Pickwickian Syndrome: A Condition To Be Aware Of If You Have Sleep Apnea

Obesity-Hypoventilation Syndrome

Obesity and obstructive sleep apnea (OSA) are closely linked to one another, and research has indicated that this is a reciprocal relationship. Excess weight, particularly around the neck, puts added pressure on the upper airway and contributes to airway collapse during sleep, leading to OSA or worsening your pre-existing OSA symptoms. Conversely, the disrupted sleep and stress from OSA can increase the risk of obesity. Understanding this relationship is crucial, as it can inform better management strategies for both conditions.

"Addressing the intertwined challenges of obesity and obstructive sleep apnea, particularly when complicated by Pickwickian Syndrome, requires a comprehensive approach. Effective treatment improves sleep quality and mitigates serious health risks, emphasizing the importance of early intervention,” says Robert Miller, Apria's Vice President of Sleep Business.

Obesity-Hypoventilation Syndrome (Pickwickian Syndrome)

A significant complication often coexisting with OSA in obese individuals is Obesity-Hypoventilation Syndrome (OHS), also known as Pickwickian Syndrome. Approximately 10-15% of obese individuals with OSA also suffer from OHS.

Normal breathing involves inhaling oxygen and exhaling carbon dioxide, but people with OHS are breathing too shallow, and too slow to pass the necessary amount of air in and out of the lungs. This slow, shallow breathing is called hypoventilation and it is dangerous because it leads to a buildup of carbon dioxide in the bloodstream (hypercapnia).

Why Monitoring OHS is Crucial

Untreated Pickwickian Syndrome can lead to severe health issues. The combined effects of shallow breathing, obesity, and carbon dioxide buildup significantly elevate the risk for cardiovascular diseases, stroke, and other complications. Untreated OHS has also been found to increase your risk of hospitalization and shorten your life expectancy. Recognizing the symptoms of OHS and seeking treatment promptly is crucial for your health.

Symptoms of Pickwickian Syndrome

While some symptoms of Pickwickian Syndrome overlap with those of OSA, such as loud snoring and daytime drowsiness, others are directly linked to insufficient oxygen levels:

• Shortness of breath or fatigue
• Bluish lips, fingers, toes, or skin
• Reddish skin
• Swollen legs or feet

Treatment Options for Pickwickian Syndrome

Effective management of OHS involves several treatment approaches:

Continuous Positive Airway Pressure (CPAP): CPAP therapy provides continuous airflow into the airway during sleep, preventing airway collapse and reducing CO2 buildup.

BiLevel Positive Airway Pressure (BPAP): Unlike CPAP, BPAP provides varying air pressure levels, offering higher pressure during inhalation and lower pressure during exhalation. This approach can be more comfortable for some patients and effectively manages OHS.

Weight Loss Treatments: Weight loss is a crucial aspect of reversing OHS. A physician-guided meal and exercise plan can help achieve sustainable weight loss. In some cases, bariatric surgery, such as gastric bypass, may be recommended for significant and rapid weight reduction.

When OSA coexists with Pickwickian Syndrome, the risk of complications increases due to the additional burden of hypercapnia (the buildup of carbon dioxide in the bloodstream). Recognizing the symptoms and seeking appropriate treatment are essential for improving outcomes. With CPAP or BiPAP therapy and weight loss strategies, individuals can manage these conditions more effectively and reduce the associated health risks. If you are ready to begin your journey to better sleep, learn more about how Apria can support you through our Sleep Care program.

References
Ghimire, Pranita, Abdulghani Sankari, and Pratibha Kaul. “Pickwickian Syndrome.” StatPearls [Internet]., February 3, 2024. 
Liu, Chaoling, Mao-Sheng Chen, and Hui Yu. “The Relationship between Obstructive Sleep Apnea and Obesity Hypoventilation Syndrome: A Systematic Review and Meta-Analysis.” Oncotarget, October 3, 2017. 
Cleveland Clinic medical. “Obesity Hypoventilation Syndrome (OHS): Symptoms & Treatment.” Cleveland Clinic. Accessed June 18, 2024. 
Satriale, Robert. “What People with Sleep Apnea Need to Know about Obesity Hypoventilation Syndrome.” Temple Health, September 21, 2023. 

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