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Pickwickian Syndrome

  • Definition

    Pickwickian syndrome is a disorder that was named after Joe, the fat, red faced boy in Charles Dickens' The Pickwick Papers.

    This syndrome is a combination of obstructive apnea in moderately to severely obese people, most of whom attempt to sleep face up.


    About 2.5 million people in the U.S. suffer from sleep apnea (episodes of cessation of breathing during sleep) with men outnumbering women.

    The several conditions often associated with obstructive sleep apnea include obesity and a short thick neck, and reduction in muscle tone of the soft palate, the uvula (the small, conical, fleshy tissue hanging from the center of the soft palate), and the pharynx. The upper airway may be narrowed by enlarged tonsils or adenoids, a deviated nasal septum, nasal polyps, or congenital abnormalities. Even at high altitudes sleep disruption may occur because of low oxygen concentration.

    The Pickwickian syndrome consists of moderate to extreme obesity, alveolar (a hollow sac or cavity) hypoventilation, prolonged drowsiness, twitching, cyanosis (a dark bluish to purplish coloration of the skin), periodic breathing, secondary polycythemia (excessive red blood cells caused by low oxygen), and right sided heart failure. Details of the origin and development of this obesity hypoventilation syndrome are unknown, as is its true incidence. Studies show that the syndrome can exist in non-obese patients as well.

    Complications associated with untreated sleep apnea include hypertension, arrhythmias, abnormal blood levels of oxygen and carbon dioxide, and peripheral edema. Other complications include sleepwalking, blackouts, automatic robot-like behavior, intellectual deterioration, hallucinations, anxiety, irritability, aggressiveness, jealousy, suspiciousness, and irrational behavior. Loss of interest in sex, morning headaches, and bedwetting may also occur with time.


    Therapy consists mainly of weight loss, which reduces episodes of sleep apnea and improves the blood gases and the daytime drowsiness.

    Nocturnal positive pressure air flow can be dramatically effective.

    A few patients may require an opening in the windpipe (tracheostomy).

    The syndrome is reversible if treated.


    What tests need to be done to diagnose the condition?

    Has any permanent damage been done to the heart?

    What treatment will you be recommending?

    Will you be prescribing any medication? What are the side effects?

    How much weight reduction will be required to eliminate this syndrome?

    What will happen if the weight is not reduced?