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Recent studies have described an inherited basis for the sleep apnoea syndrome, as suggested by reports of families with multiple affected members.1 We present evidence indicating that several members of the Ptolemys, the royal family that ruled Egypt from 305 to 30 BC, suffered from obesity and sleep disordered breathing. Most of the information was reported by the Greek philosopher and historian Athenaeos (170–230 BC).
The family‘s pedigree with all affected members (shaded) is shown in fig 1. Magas I (case 1) was morbidly obese. Athenaeos reported that Magas “was weighted down with monstrous masses of flesh in his last days; in fact he choked himself to death”.2 Ptolemy II (case 2) and his sister Arsinoe III were extremely obese. Ptolemy II was not an energetic man and he disliked physical exertion. Although he lived to the age of 62, he was troubled by ill health throughout most of his life.3 Ptolemy IV, the Philopater (case 3), was described as licentious even by the standards of his contemporaries. Calvin Wells reported that he was obese and he languished in habitual lethargy, perhaps because of chronic illness.4 Ptolemy V Epiphanes (case 4) also developed extreme obesity and used to fall asleep during social and political events. Athenaeos wrote: “One day, Aristomenes, his Prime Minister and chief advisor, had the effrontery to nudge the king awake when he dozed off during a diplomatic reception”.2 Ptolemy VI Philometor (case 5) was portrayed by historian Polybios5 as “good and kind” and “apt to be lethargic and inert”. Justinus added that he was extremely obese and sluggish.5 Ptolemy VIII Evergetes II (case 6) was morbidly obese.6 Apart from naming him Evergetes (benefactor), Alexandrians labelled him Kakergetes (malefactor) and—because of his obesity and large belly—“Physcon” (large bubble). Ptolemy VIII‘s belly was so large that its circumference was wider than two arms extended. In order to cover his belly he wore a long tunic that extended down to his ankles with sleeves up to his wrists. Because of his obesity he was unable to walk, apart from an occasion when he went to meet the Roman Consul Skipion, the African.6 In a poem entitled “Ptolemy VIII Evergetes II or Kakergetes” the Greek poet Constantine Cavafy wrote:
“Most obese, slothful Ptolemy
Physkon, and due to gluttony somnolent
observed: wise poet
your verses are somewhat exaggerated......
And from obesity heavy as a stone,
and from voracity somnolent
the unalloyed Macedonian
could scarcely keep his eyes open.”
Ptolemy X Alexander I (case 7) was so grossly obese that he had a man on either side to help him walk.7 He was idle, drunken, and extravagant in his lifestyle.
From these descriptions it is clear that obesity was present in all of them and, in at least four of the seven kings, there were reports of daytime somnolence. This dynasty was probably the first reported family with sleep disordered breathing that had a familial predisposition.