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Pickwickian Syndrome - Symptoms, Causes, Treatment, Pictures

Updated on July 11, 2014


What is Pickwickian Syndrome?

Pickwickian syndrome is a condition common to severely overweight individuals. It is a form of sleep disorder that affects moderately to severely obese individuals characterized by difficulty in breathing deeply and rapidly and is often associated with sleep apnea. The syndrome is also marked by falling asleep during daytime.

Pickwickian syndrome is also called as an Obesity hypoventilation syndrome. The term Pickwickian was derived from the character of The Posthumous Papers of the Pickwick Club written by Charles Dickens. Joe, the character in the story is a fat and red faced boy who exhibited similar symptoms with Obesity hypoventilation syndrome where the character who gained so much weight and became obese and suffered from uncontrollable sleepiness and leg edema. The syndrome affects individuals over the age of 50 years and is prevalent in male than in female. Pickwickian syndrome is associated with a reduced quality of life and patients are usually admitted to the intensive care unit. Pulmonary hypertension is common in patient and is often severe while mortality is secondary to respiratory failure and alveolar hyperventilation.

Sleep apnea is among the component of Pickwickian syndrome. Sleep apnea is a serious sleep disorder characterized by a cessation of breathing or shallow breathing during sleep. The apnea usually lasts for a few seconds to a minute and occurs about 5 to 30 times or more in an hour while at sleep.


Obese individuals suffering from Pickwickian syndrome can experience several signs and symptoms and the most prominent feature of the syndrome is the sleep apnea. It is a serious sleep disorder characterized by cessation of breathing for a few seconds to a minute during sleep. The frequency of sleep apnea occurs about 5 to 30 time or more per hour. It is a chronic condition that usually disrupts a sleep. Obstructive sleep apnea is often the manifestation which is marked by snoring and interrupted sleep during the night.

Pickwickian syndrome is also characterized by an inability to breathe rapidly thus leading to a decrease of oxygen in the blood and an increase in the levels of carbon dioxide in the blood. The consequence of imbalance in the oxygen and carbon dioxide leads to manifestation of oxygen deprivation in individuals with Pickwickian syndrome.

Cyanosis may also be exhibited due to oxygen deprivation. Pickwickian syndrome patients often have a bluish hue in their skin as evidence of oxygen deprivation.

Hypoventilation is another symptom that may be experienced. It is a condition resulting in an increase in the level of carbon dioxide in the blood. The increase will affect the acidity of the blood and the high levels of carbon dioxide in the blood will lead to drowsiness while unconsciousness or coma may occur with extremely high levels of carbon dioxide.

Pronounced fatigue or exhaustion can also be experienced even with little or without any physical exertion.

Shortness of breath or difficulty in breathing is also characteristic of the Pickwickian syndrome. The patient will find it hard to breathe deeply and rapidly.

Other signs and symptoms of Pickwickian syndrome include the following:

  • Drowsiness or somnolence
  • Edema of the legs and feet
  • Reddish skin complexion
  • Flushed face
  • Uncontrollable sleepiness during daytime
  • Disturbed sleeping pattern of sleeplessness during the night
  • Blood pressure elevation
  • Headache
  • Depression
  • Enlargement of the liver
  • Cor pulmonale or an excessive strain on the right side of the heart as a consequence of the difficulty in pumping blood.


The exact cause of Pickwickian syndrome among obese individuals has not been fully understood. Diverse processes have been implicated in the mechanism of the syndrome and the initial implication is in the accumulation of the adipose tissue that restricted the usual movement of the muscle of the chest during respiration.

Pickwickian syndrome is believed to have risen from obesity. Obesity is a chronic medical disease marked by a body mass index of more than 30 kg/meters squared. The body mass index is calculated based on the height and weight of an individual. Overweight individual has a body mass index of 25 to 29.9 while an obese has over 30. Obesity is a chronic disease that is difficult to treat and has a high rate of relapse. Obesity can directly affect the overall health of an individual while it can also bring problem with cosmetic consideration. A sleep disorder known as sleep apnea is one the health risk potential for an obese individual.

The brain is also involved in the onset of Pickwickian syndrome among obese individuals. The implication is on the part of the brain that controls the respiration. This factor accompanied by obesity or overweight is believed to impair the ability of the individual to breathe properly.


Weight management is the most important factor in treating Pickwickian syndrome. The initial step of treatment is weight loss which can be done through a set of programs for proper diet with the aim of losing weight. It is the initial option in treating moderately obese individuals where weight loss medication may be given. The extremely obese patient may be recommended with weight loss surgery or Bariatric to reduce weight.

Mechanical ventilation is recommended for extremely obese individuals to facilitate proper breathing and ensure oxygen supply in the blood. A ventilation mask may be utilized by moderately obese individuals while those in need of constant breathing assistance may be recommended for tracheotomy.


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