What Is Pickwickian Syndrome?

Medically Reviewed by Sabrina Felson, MD on July 16, 2023
3 min read

Pickwickian syndrome, also called obesity hypoventilation syndrome, happens when you're obese and have low oxygen levels in your blood combined with high levels of carbon dioxide (called Obesity Hypoventilation Syndrome).

The name for this condition comes from a character in Charles Dickens' The Posthumous Papers of the Pickwick Club who had similar symptoms.

The lack of oxygen caused by Pickwickian syndrome can cause:

  • Feeling tired during the day
  • Feeling a general lack of energy
  • Getting poor quality sleep
  • Depression
  • Frequent headaches
  • Snoring while sleeping
  • Blue toes or fingertips
  • Swollen feet and legs
  • Shortness of breath

Most people with Pickwickian syndrome experience sleep-disordered breathing, which includes conditions like sleep apnea. This is a condition in which you stop breathing for short periods while you sleep. According to one study, as many as 90% of people with Pickwickian syndrome also have sleep apnea.  

You may not realize you have symptoms of Pickwickian syndrome until someone you share a bed with lets you know about it. That's because many of the syndrome's symptoms, like difficulty breathing in your sleep or snoring, only happen while you're asleep.

Pickwickian syndrome is caused by a reduced capacity of the respiratory system due to obesity. If you have this syndrome, your body has a decreased ability to properly process carbon dioxide, allowing too much of it to build up.

While doctors don't exactly know what causes Pickwickian syndrome, many medical professionals believe extra hormones, neurological difficulty, mechanical issues with breathing, or some combination of these three health issues are behind it.

There are a few specific issues doctors look for to make an accurate diagnosis. To have this syndrome, you must be obese. You must also be experiencing hypoventilation, or difficulty moving air in and out of your lungs. This leads to high carbon dioxide levels and low oxygen levels in your blood.

Having a lower rate of respiration may be caused by difficulty breathing in certain positions, like lying down, due to obesity. Experts are not sure if this hypoventilation is caused by the excess weight of abdominal fat, a weakening of the respiratory muscles, or some combination of the two.

Another characteristic that doctors look for in diagnosing Pickwickian syndrome is sleep-disordered breathing. To diagnose your breathing problems, a doctor will perform several tests to make sure your breathing issues and tiredness aren't caused by a neurological, muscular, mechanical, or metabolic issue. These tests may include a:

  • Chest X-ray
  • Pulmonary function test
  • Blood test to measure oxygen and carbon dioxide levels in the blood
  • Pulse oximetry
  • Sleep study

They will also ask you about your medical history and calculate your BMI to see if you are obese.

One common treatment for this syndrome is using a CPAP or BiPAP machine to help you breathe at night. This alleviates symptoms of sleep apnea and leads to better sleep quality. Many people who have sleep apnea feel more well-rested during the day if they use a PAP machine.

Some people with Pickwickian syndrome also need to use supplemental oxygen. You'll need this if you still have symptoms of the syndrome while using a PAP machine at night.

If you have Pickwickian syndrome, your doctor will also encourage you to make lifestyle changes that will help you to lose weight. Losing weight can improve your breathing, both at night and during the day. If you do choose to make lifestyle changes, you should work with medical professionals to oversee your weight loss.

If lifestyle changes aren't sustainable for you, your doctor may recommend bariatric surgery to help you lose weight.

If you still have symptoms of Pickwickian syndrome while using a PAP machine and after losing weight, there are some medications your doctor may recommend. These are respiratory stimulants that may help to improve your symptoms.

The symptoms of Pickwickian syndrome are similar to symptoms of other conditions including:

  • ALS. Short for amyotrophic lateral sclerosis, ALS is a neurodegenerative disease. It can cause trouble breathing due to the weakening of the muscles and changes in neurological functioning.
  • Phrenic nerve damage: This nerve controls the diaphragm. Injury of this nerve can lead to breathing difficulties.
  • Myasthenia Gravis. This is a neuromuscular disorder that can cause trouble breathing from weakened muscles.
  • Central sleep apnea. This condition is sleep apnea without the presence of other symptoms of Pickwickian syndrome.