What is Pickwickian Syndrome?

J.M. Willhite

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.

Pickwickian syndrome was named for a Charles Dickens' character.
Pickwickian syndrome was named for a Charles Dickens' character.

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 develop sleep apnea.
Obese individuals with Pickwickian syndrome may develop sleep apnea.

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.

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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.

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Discussion Comments


One of my wife's best friends must have had Pickwickian syndrome, because she used to go into actual respiratory failure a few times when she was in the hospital for surgeries. She was a large woman, and had a lot of weight-related issues like diabetes and joint damage. She might have been able to lose more weight if her mobility hadn't been so compromised.

I don't think she went more than two hours without a nap, and when I read the part about ruddy complexion and drowsiness in the article, that's when it all came together for me.


I never knew this condition had a name, but Pickwickian syndrome does make sense to me. My brother has almost all of the Pickwickian syndrome symptoms mentioned in the article. He is very obese, and when he sleeps on his back his snoring is extremely loud. His doctor recommended a CPAP ventilator because of his sleep apnea.

I remember times back when we were teenagers when he would start snoring really loud, like he had an obstruction in his throat, and then go completely silent for a minute or two. I was seriously afraid he was choking on something. He'd snap out of it with a big gasp, then start snoring again. We've all tried to get him to lose some weight, but I suspect he had some sort of food addiction or OCD.

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