Pickwick Syndrome

Classification according to ICD-10
E66.2	Excessive Obesity with Alveolar Hypoventilation Pickwick Syndrome
ICD-10 online (WHO version 2019)

The Pickwick Syndrome derives its name from the character of the always sleeping coachman Little Fat Joe in the novel The Pickwickier by Charles Dickens. A more modern term for the syndrome is obesity hypoventilation syndrome . Pickwick syndrome occurs in people who are extremely obese (obese). This syndrome is considered to be a form of obstructive sleep apnea that is associated with a disorder of central breathing control .

Symptoms

1. extreme overweight ( obesity ) with persistent restriction of lung breathing
2. Pronounced daytime sleepiness up to sleep addiction
3. Irregular breathing and periodic pauses in breathing ( apnea ), especially during sleep, or during the day if Pickwick's syndrome is pronounced
4. Sleep disorder and snoring
5. Polyglobulia (abnormal increase in red blood cells)
6. pulmonary (occurring in the pulmonary circulation) hypertension and arterial hypertension
7. Increase in the level of CO ₂ in the blood ( hypercapnia )
8. Decrease in the level of oxygen in the blood ( hypoxia )

Development of the pathological changes ( pathophysiology )

Being overweight leads to a constant narrowing of the upper respiratory tract ("stenosis") and a constriction of the lungs due to the tissue to be moved and the upward pressure of the diaphragms , especially at night. This strain on breathing leads to alveolar hypoventilation (reduced ventilation of the alveoli) even during the day, which results in a chronic accumulation of CO ₂ . This chronic hypercapnia is understood as a mechanism that protects the breathing pump from exhaustion.

As a result, however, the respiratory center in the brain reacts less and less to the normally strongest breathing stimulus , the CO ₂ content of the blood. A setpoint shift occurs in the breathing regulation. The lack of oxygen results from decreased breathing, but is less and less compensated for. The organism reacts to the lack of oxygen by increasing the number of red blood cells.

Breathing weakness is particularly evident at night and appears as an accompanying sleep-related breathing disorder. There is no restful night sleep and the daytime sleepiness leads to attack-like sleep states, as in sleep apnea syndrome.

therapy

Weight loss is of great importance in the treatment of Pickwick syndrome. Weight reduction can also be attempted through surgical measures (gastric bypass). In addition, avoidance of alcohol consumption and the discontinuation of sleeping pills are indicated, as these further reduce the respiratory drive. Therapy should only begin in specialized centers with a sleep laboratory . In milder cases, positioning training during sleep can be sufficient. Positive nasal pressure therapy ( nCPAP ) as nightly self- ventilation is used in more severe cases. In very advanced cases, home ventilation is the last option .

forecast

The fully developed Pickwick syndrome is a life-threatening long-term consequence of extreme obesity and, if left untreated, can lead to death within a few years because of the severe obstructive sleep apnea syndrome .

Individual evidence

1. ^ Herbert Renz-Polster and Steffen Krautzig: "Basic textbook internal medicine", Verlag Elsevier, Urban & Fischer, ISBN 978-3-437-41053-6
2. ↑ Hilmar Burchardi: Etiology and pathophysiology of acute respiratory failure (ARI). In: J. Kilian, H. Benzer, FW Ahnefeld (ed.): Basic principles of ventilation. Springer, Berlin a. a. 1991, ISBN 3-540-53078-9 , 2nd, unchanged edition, ibid. 1994, ISBN 3-540-57904-4 , pp. 47-91; here: p. 68.
3. ↑ ^{a b} Wolfgang Gerok et al .: Internal medicine: reference work for specialists , FK Schattauer Verlag GmbH, 2007

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