What is Pickwickian syndrome?

Pickwickian syndrome, clinically known as obesity hypoventilation syndrome (OHS), is a condition that affects the blood. It occurs when your blood doesn’t have enough oxygen and has too much carbon dioxide. Pickwickian syndrome is a type of disordered breathing that occurs in sleep that causes long-term changes in the body’s health.

When you breathe in oxygen, the air sacs, or alveoli, in your lungs transfer the oxygen into your bloodstream through capillaries. Capillaries are tiny blood vessels that connect to your bloodstream. These vessels also transfer carbon dioxide from your bloodstream to the air sacs. This carbon dioxide is then removed from your blood when you breathe out. These steps are known as gas exchange. Gas exchange is important for keeping a healthy balance of oxygen and carbon dioxide in your blood.

While clinically known as OHS, Pickwickian syndrome is named after the character Joe from the 1836 Charles Dickens novel The Pickwick Papers. Joe had many of the symptoms later described by clinicians when they discovered this condition, including obesity and sleep apnea (not breathing for extended periods of time during sleep). The name OHS is now more commonly used by doctors to describe the symptoms associated with this condition.

Many Pickwickian syndrome symptoms are connected to the lack of oxygen in your blood. This can have effects on your body while you’re awake and while you sleep. During sleep, your breathing can become shallow and may even stop for minutes at a time or longer.

Common Pickwickian syndrome symptoms include:

  • feeling out of breath
  • having a lack of energy
  • feeling sleepy or fatigued during the day
  • swelling or a bluish color in your fingers, toes, or legs (known as cyanosis)
  • morning headaches due to high levels of carbon dioxide in your blood
  • symptoms of depression, such as feelings of sadness, loss of interest in activities you normally enjoy, and suicidal thoughts

There are also more serious symptoms of Pickwickian syndrome. Talk to your doctor as soon as possible if you experience:

  • obstructive sleep apnea, which happens when you have periods of not breathing at all while you sleep
  • high blood pressure
  • cor pulmonale, a term for what happens when low blood oxygen causes the right side of your heart to experience too much tension

No specific, direct cause of Pickwickian syndrome is known by doctors or researchers. However, a combination of factors is thought to cause Pickwickian syndrome, including:

  • obesity, which is measured using the body mass index (BMI); someone with a BMI over 30 is considered obese
  • your brain’s inability to properly control your breathing
  • improper functioning of the respiratory system due to extra weight around your chest, which makes it harder for your lungs to draw in oxygen from the air
  • inadequate oxygen to the brain, heart, and other essential organs
  • chronically low oxygen levels, which change body functioning

Obesity and low blood oxygen levels can directly affect your joints. The stress that a high body weight puts on your joints is well known to cause osteoarthritis. This happens when the cartilage and bone in your joints start to become damaged or break down completely.

Obesity can also cause your fat cells, or adipose tissue, to attack your joint tissue. This can cause long-term inflammation that can cause your joints to become damaged, which can lead to osteoarthritis.

Complications of Pickwickian syndrome can include:

  • pulmonary hypertension, or high blood pressure
  • edema, or fluid buildup, in your legs
  • secondary erythrocytosis, or an abnormal amount of red blood cells in your bloodstream

See your doctor immediately if you experience any of these complications.

Many treatment plans exist to help you manage the symptoms of Pickwickian syndrome.

Weight loss

The first line of treatment is weight loss. If your doctor concludes that your obesity is causing Pickwickian syndrome, they will likely recommend that you lose weight to bring your BMI into the normal range. Obesity is one of the main causes of Pickwickian syndrome. Losing excess weight can help take the stress off your body and get your breathing back to normal. You should also incorporate movement and walking back into your life. Make conscious and informed choices about everything you eat. Because Pickwickian syndrome can lead to numerous serious health disorders and even death, weight loss is essential.

PAP (CPAP) therapy

The most common treatment for the breathing issues that come along with Pickwickian syndrome is positive airway pressure (PAP) therapy. Your doctor may recommend this type of treatment in the form of a continuous PAP (or CPAP) machine. This machine provides oxygen from a motor into a tube that connects to a mask that you wear over your nose and mouth.

This machine allows a constant flow of oxygen into your lungs, even when you sleep. This allows your lungs to give more oxygen to your blood and prevent hypoxemia. CPAP is well-researched and effective in reducing sleep apnea and improving quality of sleep. There are numerous health benefits of a night of deep, solid sleep. With Pickwickian syndrome you will be on this machine day and night.

Ventilator machine

Your doctor may also recommend using a ventilator to make sure that your breathing is consistent. A ventilator machine moves oxygen in and out of your lungs and can help balance the oxygen and carbon dioxide in your lungs.


If these treatments don’t work, and your condition is worsening, your doctor may suggest a tracheostomy. In this procedure, your doctor cuts a hole open in your trachea, or windpipe, and inserts a tube to allow consistent breathing.

Weight loss surgery options

Your doctor may also recommend weight loss surgery, also known as bariatric surgery, to help you manage your weight. Some common weight loss surgery options include gastric bypass and laparoscopic adjustable gastric banding. Both surgeries limit the amount of food that you can hold in your stomach. You may need you to make some significant lifestyle changes if you choose either of these surgeries. Talk to your doctor about the benefits and costs of these surgeries before you decide to undergo any of them.

Other possible treatments

Some older research shows that doses of medroxyprogesterone can help manage the symptoms of Pickwickian Syndrome. This can cause some side effects, such as erectile dysfunction in men and bleeding in the uterus in women, so talk to your doctor about this option.

If you lose weight in order to get Pickwickian syndrome under control, keeping the weight off is the best way to make sure that obesity doesn’t cause the syndrome again.

Eat a healthy, balanced diet and exercise at least 30 minutes a day. This will help you take in the right nutrients for your body and avoid building up fat and gaining extra weight.

Using a CPAP machine properly can help prevent the symptoms and complications of Pickwickian syndrome. If you have sleep apnea, get it treated. Talk to your doctor about choosing a machine that works best for you. A medical equipment provider can help you set up and operate your machine.

If you have any complications from Pickwickian syndrome, such as hypertension or erythrocytosis, talk to your doctor about treatment plans to get these conditions under control or prevent them from causing any further complications.

Obesity is increasingly common in the United States and around the world. Many treatments for the symptoms and conditions caused by obesity are now available.

Diagnosing Pickwickian syndrome early can help prevent many of the complications caused by low oxygen and high carbon dioxide in your blood. There are serious consequences that happen when the brain and other vital organs don’t receive the oxygen they need. See your doctor to treat sleep apnea before it gets worse. If you think you have Pickwickian Syndrome, see your doctor immediately.