Pickwick syndrome is a condition that occurs in people who are extremely overweight. It is a form of obstructive sleep apnea.
What is Pickwick Syndrome?
Pickwick syndrome owes its name to a character in Charles Dickens’ novel The Pickwickians. The coachman Little Fat Joe sleeps most of the time in this book. Patients with Pickwick syndrome also suffer from extreme fatigue on a daily basis. Pickwick syndrome is also known as obesity hypoventilation syndrome or obesity-related hypoventilation syndrome. See dictionaryforall for Hyperthecosis Ovary in Dictionary.
It only occurs in people who are severely obese, i.e. who are extremely overweight. From a body mass index of over 30, the World Health Organization (WHO) speaks of obesity. However, patients with Pickwick syndrome often have a BMI of over 40 or 50. Hypoventilation syndrome develops as a result of being overweight. In hypoventilation, the normal ventilation of the lungs is abnormally reduced.
The term hypoventilation is often used interchangeably with the term respiratory depression. Actually, hypoventilation refers to the ventilation of the lungs, while respiratory depression affects breathing control. Due to the reduced ventilation of the lungs, gas exchange is restricted, resulting in an undersupply of oxygen.
Causes
The main cause of Pickwick syndrome is pathological obesity. Being overweight causes a narrowing of the upper airways. The lungs are also constricted by the surrounding tissue masses. Pushing up the diaphragm, a very important mechanism for breathing, is made more difficult by the tissue masses that have to be moved.
Stenosis breathing occurs, especially at night. Patients must breathe against the tissue. Due to the strain on breathing, the lungs are less ventilated and the alveoli receive less air. This condition is also known as alveolar hypoventilation. The reduced alveolar ventilation can also be observed during the day. There is an insufficient supply of oxygen (hypoxemia).
At the same time, too little carbon dioxide is exhaled, so that in addition to the lack of oxygen, an excess of carbon dioxide develops in the blood. This excess of carbon dioxide is also known as hypercapnia. It is believed that chronic hypercapnia serves to protect the respiratory pump. Normally, carbon dioxide levels are the strongest stimulus for breathing.
However, the respiratory center reacts less and less to the chronic hypercapnia, so that there is a shift in the target value in respiratory regulation. Breathing is reduced and the oxygen content in the blood decreases. The body reacts to this by producing more red blood cells (erythrocytes).
Symptoms, Ailments & Signs
The weakness of breathing in patients with Pickwick syndrome is particularly evident at night. It manifests itself as an accompanying and stroke-related respiratory disorder. Sleeping at night is not restful, so that there is a pronounced daytime tiredness with sleep attacks. Here the symptoms are similar to the sleep apnea syndrome. Breathing is irregular and there are periodic pauses in breathing.
These mainly occur during sleep. In the case of a pronounced Pickwick syndrome, however, breathing can also be impaired during the day. Sleep disorders and heavy snoring are also typical of the disease. Other important symptoms are an increase in the level of CO2 in the blood (hypercapnia) and a reduction in the level of oxygen in the blood (hypoxia). Arterial hypertension (high blood pressure) also develops.
However, high blood pressure is not only found in the systemic circulation, but also in the pulmonary circulation. In medical terminology, the increase in blood pressure in the pulmonary circulation is referred to as pulmonary hypertension.
Diagnosis & course of disease
Visual findings already provide the first indications of Pickwick syndrome. Patients with Pickwick syndrome are extremely overweight. Blood gas analysis provides further diagnostic information. The blood gas analysis allows statements about the gas distribution of carbon dioxide and oxygen in the blood. In patients with Pickwick syndrome, the oxygen content in the blood is low. The carbon dioxide content, on the other hand, is increased.
Further examinations are carried out to confirm the diagnosis. For example, a long-term blood pressure measurement is carried out. Certain blood lipid values such as HDL, LDL and triglycerides are also determined. An ECG is performed to assess the heart function . Echocardiography can also be used. X-ray diagnostics are also used. In the lung function test, the various lung volumes and other clinical parameters are recorded.
Complications
A feared complication is the development of pulmonary hypertension. This is constant high blood pressure caused by the squeezing of the pulmonary vessels. There is also an increased risk of heart disease caused by high pressure and triggered by being overweight. This can, for example, lead to an inefficiency in the right heart. This is due to the arteries hardened by fat. This also increases the risk of having a heart attack.
Difficult breathing, which occurs not only during the day but also during sleep, leads to breathing stops at night and even to respiratory arrest. During the day, in the advanced stage of Pickwick’s disease, a bluish discoloration of the face (“blue bloater”) and constant shortness of breath can also occur. The nocturnal breathing problems lead to a pronounced daytime sleepiness. As a result, some patients become permanently unable to work and have to retire early.
If there is an increase in the number of red blood cells (polycythemia), the risk of thrombosis, in which blood clots form on the vessel walls, is increased. If these detach and migrate upwards, the dreaded pulmonary embolism occurs. This also leads to shortness of breath and sudden heart failure.
