documenting the prevalence of the syndrome in the general population, and by the accumulated evidence that the syndrome is a major cardiovascular risk factor. Bibliometric analysis of the literature on sleep apnoea reveals that future research will focus on the long-term outcomes of the syndrome, on the effects of treatment, and on the underlying mechanisms linking it with cardiovascular morbidity.