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Pickwick syndrome, or obesity hypoventilation syndrome, affects breathing in morbidly obese individuals during sleep. Its cause is unknown, but it can be diagnosed through pulmonary function and arterial blood gas tests. Treatment involves mechanical ventilation and lifestyle changes to promote weight loss. Left untreated, it can lead to serious cardiovascular and circulatory problems.
Pickwick syndrome, also known as obesity hypoventilation syndrome (OHS), is a serious medical condition characterized by impaired breathing that affects morbidly obese individuals. Named for the Charles Dickens character, Pickwick syndrome primarily affects an individual’s breathing while they sleep. Treatment for this condition often involves the use of mechanical ventilation and lifestyle changes aimed at promoting weight loss.
There is no known, definitive cause for developing Pickwick syndrome. It has been argued that a defect within the portion of the brain that controls breathing combined with unnecessary weight placed on the chest wall can impair an individual’s ability to breathe properly. Impaired breathing of the individual leads to an imbalance of oxygen and carbon dioxide within the blood causing the manifestation of symptoms indicative of oxygen deficiency.
Obese individuals with Pickwick syndrome can present and experience several different signs and symptoms. The most predominant symptom is the development of sleep apnea, or cessation of breathing during sleep, which can occur when the individual is lying on their back. Some individuals whose breathing is restricted may have cyanosis or a bluish tinge to the skin caused by lack of oxygen. Symptomatic individuals may also experience pronounced fatigue with little or no physical exertion, shortness of breath, and swelling of the legs and feet. Individuals with OHS may also exhibit a ruddy complexion and drowsiness, also known as drowsiness.
Diagnostic tests used to determine whether an individual has Pickwick syndrome may include a pulmonary function test (PFT) and arterial blood gas analysis. A PFT can be used to assess an individual’s lung function efficiency, including volume and diffusing capacity. An arterial blood gas test can be done to measure the levels of carbon dioxide and oxygen in the blood and evaluate any degree of imbalance. Additionally, the individual may be referred to participate in a sleep study to assess the severity of their sleep apnea.
Treatment for Pickwick syndrome often includes the use of mechanical ventilation. Individuals with morbid obesity may require respiratory assistance to ensure proper blood oxygenation. An individual may be fitted with a ventilation mask that fits comfortably over the nose or both the nose and mouth while sleeping. Those who require constant ventilation assistance due to a narrowed airway passage may have a tracheostomy, which involves placing a breathing tube directly into the windpipe through a surgical incision in the neck.
Additional aspects of treatment may include implementing dietary and lifestyle changes to promote weight loss and exercise. Pickwick syndrome is a disease that can be reversed if proactive steps are taken. Individuals are often encouraged to seek out support groups that can make implementing lifestyle changes easier with educational materials, focus groups, and fellowship.
If Pickwickian syndrome is left untreated, it can lead to the development of serious cardiovascular and circulatory problems. Additional complications associated with OSH include high blood pressure, sexual dysfunction, and mood changes, such as irritability and depression. Obesity hypoventilation syndrome can be prevented by conscientious measures including maintaining a healthy lifestyle and body weight.
