Definition
Pickwick syndrome (also known as obesity-hypoventilation syndrome) is a complication of severe obesity that causes diurnal hypercapnia (ie an increase in carbon dioxide in the blood) and obstructive sleep apnea. This condition occurs in the absence of other known causes of hypoventilation, such as, for example, a COPD (chronic obstructive pulmonary disease).
Commonly, the increase in adiposity is related to:
- Structural and / or functional changes in the airway gauge;
- Decrease in lung volumes (excess adipose tissue mechanically reduces diaphragmatic excursions and alveolar ventilation);
- Inability of respiratory centers to respond adequately to an increase in carbon dioxide (CO2) concentration.
Furthermore, in the pathogenesis of Pickwick syndrome, an alteration of the leptin-adiponectin system contributes; leptins are hormones produced by circulating adipocytes, which induce a sense of satiety by stimulating receptors at the level of the hypothalamus; at the same time, leptins act on central respiratory centers to stimulate ventilation. Therefore, a deficit of leptin synthesis or receptor resistance to it is associated with chronic hypoventilation.
Most common symptoms and signs *
- Respiratory acidosis
- Apnea
- Arrhythmia
- Asthenia
- Dry mouth
- Catalepsy
- Cyanosis
- Dyspnoea
- Mood disorders
- Chest pain
- Shortness of breath
- Insomnia
- Hypercapnia
- Hypoxia
- Headache
- orthopnea
- Pallor
- Water retention
- Snoring
- Sense of suffocation
- Drowsiness
- Sweating
- tachypnoea
Further indications
Pickwick syndrome is characterized by the combination of obesity (body mass index> 30 kg / m2), chronic wakeful hypercapnia (PaCO 2 > 45 mm Hg) and sleep-related breathing disorders.
The symptomatology includes daytime sleepiness, loud snoring and sudden awakenings with a sense of suffocation. Moreover, Pickwick's syndrome can cause morning headaches (due to the increase in carbon dioxide), cyanosis, personality disorders and depression.
In the most advanced stages of the disease, chronic hypoxemia, superficial and periodic breathing, pulmonary hypertension and secondary polycythemia may also appear. Respiratory impairment may also occur with signs of right ventricular failure and chronic pulmonary heart. These complications expose you to the risk of premature death.
Fortunately, the symptomatology of Pickwick syndrome significantly improves with weight loss. For this purpose, measures such as a controlled diet, exercise or bariatric surgery can be applied.
The management of Pickwick syndrome may also include ventilatory support or tracheostomy.
