Pickwickian Syndrome

Pickwickian syndrome is a condition occurring in very obese patients. It significantly impairs their quality of life of people and in some cases; it is directly life-threatening.


The syndrome is caused by a hypoventilation in horizontal position. During sleep, obese people usually suffer from sleep apnea. Their soft palate and muscles of the upper respiratory tract are not strong enough and they have increased tendency to collapse. This is worsened by diaphragm, which is pushed by the obese abdomen upwards towards the chest compressing the lungs.


Pickwickian syndrome


Scheme - compression of lungs in horizontal position




The syndrome manifest with lack of oxygen while lying on the back. The person suffers from shortness of breath, fatigue and excessive sleeping during the day. When the sleep apnea is present, the person snores and repeatedly stops breathing for a short period of time during the night. These nocturnal choking episodes are associated with elevated blood pressure and risk of cardiovascular diseases. It should be noted that highly obese polymorbid patients have increased risk of sudden death when immobilized in horizontal position for a long time.


The diagnosis is almost sure in extremely obese patients. The diagnostics of sleep apnea is performed in special sleep laboratories.


The main solution is to significantly lose weight. The night problems of sleep apnea may be solved either by surgery (or laser surgery) of the soft palate or by a special machine called CPAP that increases the pressure of inhaled air (see the relevant text dedicated to sleep apnea).


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources