II. Definitions

  1. Obesity-Hypoventilation Syndrome (OHS, Pickwickian syndrome)
    1. Central Sleep Apnea in morbidly obese patients
    2. Results from Chemoreceptor hyporesponsiveness
    3. Charactized by chronic hypercarbia, Hypoxia and polycythemia, as well as Hypersomnolence

III. Epidemiology

  1. Prevalence: 0.4% of adults in U.S.
  2. Age of diagnosis (typically delayed): 40 to 60 years old

IV. Findings

  1. Morbid Obesity (BMI >40 kg/m2)
  2. Sleep disordered breathing
  3. Daytime arterial hypercapnia (PaCO2>=45 mmHg)
    1. Commonly presents with adute on chronic hypercapni Respiratory Failure
  4. Sleep Study with apnea/hypopnea index
    1. Moderate Obstructive Sleep Apnea (>=5 events/hour): 90% of OHS patients
    2. Severe Obstructive Sleep Apnea (>=15 events/hour): 70% of OHS patients

V. Associated Conditions

  1. Obstructive Sleep Apnea
    1. Obstructive Sleep Apnea (OSA) is comorbid in 90% of Obesity-Hypoventilation Syndrome patients (severe in 70%)
    2. However, only 10 to 20% of patients with OSA have Obesity-Hypoventilation Syndrome
  2. Cardiopulmonary Disease (see complications below)
    1. Heart Failure
    2. Coronary Artery Disease
    3. Pulmonary Hypertension

VI. Management

  1. Positive Airways Pressure (CPAP or BiPAP)
    1. Use BiPap for patients with Central Sleep Apnea (by Sleep Study)
    2. Paradoxically, nighttime Central Sleep Apnea is less common in OHS
      1. Most OHS patients are treated with CPAP for Obstructive Sleep Apnea
  2. Weight loss
    1. Bariatric Surgery is often indicated

VII. Complications

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Related Studies

Ontology: Obesity Hypoventilation Syndrome (C0031880)

Definition (MSHCZE) Pickwickův syndrom – stav, který vzniká jako důsledek nadměrné obezity, při níž je ztíženo dýchání (hypoventilace). V těle se hromadí oxid uhličitý, který způsobuje výraznou spavost s usínáním během dne. Dochází k postižení srdce a plic. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (MSH) HYPOVENTILATION syndrome in very obese persons with excessive ADIPOSE TISSUE around the ABDOMEN and DIAPHRAGM. It is characterized by diminished to absent ventilatory chemoresponsiveness; chronic HYPOXIA; HYPERCAPNIA; POLYCYTHEMIA; and long periods of sleep during day and night (HYPERSOMNOLENCE). It is a condition often related to OBSTRUCTIVE SLEEP APNEA but can occur separately.
Concepts Disease or Syndrome (T047)
MSH D010845
ICD9 278.03
ICD10 E66.2
SnomedCT 78897001, 190973002, 190972007, 154777006, 190966007
English Syndrome, Pickwickian, Extrem obesity+alveol hypovent, OBESITY-HYPOVENTILATION SYNDROME, PICKWICKIAN SYNDROME, Pickwickian syndrome (diagnosis), Obesity Hypoventilation Syndrome [Disease/Finding], Obesity hypovent synd, pickwickian syndrome, hypoventilation obesity syndrome, obesity hypoventilation syndrome, Obesity-Hypoventilation Syndrome, Pickwickian syndrome (disorder), Hypoventilation associated with obesity syndrome, Extreme obesity with alveolar hypoventilation, Extreme obesity with alveolar hypoventilation (disorder), cardiopulmonary; obesity syndrome, syndrome; cardiopulmonary-obesity, Pickwickian syndrome, Obesity hypoventilation syndrome, Pickwickian Syndrome, Hypoventilation Syndrome, Obesity, Syndrome, Obesity Hypoventilation, Obesity Hypoventilation Syndrome
Dutch obesitas-hypoventilatiesyndroom, cardiopulmonaal; vetzuchtsyndroom, syndroom; cardiopulmonale vetzucht, Extreme vetzucht met alveolaire hypoventilatie, Pickwick-syndroom, Syndroom, Pickwick-
German Obesity-hypoventilations-syndrom, Uebermaessige Adipositas mit alveolaerer Hypoventilation, Pickwick Syndrom, Pickwick-Syndrom
Italian Sindrome ipoventilatoria dell'obeso, Sindrome di Pickwick, Sindrome obesità-ipoventilazione
Portuguese Síndrome de hipoventilação da obesidade, Síndrome de Hipoventilação da Obesidade, Síndrome de Pickwick, Síndrome de Hipoventilação por Obesidade
Spanish Síndrome de obesidad-hipoventilación, hipoventilación asociada al síndrome de obesidad, síndrome de Pickwick (trastorno), síndrome de hipoventilación asociada a la obesidad, Síndrome de Hipoventilación de la Obesidad, obesidad extrema con hipoventilación alveolar (trastorno), obesidad extrema con hipoventilación alveolar, obesidad extrema por hipoventilación alveolar (trastorno), obesidad extrema por hipoventilación alveolar, síndrome de Pickwick, Síndrome de Pickwick, Síndrome de Hipoventilación por Obesidad
Swedish Fetma med alveolär hypoventilation
French Syndrome d'hypoventilation de l'obésité, Syndrome pickwickien, Syndrome de Pickwick, SOH (Syndrome Obésité-Hypoventilation), Syndrome obésité hypoventilation, Syndrome obésité-hypoventilation (SOH)
Japanese ピックウィックショウコウグン, ヒマンテイカンキショウコウグン, Pickwick症候群, 低換気症候群-肥満, Pickwickian症候群, ピクウィック症候群, ピックウィック症候群, ピックウィッキアン症候群, 肥満低換気症候群
Czech Pickwickův syndrom, hypoventilační syndrom při obezitě, extrémní obezita s alveolární hypoventilací, Syndrom hypoventilace u obezity
Finnish Pickwick-oireyhtymä
Russian OZHIRENIIA GIPOVENTILIATSIONNYI SINDROM, PIKVIKSKII SINDROM, ПИКВИКСКИЙ СИНДРОМ, ОЖИРЕНИЯ ГИПОВЕНТИЛЯЦИОННЫЙ СИНДРОМ
Korean 폐포저환기를 동반한 극심한 비만
Polish Zespół Pickwicka
Hungarian Pickwick syndroma, Obesitas okozta hypoventilatiós syndroma
Norwegian Pickwicks syndrom, Overvektsrelatert hypoventilasjonssyndrom