Pickwickian Syndrome

Sleep Apnea

The Pickwickian syndrome, also known as obesity hypoventilation syndrome, is the combination of severe obesity, suffering from obstructive sleep apnea (episodes of cessation of breathing during sleep) causing hypoxia (low blood oxygen levels) and hypercapnia (high blood CO2 levels) resulting in marked daytime somnolence (sleepiness).

It is more common in men and more common in obese people who sleep facing up (on their back).

Although it is an eponym (named after a person), it is not named after the doctor who first described it (as commonly happens) but after a literary character by Charles Dickens.

Therapy includes:

• Weight loss to decrease occurrences of sleep apnea and thereby improves the blood levels of oxygen and carbon dioxide, resulting in reduced daytime drowsiness.

• Nocturnal positive pressure air flow - a device is used to cordinate with the breathing rhythm of the user such that at in-breath, positive pressure is applied to increase airflow into the lungs.

• Some patients may require a tracheostomy (an opening in the windpipe) to bypass the soft palate, uvula and anything else that may be obstructing normal breathing in the upper throat (for example, enlarged tonsils).

The Pickwickian syndrome is reversible if treated correctly.

Julian Kennedy

Back to top