For Release: July 13, 2000
WAS THE COMPOSER OF BRAHM'S LULLABY THE VICTIM OF A SLEEP DISORDER?
The hypothesis that the composer of one of the world's best known lullabies suffered from a common sleep disorder was advanced today in a special article in the July issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Johannes Brahms had a mixture of symptoms, behaviors, and risk factors that are associated with obstructive sleep apnea (OSA), a condition unknown to the physician of his day, according to Mitchell L. Margolis, MD, FCCP.
Sleep apnea is the most common sleep disorder which affects as many as 20 million Americans. Conditions associated with sleep apnea include sudden interruption of breathing, heavy snoring, sleep deprivation, and excessive daytime sleepiness. The cost to society due to the loss of productivity, industrial accidents and medical bills is estimated to be over $60 billion each year. The consequences range from annoying to life-threatening and include personality changes, sexual dysfunction, and falling asleep at work, on the phone, or while driving. Many of these characteristics, Dr. Margolis notes, can be found in the personal history of Johannes Brahms.
Brahms (1833-1897) is believed to have died of pancreatic cancer. Since he never married, there is no documentation by a spouse of habitual snoring. However, a traveling companion, baritone George Henschel, refers to the composer's habit of snoring and how it once drove him from the room they shared, since staying there "would mean death to any hope of sleep on my part."
Dr. Margolis points out that in his later years, the then portly Brahms frequently snoozed in the afternoon in the cafes of Vienna becoming a familiar sight for gawking tourists. By the time he reached his sixties, Brahms was known to fall asleep at the table or theater box. In addition to the symptoms of snoring and apparent sleep deprivation, Dr. Margolis notes some physical characteristics of the composer, particularly obesity, adds to the hypothesis that he suffered from sleep apnea. While slender as a youth, Brahms became too stout for his fur coat by the age of 35. In addition, his neck size became larger and larger. "His neck size doubtlessly contributed to his aversion to neckties of any kind," Dr. Margolis said, and from age 50 onward, Brahms wore the collar-less shirt of a hunter." The author added that increased upper-body obesity, as reflected by neck circumference, is a particularly good predictor of OSA.
Brahm's alcohol consumption is also cited as suggestive of OSA. In his later years, he became a fixture at various pubs and taverns. Alcohol is recognized as a common and important exacerbating factor in OSA .
Brahms has been quoted as saying: "If there is anyone here I have not offended, I apologize."
Whether true or apocryphal, that quote reflects the composer's prickly personality, according to Dr. Margolis. "Irritability and depression are typical of the personality changes that may accompany the sleep disorder. Thus, it is tempting to hypothesize that the composer's intermittent bouts of depression and notorious irascibility could in part relate to chronic sleep fragmentation and/or nocturnal hypoxemia (a deficiency of oxygen in the blood)," he said.
A detailed reading of the literature, Dr. Margolis pointed out, reveals near-classic descriptions of the most characteristic symptoms of the disorder: loud snoring and daytime hypersomnolence (excessive drowsiness). He added: "The composer's eventual physical attributes also correspond to those of a typical OSA patient, particularly his obesity and thick neck. Extensive lifelong alcohol consumption comprises a likely and familiar exacerbating factor."
Dr. Margolis said: "I conclude that the hypothesis that Johannes Brahms suffered from OSA is tenable, and that OSA could help explain some important aspects of his life and personality. One wonders if the disorder contributed to lifelong alienation from friends and marriage, thereby indirectly nurturing his determined devotion to the creation of his immortal music."
CHEST is published by the American College of Chest Physicians which represents 15,000 members who provide clinical, respiratory, and cardiothoracic patient care in the U.S. and throughout the world.
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Reporters may wish to contact Kimberly Lynch of the ACCP at (847) 498-8341 for a copy of the article. She can also be reached by fax at (847)498-5460 or by email at [email protected]. Dr. Margolis can be reached by phone at (215) 823-5807 or fax at (215) 823-5168. He can also be reached by email at [email protected].
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