 The description of Joe, "the fat boy" in Dickens's novel "The Pickwick Papers", is an accurate clinical picture of an adult with obstructive sleep apnea syndrome.The early reports of obstructive sleep apnea in the medical literature described individuals who were very severely affected, often presenting with severe hypoxemia, hypercapnia and congestive heart failure.The management of obstructive sleep apnea was improved with the introduction of continuous positive airway pressure (CPAP), first described in 1981 by Colin Sullivan and associates in Sydney, Australia.