ABSTRACT
Pediatric sleep medicine has evolved into a major field of study (1). One of the most important conditions in this field is sleep-related breathing disorders (SRBD), which comprise a spectrum of disease ranging from simple snoring to potentially life-threatening obstructive sleep apnea (OSA). This clinical spectrum can occur at any age. Many clinicians learn that OSA emerged from the study of Pickwickian syndrome. However, it is important to point out that in Charles Dickens’ first novel, The Posthumous Papers of the Pickwick Club, the classic description of snoring with arousals and excessive daytime sleepiness was not of Mr. Pickwick (although he probably did have OSA) but instead it was the boy, Joe, who constantly falls asleep in any situation at any time of day.The first medical description in English of children with abnormal breathing in sleep is attributed to William Osler (2) in his 1892 textbook. Osler wrote a dramatic description of the condition: “Chronic enlargement of the tonsillar tissue is an affection of great importance, and may influence in an extraordinary way the mental and bodily development of children. At night the child’s sleep is greatly disturbed, the respirations are loud and snorting, and there is sometimes prolonged pauses, followed by deep, noisy inspiration. The child may wake up in a paroxysm of shortness of breath… . In long-standing cases the child is very stupid-looking, responds slowly to questions, and may be sullen and cross.”
