If you’re overweight and always feel sleepy then the Pickwickian Syndrome could be to blame. Rhea Dhanbhoora finds out what it is all about

The Pickwickian Syndrome, also known as Obesity Hypoventilation Syndrome, is a combination of low blood oxygen levels and high blood carbon dioxide levels in your body. Dr. Manish Motwani, Obesity Surgeon at Aastha Healthcare, tells us, “The condition is seen in severely overweight people with an inability to breathe properly.

Sometimes, many of them stop breathing altogether for short periods of time while they sleep. This condition is called Obstructive Sleep Apnea. This results in partial awakenings during the night, leading to continual sleepiness during the day. It is commonly treated with nocturnal ventilation with positive airway pressure (CPAP), but the most effective treatment is weight loss.”

This means that you could constantly be sleepy, have a lower level of concentration and even suddenly fall asleep in the midst of your day. It can also cause heart problems.

Signs of Pickwickian Syndrome
The syndrome is usually caused by obesity. Some of the symptoms include:
• Obstructive sleep apnea which means a lot of snoring and brief episodes where you stop breathing during the night.
• Depression.
• Interrupted sleep.
• Excessive daytime sleepiness.
• High blood pressure which is difficult to control with medication.
• Aggravated morning headaches.

“Obese people need to expend more energy to breathe effectively. Low oxygen levels lead to hypoxic pulmonary vasoconstriction — the tightening of small blood vessels in the lungs to create an optimal distribution of blood throughout them. Persistently low oxygen levels, which cause chronic vasoconstriction can lead to increased pressure on the pulmonary artery,” Dr. Manish explains.

Spotting It
These signs and symptoms don’t necessarily mean that you have Pickwickian Syndrome, especially if you’re not overweight. Dr. Manish tells us, “When we’re trying to diagnose the disease, we take a number of tests including measuring the BMI of a person. We also determine the arterial carbon dioxide level and sometimes take a chest X-ray, CT/CAT scan or an Echocardiography to distinguish it from other diseases.”

Treating It
The most obvious way to fight Pickwickian Syndrome is to lose weight, even if it needs to be done with surgery. “Bariatric surgeries have been shown to improve the symptoms and are better than dieting and exercise because morbid obesity is often risky for your health. You often don’t have time to go on a diet and form an exercise plan.”

He also suggests a nighttime positive airway pressure (PAP) treatment. The treatment involves making a surgical opening in the trachea to bypass obesity related airway obstructions in the neck.

“While people with Obesity Hypoventilation Syndrome are cared for on an outpatient basis, some deteriorate suddenly and when admitted to hospital may show severe abnormalities such as markedly deranged blood acidity or a low level of consciousness due to very high carbon dioxide levels. On occasion, admission to an intensive care unit is necessary.

“Non-surgical methods may be useful to an extent, but the final treatment is effective, substantial and permanent weight loss. Bariatric surgery has created new pathways in treatment where we have seen extraordinary results in more than 80% of population and moderate results in the rest,” Dr. Manish explains.

Expert Speak
"Pickwickian Syndrome is associated with breathing problems in severely obese patients. In the initial stages, when it is seen in the form of minor awakenings in the night, diet and weight loss are able to effectively take care of the situation. If the weight loss is not controlled, then over a period of time in severely obese patients, increased morbidity and decreased quality of life becomes a part of their daily routine."