When should you go to the doctor?
Obese people who notice irregular breathing, sleepiness and other signs of a serious condition should consult the doctor. Pickwick syndrome results from extreme obesity and can be treated by weight reduction. The prerequisite for this is an early diagnosis, if possible before complications such as pulmonary or arterial hypertension or hypoxia have set in. People suffering from obesity should see their doctor if they experience any unusual symptoms that go beyond the usual side effects of obesity.
Sleep apnea should be checked out by a doctor immediately. If breathing stops as a result of the sleep apnea syndrome, the emergency doctor must be called. Pickwick syndrome is diagnosed by the family doctor. For treatment of the underlying obesity, sufferers should consult a dietitian. Physiotherapeutic measures must be carried out to lose weight, for which the sports physician or a physiotherapist is the right contact person. In addition, a stomach reduction is an option, which is carried out on an inpatient basis and aftercare by a gastroenterologistrequirement. Any psychological comorbidities should be worked through with a therapist so that obesity can be alleviated in the long term and the Pickwick syndrome can be remedied.
Treatment & Therapy
Patients with Pickwick syndrome must reduce their weight. Weight reduction can be done conservatively with a change in diet. Alternatively, a gastric bypass can also be placed. In addition, patients must strictly avoid alcohol. Despite the insomnia, sleeping pills should not be used. Sleeping pills reduce the drive to breathe and are therefore contraindicated in Pickwick syndrome.
Since Pickwick syndrome can have life-threatening consequences, depending on its severity, therapy always begins in specialized centers with a sleep laboratory. In milder cases, it is often sufficient if the patient is positioned differently at night. In severe cases, positive nasal pressure therapy (nCPAP) is used.
This is nocturnal self-ventilation. Very advanced cases can only be treated by home ventilation. The patients are mechanically ventilated. As a life-threatening late consequence of extreme obesity, Pickwick syndrome can be fatal within a few years.
Outlook & Forecast
In general, the further course of Pickwick syndrome depends very much on the state of health of the person affected, so that a general prognosis cannot be given here. The course also depends very much on whether and how much weight the person concerned loses and whether action is taken to combat the excess weight. If the underlying disease is not cured, the symptoms of Pickwick syndrome usually do not disappear and in many cases can also become significantly worse. Therefore, a doctor should be contacted as soon as the first symptoms and signs appear and treatment should be initiated to prevent further complications and symptoms. In the worst case, this can result in the death of the person concerned due to the enormous overweight if no action is taken.
If the obesity is reduced, the symptoms of Pickwick syndrome usually disappear as well. They can also be completely limited if the excess weight is completely reduced. In severe cases, those affected are dependent on mechanical ventilation.
In general, a healthy lifestyle has a positive effect on the further course of the disease. In many cases, the obesity itself can also significantly reduce the life expectancy of the person concerned.
Prevention
Pickwick syndrome is a result of being overweight. Overweight patients can therefore prevent the syndrome by reducing their weight. A healthy and balanced diet is an absolute prerequisite for a normal body weight. A wholefood diet with a high proportion of fruit and vegetables can counteract obesity.
In addition, overweight people should ensure sufficient exercise. If you are very overweight, you should consult a doctor who will support you before you lose weight.
Aftercare
In most cases, those affected with Pickwick syndrome have only a few or very limited follow-up measures available. The patient should consult a doctor as soon as the first signs and symptoms of the disease appear, so that there are no further complications or other symptoms. In general, the further course of this disease depends very much on whether and how the person affected can reduce their excess weight, so that a general prediction is not possible.
However, a healthy lifestyle with a balanced diet has a positive effect on the further course of the disease. A doctor can also create a nutrition plan for the person concerned, which should be followed in any case. Insomnia can be alleviated with the help of sleeping pills. The person concerned should always adhere to the correct dosage so that poisoning does not occur.
In the case of obesity, a reduction is necessary in the long term, as this significantly reduces life expectancy. In some cases, those affected also depend on the help and support of their own families in everyday life in order to prevent depression and other mental disorders.
You can do that yourself
People suffering from Pickwick syndrome should seek medical treatment early. By constantly improving the quality of sleep, those affected can often alleviate the symptoms themselves. Regular sleep is particularly important. Patients should go to bed at the same time every day and sleep between seven and nine hours a day. Optimally, sleep masks, earplugs and other aids are used to improve sleep quality.
While good sleep hygiene won’t fix sleep apnea, it can significantly reduce symptoms. People who are overweight should take dietary and exercise measures to eliminate the weight problems in the long term.
Patients with Pickwick syndrome who are in an advanced stage of the disease should not sleep unsupervised so that emergency services can be called immediately in the event of a medical emergency. At best, the condition is treated at an early stage, which requires early diagnosis. Patients can often improve symptoms by sleeping in a different position or adjusting their sleep schedule. Factors such as diet and body weight also have an influence on the development of Pickwick syndrome.
