early cpap studies

ResMed Beginnings: The Birth of CPAP


 

ResMed is arguably the face of CPAP. This article explains how they came to be the powerhouse they are today.

 

early cpap studies

Timeline

  • 2,000+ years ago: First records of sleep apnea symptoms
  • 1836: Charles Dickens inspires first term for sleep apnea, “Pickwickian syndrome”
  • 1877: London Physician gives first known detailed description of OSA
  • 1965: First “apnea” recorded using a polysomnograph
  • 1970: First sleep clinic opened at Stanford University, in California
  • 1975-1980: Sleep apnea research explodes with over 300 articles written
  • 1980: Sullivan published findings of 6 major sleep related disorders
  • 1986: Baxter Centre of Medical Research established
  • 1988: Sullivan Nasal CPAP System (R2) goes on the market
  • 1989: ResCare Holdings Limited established by Dr. Peter Farrell
  • 1995: ResMed lists on NASDAQ

 


Origins

Heavy snoring is an obnoxious sound, not only to our present generations but also to our ancestors of thousands of years ago. There are records of OSA symptoms regarding some prominent historical figures like Napolean Bonaparte, Queen Victoria, President Taft and both Roosevelt Presidents. (ResMed Origins, 5)

Charles Dickens, surprisingly, was the inspiration behind the first confirmed term relating to sleep apnea, “Pickwickian syndrome” in 1836. A character from one of his stories was an overweight man who suffered from excessive snoring and fatigue. However, the term is currently known to be a slang term for obesity hypoventilation syndrome. OHS is very similar to obstructive sleep apnea but, nonetheless, different.

A Physician from London gave the first known detailed description of the disorder:

 


“He described loud snoring, attributed to resistance in the pharynx, silence through two or three respiratory periods, during which there were ineffectual chest movements, and finally respiration resuming with a loud snort. He recognized the repetition of this cycle ‘at regular intervals, and the pause was so long as to excite attention, and indeed alarm.'”

 

Three French medical professionals recorded the first apnea in 1965. They recorded respiratory airflow and recognized obstructive and central apneas. Their work is the first polysomnograph showing apneas during sleep. This procedure is still the standard of diagnosing sleep apnea today.


polysomnogram


 

The first sleep clinic came in 1970, opened by William Dement in California at Stanford University. Shortly after, a man named Christian Guilleminault joined Dement, and decided to concentrate on respiratory conditions. The final 5 years of the 1970s saw a great increase in sleep apnea research. As a result, the time period saw over 300 articles written and published.


Creation of CPAP: Dr. Colin Sullivan

 

Dr. Colin Sullivan, an Australian physician, teamed up with his mentor David Read. Read was an expert in SIDS (sudden infant death syndrome). The two men determined that the condition had something to do with respiratory issues, also like sleep apnea. The time with Read led Dr. Sullivan to Toronto, where he found a connection between sleep and breathing.

After Toronto, Dr. Sullivan returned to Australia to continue his studies. Dogs were the first test subjects. He connected tubing to a vacuum cleaner, and the tubing to a fiberglass mask that went over the dog’s nose. The idea was to force air through the airway to improve breathing. The results from the dogs were promising, so Dr. Sullivan continued his research.

 


“In his review, Disorders of Breathing in Sleep, published in 1980 (23), Sullivan was able to identify 6 major disorders. These were described as OSA, snoring, central sleep apnea and hypoventilation, Cheyne-Stokes breathing, REM-sleep-coupled arterial haemoglobin oxygen de-saturation in chronic lung disease, and sudden infant death syndrome.” (ResMed Origins, 9/10)

 

First CPAP Mask

Following the publication it was difficult for Dr. Sullivan to get the rest of the medical world to catch on. One thing that helped was his initial work with human patients. Every mask required a mold of each person’s nose. As much as 350 patients were successfully treated using the mask.

 

dr. sullivan with a patient
Dr. Sullivan with a patient

 

Here’s the elaborate process:

  1. Make a plaster cast of the nose
  2. From the plaster cast a fiberglass cover is fashioned
  3. Then, air inlets and outlets are fitted to a manifold
  4. The manifold is attached to fiberglass cover to form the mask
  5. Lastly, the mask is glued to the patient’s nose each night with silicone adhesive
  6. Each morning the mask is removed and cleaned for reuse.

First Commercial CPAP Machines

 

sullivan/bruderer cpap machine

 

Designed to be for a spa bath, the first commercial airflow generator gave Sullivan a means to continue. The device had a 60 watt, 240 volt AC motor connected to a vortex blower. That machine weighed roughly 5-6 times more than machines today, and was too loud to be in the same room as the patient. The device was kept in a separate room so the sleeper was not disturbed.

Sullivan introduced a more practical motor in 1989. By that time, there were more than 1,000 people using the original vortex blower machine.


Baxter Centre for Medical Research

 

Dr. Peter Farrell, a bio-engineer would establish the Baxter Centre for Medical Research in 1986. The BCMR would become the platform that Dr. Farrell and Dr. Sullivan would use to further their quest for CPAP recognition.

The goal was to take the original CPAP device and mask that Dr. Sullivan had created, and make it into a practical, also easily reproduced product. Eventually, their ambition led them to produce the Sullivan Nasal CPAP System (R2), in 1988

Sullivan Nasal CPAP System (R2)

ResCare

 

Dr. Farrell established ResCare Holdings Limited in August of 1989, following a fallout with BCMR. At this point, the CPAP world began its worldwide recognition. ResCare saw the creation of the “bubble cushion,” a silicone piece that resembles cushions of today. The company grew leaps and bounds from 1990-1995…

 


“In fiscal year ending 30 June 1994, sales were US$13.75million, an 80% increase over the previous years, with the USA providing 50% of revenue. Peter Farrell, as Chairman of the Board, was delighted that revenues and profits had provided a compound annual growth rate of about 100% for each of the 5 years since the company was formed.” (ResMed Origins, 28)

 

The birth of ResMed came in June of 1995. They listed themselves on the NASDAQ stock exchange, joining the elite technology companies of the time.

References

 

  • “CPAP History – An Aussie Doctor and a Vacuum Cleaner – Easy Breathe.” Easy Breathe Blog, 21 May 2014, blog.easybreathe.com/cpap-history-aussie-doctor-vacuum-cleaner/.
  • “CPAP’s Amazing Evolution – Easy Breathe.” Easy Breathe Blog, 24 Apr. 2015, blog.easybreathe.com/cpaps-amazing-evolution/.
  • Hansford, Alison. “30 Years of CPAP.” Resmed.com, 2011, www.resmed.com/au/dam/documents/articles/clinical_newsletter/resmedica14.pdf.
  • “Interview Mit Prof. Colin E. Sullivan 2001.” Praxis, 2001, www.apnoe.net/hello-world-2/.
  • Owens, Robert L., et al. “Sleep and Breathing … and Cancer?” Cancer Prevention Research, American Association for Cancer Research, 1 Nov. 2016, cancerpreventionresearch.aacrjournals.org/content/9/11/821.
  • Samaha, Ibrahim. “- Pickwickian Syndrome.” Http://Simple-Med.blogspot.com, 2009, simple-med.blogspot.com/2009/12/pickwickian-syndrome.html.

 

About the Author

1800CPAP

Jason Smith is recognized by the board of polysomnographic technologists (BRPT) as a registered polysomnographic technologist (RPSGT) since 2003.