Obesity hypoventilation syndrome

The Pickwick syndrome derives its name from the figure of eternal sleeping coachman Little Fat Joe in the novel The Pickwick Papers by Charles Dickens. A more modern name of the syndrome is obesity - hypoventilation syndrome. The Pickwick syndrome occurs in individuals with extreme obesity (overweight) on. This syndrome is considered a form of obstructive sleep apnea.

Symptoms

Development of pathological changes ( pathophysiology )

The preponderance leads to an ongoing tightness of the upper respiratory tract ( " wheezing " ) and a narrowing of the lungs through the tissue to be moved masses and the highly oppressive, diaphragm, especially at night. This burden of breathing leads to alveolar hypoventilation (decreased ventilation of the pulmonary alveoli ) in the daytime, the effect in a chronic accumulation of CO2. This chronic hypercapnia is understood as a mechanism that protects the respiratory pump from exhaustion.

As a result, the respiratory center in the brain, however, less and less responsive to the breathing normally strongest incentive, the CO2 content of the blood. It comes to a setpoint shift in the respiratory control. The lack of oxygen results from the decreased respiration, but is always less balanced. The organism reacts to the lack of oxygen with an increase in the red blood cells.

The weakness of the breathing is especially evident at night and occurs as an accompanying sleep-related breathing disorder in appearance. It remains from the refreshing atmosphere of nocturnal sleep and it comes because of daytime sleepiness to paroxysmal sleep states, as in sleep apnea syndrome.

Therapy

Weight reduction is for the treatment of the Pickwick syndrome is of great importance. The weight loss can be attempted by surgical procedures ( gastric bypass ). In addition, avoiding alcohol consumption and discontinuation of sleeping pills is displayed, as these reduce the respiratory drive on. The initiation of treatment should take place only in specialized centers with sleep laboratory. In milder cases may be sufficient storage, a workout during sleep. A positive nasal pressure therapy ( nCPAP ) as nocturnal self- ventilation is used in more severe cases. In very advanced cases, a ventilator is used by tracheotomy as a last resort.

Forecast

The full-blown Pickwick syndrome is a life-threatening late effect of extreme obesity and untreated can lead to death within a few years because of severe obstructive sleep apnea syndrome.