Dormouse Disease?

Abstract

The sleep apnea syndromes encompass a variety of clinical disorders which have attracted at least three literary eponyms. The best known of these is the “Pickwickian Syndrome.” With this, Burwell et al1Burwell C Robin E Whaley R Bickelman AG Extreme obesity associated with alveolar hypoventilation; a Pickwickian syndrome.Am J Med. 1956; 21: 811-818Abstract Full Text PDF PubMed Scopus (529) Google Scholar invoked the image of the fat boy Joe in Dickens’ The Posthumous Papers of the Pickwick Club (1837). Joe, who sometimes drove Mr. Wardle’s barouch, used to run errands for him, and also waited at table. He was a “fat and red-faced boy in a state of somnolency,” and even dosed off while running errands. He snored while serving table and was referred to as a “young dropsy” because of his edema (caused no doubt by his cor pulmonale). It is now recognized that the patient’s cor pulmonale and sleep disturbance is caused by obstructive sleep apnea.2Guilleminault C Tilkian A Dement WC The sleep apnea syndromes.Ann Rev Med. 1976; 27: 456-484Crossref Scopus (1116) Google Scholar Comroe3Comroe J Retrospectoscope—Frankenstein, Pickwick, and Ondine.Am Rev Respir Dis. 1975; 111: 689-692PubMed Google Scholar has pointed out, however, that this is a literary error since Joe was not a member of the Pickwick Club, and therefore, not “a Pickwickian.” Nevertheless, the eponym continues to be used, be it in “its Pickwickian sense.” (Oxford dictionary: a (of words and their sense:) not in accordance with the usual meaning, conveniently understood so as to avoid offense, etc). Similarly, another erroneous literary eponym is used to describe primary alveolar hypoventilation.4Severinghaus JW Mitchell R Ondine’s curse—Failure of respiratory center automaticity while awake.Clin Res. 1962; 10: 122Google Scholar Ondine’s Curse is meant to reflect the need to remember to breathe that is a part of “The Old One’s” curse on Hans, Ondine’s mortal lover. The literary error lies here; for it was the King of the Ondines, “The Old One,” and not Ondine, who cursed Hans in accordance with “the pact.” Notwithstanding these, and the view of some that such eponyms rarely advance and usually retard medical science,3Comroe J Retrospectoscope—Frankenstein, Pickwick, and Ondine.Am Rev Respir Dis. 1975; 111: 689-692PubMed Google Scholar Phillipson5Phillipson EA Pickwickian obesity, hypoventilation or fee-fi-fofum syndrome?.Am Rev Respir Dis. 1980; 121: 781Google Scholar has proposed that a more correct literary label would be the “Fee-Fi-Fo-Fum syndrome.” The giant in Jack and the Beanstalk was, as everyone knows, obese, demonstrated daytime somnolence (by falling asleep after breakfast), snored (the melody of the golden harp drowned out by the snores of the sleeping giant), and had numerous personality disorders including irritability and aggressiveness. These literary eponyms relating to sleep and repiration are useful as short names for a long syndrome, but it is worth pointing out that both the Pickwickian and Fee-Fi-Fo-Fum syndromes refer to obese individuals, and yet it is now appreciated that obesity is not a prerequisite for the development of sleep apnea.2Guilleminault C Tilkian A Dement WC The sleep apnea syndromes.Ann Rev Med. 1976; 27: 456-484Crossref Scopus (1116) Google Scholar In addition, the degree of daytime somnolence may be so severe as to be either potentially dangerous, such as falling asleep while driving or at least embarrassing, such as two patients of mine who have regularly fallen asleep micturating in public lavatories. In the absence of obesity, falling asleep in unusual places may be associated with disturbances of respiration during sleep. In this year of the 150th anniversary of the birth of the Reverend Charles Dodgson (Lewis Carrol, 1832–1898), a literary eponym derived from Alice’s Adventures in Wonderland (1865) may be appropriate for such a syndrome. “The dormouse’s disorder” would indicate a condition in which there is a tendency to sleep in unusual places. The March Hare and the Hatter were having tea . . . a Dormouse was sitting between them, fast asleep, and the other two were using it as a cushion, resting their elbows on it, and talking over its head. “Very uncomfortable for the Dormouse,” thought Alice; “only as it’s asleep, I suppose it doesn’t mind.” And one which there are disturbances of respiration during sleep. . . . “then you should say what you mean,” the March Hare went on. “I do,” Alice hastily replied: “at least—at least I mean what I say—that’s the same thing you know.” “Not the same thing a bit!” said the Hatter. “Why you might just as well say that I see what I eat is the same as I eat what I see” . . . “You might just as well say,” added the Dormouse which seemed to be talking in its sleep, “that I breathe when I sleep is the same thing as I sleep when I breathe!”“It is the same thing with you,” said the Hatter, and here the conversation dropped.