What Is Pickwickian Syndrome (or Obesity Hypoventilation Syndrome)?

Without treatment, obesity hypoventilation syndrome can lead to serious or life threatening complications. Assistive breathing devices, losing weight, and treating underlying conditions can help manage OHS.

• Shortness of breath
• Extreme tiredness or fatigue
• Daytime sleepiness
• Headaches
• Dizziness

• Snoring
• Pauses in breathing, choking, or gasping during sleep
• Morning headaches
• Daytime sleepiness
• Difficulty with concentration

• Changes in the way your brain regulates breathing
• Difficulty breathing deeply, due to extra fat on your neck, chest, and belly
• Hormones produced by fat cells that affect your body’s breathing patterns

Your doctor will first ask about your symptoms and whether you have trouble sleeping. They’ll also do a physical exam and calculate your body mass index (BMI) to determine whether you have obesity. Obesity is defined as a BMI of 30 or higher.

• Arterial Blood Gas This test measures oxygen and carbon dioxide levels in a sample of your blood.
• Pulse Oximetry Your doctor places a sensor on your finger to measure the amount of oxygen in your blood. This test is less accurate than measuring a blood sample.
• Pulmonary Function Tests These tests check how well your lungs are functioning to rule out other causes, like chronic obstructive pulmonary disease.
• Imaging Tests A chest X-ray or computed tomography scan allows your doctor to rule out other possible causes of breathing problems.
• Sleep Study (Polysomnography) A sleep study can help identify whether you have sleep apnea and determine how severe it is.

The main treatment for OHS is weight loss. Breathing assistance may also be necessary.

Weight Loss

If lifestyle changes aren’t enough or your symptoms get worse, weight loss surgery, such as gastric bypass surgery, may be an option to help you lose weight.

Breathing Assistance

• Continuous Positive Airway Pressure (CPAP) A CPAP machine delivers constant air pressure when you breathe in and out.
• Bilevel Positive Airway Pressure (BiPAP) A BiPAP machine delivers a higher pressure of air when you breathe in than when you breathe out. This may be an option if CPAP isn’t effective or you can’t tolerate it.

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Rarely, people who don’t see improvement with assistive devices may need a tracheostomy. In this procedure, a surgeon cuts a hole through your neck into the trachea (windpipe) to deliver oxygen more efficiently into your lungs.

Without treatment, the outlook for people with OHS is poor. OHS can significantly decrease your quality of life, and a lack of oxygen can lead to life-threatening complications, like heart failure.

• High blood pressure (hypertension)
• High blood pressure in the lungs (pulmonary hypertension)
• Right-sided heart failure (cor pulmonale)

• Irritability and agitation
• Increased risk of accidents
• Depression
• Problems with sex and intimacy

• Pickwickian syndrome, also known as obesity hypoventilation syndrome, is a breathing disorder that affects some people with obesity. Weight on the airways from excess fat, along with hormone and brain changes, may contribute to OHS.
• Common symptoms of OHS include shortness of breath, fatigue, and daytime sleepiness. Most people with OHS also have symptoms of obstructive sleep apnea, including snoring and gasping or choking during sleep.
• Treatment for OHS involves weight loss (with healthy lifestyle changes) and breathing assistance (with a ventilation machine). In some cases, weight loss surgery or, rarely, a tracheostomy may be necessary.
• Without treatment, OHS can be life-threatening. Early diagnosis and treatment can reverse OHS symptoms and reduce your risk of complications.