Fat snorers and sleepy-heads: Were many distinguished characters of the past affected by the obstructive sleep apnea syndrome?

The obstructive sleep apnea syndrome (OSAS) is a clinical condition characterized by the coexistence of irregular breathing at night with excessive daytime sleepiness, and it represents a major social health issue because of its high prevalence and of the growing public awareness of it. The XIX century description of "Fat Joe", the famous character of Charles Dickens's Pickwick Papers, is often retained the first presentation of a person affected by OSAS, since Joe was an obese individual who fell asleep during daytime while performing even extremely simple tasks. However, apart from the fact that Joe's Picwickian syndrome ("the obesity hypoventilation syndrome") needs to be differentiated from true OSAS, already in the Hippocratic Corpus (V-IV century BC) many clues regarding apnea and sleepiness are present, and in 79 AD the Roman author Pliny the Younger clearly reported the death of a man in whom obesity, sleepiness and snoring were co-present in a unique clinical picture. In this paper, elements suggesting OSAS are traced back and evidenced in the XIX and XX centuries in distinguished figures, including Emperor Napoleon Bonaparte, Queen Victoria and President Franklin D. Roosevelt. A posteriori reconstruction of the health status of characters of the past is difficult, and, to an extent, speculative, but the elements here provided appear relevant, since the possible presence of disabling OSAS in important personages of the past may have negatively influenced not only their health status, but also their social life and their work activity.