What is Pickwickian Syndrome?

Pickwickian syndrome, also known as obesity hypoventilation syndrome (OHS), is a serious medical condition characterized by impaired respiration that affects morbidly obese individuals. Named for a Charles Dickens’ character, Pickwickian syndrome mainly affects an individual’s respiration while he or she sleeps. Treatment for this condition often involves the use of mechanical ventilation and lifestyle changes intended to promote weight loss.

There is no known, definitive cause for the development of Pickwickian syndrome. It has been asserted that a defect within the portion of the brain that controls respiration combined with the unnecessary weight that rests on the chest wall may impair an individual’s ability to breathe properly. The impairment of the individual’s respiration leads to an imbalance of oxygen and carbon dioxide within the blood causing the manifestation of symptoms indicative of oxygen deprivation.

Obese individuals with Pickwickian syndrome may exhibit and experience several signs and symptoms. The most predominant symptom is the development of sleep apnea, or cessation of respiration while sleeping, that may occur when the individual lies on his or her back. Some individuals whose respiration is limited may exhibit cyanosis, or a bluish hue to their skin caused by a lack of oxygen. Symptomatic individuals may also experience pronounced fatigue with little to no physical exertion, shortness of breath, and swelling of the legs and feet. Individuals with OHS may also present a ruddy complexion and drowsiness, also known as somnolence.

Diagnostic tests used to determine if an individual has Pickwickian syndrome may include a pulmonary function test (PFT) and an arterial blood gas test. A PFT may be utilized to evaluate the efficiency of an individual’s lung functionality, including volume and diffusion capacity. An arterial blood gas test may be performed to measure carbon dioxide and oxygen levels in the blood and assess any degree of imbalance. Additionally, the individual may be referred to participate in a sleep study to evaluate the severity of his or her sleep apnea.

Treatment for Pickwickian syndrome often includes the utilization of mechanical ventilation. Morbidly obese individuals may require breathing assistance to ensure the proper oxygenation of their blood. An individual may be fitted with a ventilation mask that fits snuggly over either the nose or both the nose and mouth while she or he sleeps. Those who require constant ventilation assistance due to a narrowed airway passage may undergo a tracheostomy, which involves the placement of a breathing tube directly into the windpipe through a surgical incision in the neck.

Additional aspects of treatment may include the implementation of dietary and lifestyle changes to promote weight loss and exercise. Pickwickian syndrome is a disorder that may be reversed if proactive measures are taken. Individuals are often encouraged to seek out support groups that may make the implementation of lifestyle changes easier with educational materials, discussion groups, and amity.

If Pickwickian syndrome is left untreated it can lead to the development of serious cardiovascular and circulatory problems. Further complications associated with OHS include hypertension, sexual dysfunction, and mood changes, such as irritability and depression. Obesity hypoventilation syndrome may be prevented with conscientious measures that include maintaining a healthy lifestyle and body weight.