Sotos syndrome

To the Editor:

John Sotos has presented a convincing case that the late President Taft bad obstructive sleep apnea (September 2003). (1) However, the presidential years (1909-1913) were a period of relative stability for the United States, and subsequent events have shown that his condition has not prevented the emergence of the United States as a dominant force in world affairs. In contrast Chouard et al (2) present an equally convincing case that Napoleon Bonaparte also had this condition. Unfortunately, their article was in French and therefore may not be widely appreciated in the United States. However, the strength of their case is borne out by portraits of Napoleon available from the Hotel des Invalides in Paris (Fig 1). They argue that his condition led to errors of judgment, resulting in the failure to capture Moscow (and the subsequent winter retreat) and thus to final defeat at Waterloo. Early diagnosis and treatment of his condition might have altered the course of European history.

Michael I. Polkey, MRCP, PhD

Mary J. Morrell, PhD

Anita K Simonds, FRCP, MD

Royal Brompton Hospital/National Heart and Lung Institute

London, UK

REFERENCES

(1) Sotos JG. Taft and Pickwick: sleep apnea in the White House. Chest 2003; 124:1133-1142

(2) Chouard C, Meyer B, Chabolle F. Napoleon souffrait-il du syndrome d'apnee du sommeil. Ann OtolaryngoI Chir Cervicofac 1988; 105:299-303

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: permissions@chestnet.org).

Correspondence to: Michael I. Polkey, MRCP, PhD, Royal Brompton Hospital, Fulham Rd, London SW3 6NP, United Kingdom; e-mail: m.polkey@rbh.uthames.nhs.uk

To the Editor:

Chouard and colleagues (1) describe several reasons to suspect Napoleon I (1769-1821) had obstructive sleep apnea in the last decade of his brief life: he was obese and perhaps retrognathic, his neck was short and thick, he had nasal obstruction, he frequently slept during the day, he complained of declining energy and intellect and, if the 1814 painting reflects reality, he was quite tired looking and somewhat disheveled. However, Chouard and colleagues 91) title their article as a question, and give evidence that weakens the diagnosis. Napoleon had unusual sleep habits all his adult life. For example, he would go to bed at midnight, awaken at 3 AM to do work and to take a hot bath, and then return to bed at 5 AM. Multiple anecdotes describe him napping during the day, as early as 1805. Despite this frequent and sometimes public daytime sleeping, Chouard et al (1) could not find accounts of Napoleon snoring. They suggest it was somehow a forbidden topic, as it would damage his prestige. Finally, there is the question of whether Napoleon simply slept too little, which, for an Emperor with great responsibilities, would not be surprising.

Given the high prevalence of sleep apnea in developed societies, many historical figures likely had (or have) the condition. Readers wishing to probe for sleep apnea in history will find a nascent list of candidates at http://www.apneos.com/historicals.html. For example, President Franklin Roosevelt had several risk factors for both central and obstructive sleep apnea, (2,3) including severe hypertensive heart failure, a history of polio, smoking, snoring, variable obesity, and coronary artery disease. Near the end of his life, he would sometimes sleep 10 h at night and complain about his excessive sleeping. (2) An aide recalled "He seemed strangely tired, even in the morning hours; he occasionally nodded off during a conversation: once, he blacked out half-way through signing his name to a letter, leaving a long scrawl." (4)

John G. Sotos, MD

Apneos Corporation

Belmont, CA

REFERENCES

(1) Chouard C. Meyer B, Chabolle F. Napoleon souffrait-il du syndrome d'apnee du sommeil? Ann Otolaryngol Chir Cervicofac 1988; 105:299-303

(2) Ferrell RH. The dying president: Franklin D, Roosevelt 1944-1945. Columbia, MO: University of Missouri Press, 1998

(3) Dugan H. Bedlam in the boudoir. Colliers, February 22, 1947. Cited in: Fairbanks DNF, Fujita S, eds. Snoring and obstructive sleep apnea. 2nd ed. New York, NY: Raven Press, 1994; 1-16

(4) Goldsmith HS. Unanswered mysteries in the death of Franklin D. Roosevelt. Surg Gynecol Obstet 1979; 149:899-908

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: permissions@chestnet.org).

Correspondence to; John G. Satos, MD, Apneos Corporation, 2033 Ralston Ave. 4, Belmont, CA 94002; e-mail: taft@apneos.com

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