Pickwickian syndrome

In 1837, Charles Dickens referred to a character named Joe in one of his works, describing him as an individual who was overweight, had a rosy complexion, snored, struggled to breathe, and felt constantly drowsy. (1)

Subsequently, in 1889, the first literature report was published linking excess weight to excessive sleepiness. Lavie was the first to coin the term “Pickwick” about a sleep disorder and the first to use the term Pickwick associated with sleeping sickness. (2)

The first well-documented case of a patient with OHS in the medical literature was described in 1955 with the clinical and physiological aspects of a patient with obesity who presented erythrocytosis and hypoventilation. (3)

The term “Pickwick Syndrome” then gained popularity thanks to Burwell who recollected a patient who bore a resemblance to the Dickens character Joe. The patient exhibited drowsiness, hypoventilation, and signs of cor pulmonale. After losing 18 kg, the patient’s PaCO2 and blood pressure levels were normalized. (4)

Pickwickian syndrome has become a term used to describe individuals who are obese, have some degree of respiratory failure during the day and suffer from cor pulmonale. There is a reliance on hypoxic drive for ventilation rather than hypercapnia.

Other features include: (5)

• sleep apnoea
• episodic somnolence
• secondary polycythaemia
• right ventricular hypertrophy or failure

Reference

1. Dickens C. The Posthumous Papers of the Pickwick Club, by Charles Dickens. With Eight Illustrations. London, Chapman and Hall... 1869. (Chapman and Hall, ed.). London; 1869
2. Lavie P. Who was the first to use the term Pickwickian in connection with sleepy patients? History of sleep apnoea syndrome. Sleep Med Rev. 2008;12(1):5–17
3. Auchincloss JH, Cook E, Renzetti AD. Clinical and physiological aspects of a case of obesity, polycythemia and alveolar hypoventilation. J Clin Invest. 1955;34(10):1537–1545
4. Burwell CS, Robin ED, Whaley RD, Bickelmann AG. Extreme obesity associated with alveolar hypoventilation--a Pickwickian Syndrome. 1956. Obes Res. 1994;2(4):390–397
5. Masa JF, Pépin JL, Borel JC, Mokhlesi B, Murphy PB, Sánchez-Quiroga MA. Obesity hypoventilation syndrome. Eur Respir Rev. 2019;28(151):180097