Breathing too slowly or taking breaths that are too shallow means the lungs are unable to take in enough oxygen and expel enough carbon dioxide in a process known as gas exchange. This leads to low levels of oxygen and high levels of carbon dioxide in the blood.
Pickwickian syndrome affects people who are obese and is also called obesity hypoventilation syndrome (OHS).
In approximately 90 percent of cases, people with OHS have obstructive sleep apnea. Obstructive sleep apnea is characterized by momentary pauses in breathing during sleep due to airway collapses or blockages.
- Pickwickian syndrome was first described as a disease in the 1950s.
- It was named after a character from the novel "The Pickwick Papers," written by Charles Dickens in 1836. The character, Joe, displayed several of the symptoms of OHS.
- Medical professionals now more commonly use the name obesity hypoventilation syndrome when referring to Pickwickian syndrome.
- Treatments include weight loss and oxygen therapy.
What are the symptoms?
Pickwickian syndrome is when breathing in sleep is disordered.
Symptoms of Pickwickian syndrome include:
- low energy
- daytime fatigue
- breathlessness, known as dyspnea
- bluish discoloration of the fingers or toes, called cyanosis
- headaches upon waking, due to raised carbon dioxide levels in the blood
- depression and suicidal thoughts
- high blood pressure
- sleep apnea
Symptoms tend to be connected to reduced blood oxygen levels and lack of sleep.
Causes and risk factors
The exact cause of Pickwickian syndrome is unknown, although many believe it is linked to a defect in the central respiratory control system. This system is the part of the brain that controls breathing.
The biggest risk factor for Pickwickian syndrome is obesity. Carrying excess weight means that the chest wall and respiratory muscles need to work harder to draw deep breaths and to breathe at an adequate pace.
Lung capacity and maximal voluntary ventilation, which is the maximum amount of air that can be inhaled and exhaled in 60 seconds, may also play a role in Pickwickian syndrome.
Research suggests that people with OHS have total lung capacities that are 20 percent lower and maximal voluntary ventilation that is 40 percent lower than people who are obese but do not have OHS.
What are the complications?
Obesity is the single biggest risk factor for Pickwickian syndrome.
Pickwickian syndrome can lead to several complications, such as:
- hypertension, or high blood pressure
- edema, or a buildup of fluid in the legs
- secondary erythrocytosis, or raised levels of red blood cells
If left untreated, Pickwickian syndrome can result in death.
This is a complication that causes the right side of the heart to fail. Symptoms include edema, chest pain, and low tolerance for physical activity. Cor pulmonale occurs in approximately 1 in 3 people with Pickwickian syndrome.
The primary features of Pickwickian syndrome are:
- high levels of carbon dioxide
- low levels of oxygen
- sleep-disordered breathing
To check for these features, a doctor may want to carry out a physical examination and some clinical tests.
A doctor will perform a physical examination to look for:
- symptoms of cor pulmonale
- shortness of breath
Tests used to diagnose OHS include:
- arterial blood gas (ABG) test
- imaging tests, such as a chest X-ray or CT scan
- pulmonary function tests to check lung function
- a sleep study, known as polysomnography
What are the treatment options?
Treating Pickwickian syndrome is extremely important. When treated, symptoms may be reduced or resolve completely, improving a person's quality of life, and reducing the risk of serious complications.
Treatment options include:
Losing excess weight is the first line of treatment for Pickwickian syndrome. If someone with Pickwickian syndrome achieves a normal BMI, the condition may be reversed. Weight loss can be achieved by combining a balanced diet and regular physical activity.
In some cases, medications may be used to encourage weight loss.
Weight loss surgery, known as Bariatric surgery, is another option. This type of surgery reduces the size of the stomach to cut food intake. Significant lifestyle changes need to be made, following surgery, and a person should discuss the benefits and risks of bariatric surgery with their doctor.
Positive airway pressure (PAP) therapy
A CPAP mask may be used to help treat disordered breathing during sleep, and can be used for Pickwickian syndrome as well as sleep apnea.
PAP therapy uses mild air pressure to keep the airways open. It is a commonly prescribed treatment for Pickwickian syndrome.
PAP may be administered with a continuous positive airway pressure (CPAP) machine. With this treatment, a mask is worn over the mouth or nose, or both. A tube connects the mask to a CPAP machine, which pumps through a continuous flow of air. CPAP is also the leading treatment for sleep apnea.
People with Pickwickian syndrome may have to use PAP therapy both day and night. Benefits include:
- higher quality sleep
- less snoring
- reduced fatigue
- blood pressure control
- lower risk of stroke
- improved memory
Some research suggests that CPAP therapy resolves sleep-disordered breathing and nighttime hypoxemia in more than half of people with OHS.
If PAP is not effective and oxygen levels remain persistently low, oxygen therapy through a ventilator may be used.
In severe cases that do not respond to other treatments, a tracheostomy may be required. An opening is made in the windpipe (trachea) and a tube is inserted to bypass any type of obstruction in the neck. A tracheostomy may be used in conjunction with a ventilation machine.
The most effective way to prevent Pickwickian syndrome is to maintain a healthy body weight by eating a balanced diet and engaging in regular physical activity.
People who already have Pickwickian syndrome can prevent complications from arising by using PAP therapy, losing weight, and by treating existing complications, such as high blood pressure and edema.
Pickwickian syndrome can lead to serious complications and, in some cases, death. One study reported a 5-year mortality rate of 15.5 percent for people with OHS and sleep apnea, while the rate for people with obstructive sleep apnea alone was just 4.5 percent.
Correct diagnosis and early intervention are key in managing and reducing the symptoms of Pickwickian syndrome. Losing weight and receiving other treatments for the condition reduce the symptoms and the risk of complications. Treatments can even reverse cases of Pickwickian syndrome.