In most cases people really didn't know about sleep apnea and just thought it was bad snoring. Treatment was aimed at reducing the noise of snoring and in really bad cases they used a tracheotomy. There were lots of experiments with surgery (some of which is still done today) and laser ablation of the soft palate.
There is a really good article here:
https://www.resmed.com/au/dam/documents/...dica14.pdf
I will post the full text of the main article below so that we have a copy available in case the original disappears. There are several interviews and side-articles which are also worth reading.
RESMEDICA
ISSUE 14 2011
THIRTY YEARS OF CPAP
Is 30 years a long time or a short time in medical science?
Have we come a long way, or is our understanding of
OSA still in its infancy? Whichever way you look at
it, Sullivan et al’s 1981 paper brought a revolutionary
treatment to light.
OSA has been observed since ancient times, and there are
records of its symptoms, such as heavy snoring, dating
back over 2,000 years. The term ‘Pickwickian syndrome’
was adopted in the late 19th century to describe apneic
symptoms, but research concentrated on the patients’
obesity rather than on disordered breathing during sleep. In
1965 the first polysomnograph recorded apneas during sleep.
Further research in the 1960s established that obesity was
not essential for OSA, but that there were other comorbidities
associated with sleep-disordered breathing.1
In 1970 the first sleep clinic was established at Stanford
University, California, USA by William Dement. In 1972
Christian Guilleminault joined the clinic, concentrating on
respiratory disorders during sleep.
The period 1975–80 saw an intense amount of research
into sleep and apnea, with 319 articles appearing in medical
literature. In 1978 JE Remmers et al resolved the key question
of where airway obstruction occurred during an apnea,
showing that the locus of airway closure lay in the oropharynx,
not the larynx.2
In Toronto, Canada, Eliot Phillipson started investigating
respiratory control in dogs in 1970. He was joined in 1976
by Colin Sullivan on a post-doctoral research fellowship from
Sydney University, Australia. Sullivan worked with the dogs in
the laboratory, studying effects such as hypoxia, hypercapnia,
control mechanisms during REM and non-REM sleep, arousal
and laryngeal stimulation. In 1979 Sullivan returned to Sydney
and devised a mask that would fit over a dog’s snout to deliver
air or an experimental gas.
Until this time the experiments on the dogs had been
conducted via a tracheotomy. Similarly, people who were
severely affected by OSA were given tracheotomies to
bypass the blockage in the upper airway and allow unimpeded
breathing. However, this was a dramatic solution for the
problem, and could in itself have serious consequences for
the patient. Sullivan was moving towards an alternative noninvasive treatment for OSA.
He applied his experimentation on dogs to humans, using
masks that were created for each patient. A plaster cast would
be made of their nose and fibreglass moulded over the cast.
The resulting fibreglass shape would be fitted with air inlets
and outlets and attached to the patient’s face each night with
silicone adhesive. Tubes to the therapy device were attached
to the mask, providing the patient with a source of continuous
positive airway pressure that could be regulated.
Sullivan used his observations of five patients using this
technology for his 1981 paper. He describes the patients as
having long histories of noisy snoring and excessive daytime
sleepiness to the point where their lives were seriously
affected. Two had lost their jobs as a result of falling asleep
at work, and one, a 13-year-old boy, was unable to stay
awake at school and had consequently been categorised as
‘mentally retarded’. Sullivan notes that three of the five had
been offered, but refused a tracheotomy. He conducted three
all-night sleep studies on each patient, using CPAP on the
third night. He writes: ‘Continuous positive airway pressure
completely prevented the upper airway occlusion in each of
the five patients. The upper airway occlusion could be turned
off and on simply by increasing or reducing the level of positive
airway pressure.’
Sullivan had shown that the occurrence of obstructive sleep
apnea could be reversed by the application of CPAP to
provide ‘a pneumatic splint for the nasopharyngeal airway’.
Acceptance of this treatment did not come immediately, and
application of his findings to a wide audience was even slower.
Twelve years later the first major epidemiologic study of the
prevalence of OSA was published by Young et al, finding OSA
to be present in 2% of middle-aged women and 4% of middleaged men. Seven years after that, in 2000, four separate
papers were published that demonstrated associations
between OSA and hypertension (see Key research articles
p14-15). This was a turning point in sleep apnea studies. They
were the first full studies involving sleep apnea effects that
were well-designed with a large patient base, which found a
significant OSA health effect. That the four separate papers
were all published within the same year gave a lot of impact
to the result.
From then on, treatment of OSA was not just about relieving
daytime sleepiness—there was the probability that there was
a mortality benefit as well. In 2001 further research showed
an increased prevalence of coronary heart disease, heart
failure, and stroke at levels of an apnea-hypopnea index equal
to or greater than five per hour.3
The connections between OSA and a range of comorbidities
continue to grow. The medical consequences of OSA are
currently considered to arise from a complex interaction
between five factors: disturbed sleep, intrathoracic pressure
swings, intermittent hypoxia, sympathetic activation and the
mechanical consequences of snoring. Figure 1 shows the
symptoms resulting from these five factors.
1. Barnes, CS. ResMed Origins. ResMed, 2007. 2. Remmers JE, De Groot WJ,
Sauerland EK, Anch AM. Pathogenesis of upper airway occlusion during sleep. J Appl
Physiol 1978;44(6):931–8. 3. Shahar E, Whitney CW, Redline S, Lee ET, Newman AB,
Javier Nieto F, O’Connor GT, Boland LL, Schwartz JE, Samet JM. Sleep-disordered
breathing and cardiovascular disease: cross-sectional results of the Sleep Heart
Health Study. Am J Respir Crit Care Med. 2001;163(1):19-25.
