The History of Sleep Surgery

Abstract

Snoring and the subsequent diagnosis of obstructive sleep apnea (OSA) was a life-threatening medical condition with no available treatment until the late 20th century. An early description of OSA was provided by Charles Dickens in his 1836 novel Pickwick Papers with the description of a "fat boy" who was thought to be lazy and always falling asleep but likely displayed hypersomnolence from OSA. It was not until 1976 that Ikematsu first described uvulopalatopharyngoplasty (UPPP) as an alternative surgical treatment of "snoring," with a reported cure rate of 81%. The only other surgical procedure for OSA was permanent tracheostomy, but patients suffered from social stigma from the visible stoma with skin flaps and complications such as tracheal granulomas and tracheitis. UPPP was introduced in the USA as an alternative to permanent tracheostomy by Fujita in 1981. Since then, multiple surgical approaches and combinations of approaches have surfaced, with variable success rates.

Consensus Statements among European Sleep Surgery Experts on Snoring and Obstructive Sleep Apnea: Part 1 Definitions and Diagnosis

“…For instance, the uvulopalatopharyngoplasty (UPPP) was first introduced by Ikematsu in 1964 to be applied in simple snoring patients. In 1981, Fujita was the first to apply UPPP in OSA patients [30]. Since then, several modifications to the traditional UPPP have been introduced, moving from partial demolition procedures that act mainly on the median portion of the soft palate to procedures that have the aim of stiffening the soft palate, acting also to remodeling the lateral wall pharyngeal muscles [31,32].…”

Disruption Index in Otolaryngology: Uncovering a Bibliometric History of a Rapidly Evolving Field

“…Of particular interest are Fisch's first landmark reports of lateral skull base surgery for tumors of the skull base 18,19 (Tables S2 and S3), for which he is remembered as the founder of modern otoneurology 20 . Sleep surgery is also represented with a minimum citation count of 100 with Fujita's landmark case series illustrating uvulopalatopharyngoplasty as an alternative to permanent tracheostomy for obstructive sleep apnea in adults 21,22 . Furthermore, in the field of laryngology, Isshiki's modern medialization thyroplasty 23 and Cotton and Myer's system of classification based upon sizing of endotracheal tubes 24 for subglottic stenosis rank 83 and 66, respectively, in most disruptive among publications with more than 100 citations (Table S3).…”

A Scoping Review of Sleep Apnea: Where Do We Stand?

“…For years, the initial focus was on the process of understanding the intermittent closure of the upper airway; however, the late 1960s brought a fresh perspective to observe the various symptoms and risk factors at the same time, though limited by methodological difficulties at the time [ 9 , 12 ]. Research studies were mainly conducted via observing dogs and treating the condition with tracheotomies [ 13 ]. Though an earlier concept of continuous positive airway pressure (CPAP) using a customized mask in the 1970 and 1980s further advanced modern management [ 14 ].…”