Obesity Hypoventilation Syndrome (Pickwickian Syndrome)

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.

Also Known As:

Networked: 240 relevant articles (14 outcomes, 25 trials/studies)

Relationship Network

Disease Context: Research Results

Related Diseases

1.	Hypoventilation
2.	Sleep Apnea Syndromes (Sleep Apnea)
3.	Obstructive Sleep Apnea
4.	Hypertension (High Blood Pressure)
5.	Respiratory Insufficiency (Respiratory Failure)

Experts

1.	Mokhlesi, Babak: 24 articles (03/2022 - 06/2007)
2.	Masa, Juan F: 12 articles (03/2022 - 03/2016)
3.	Chiner, Eusebi: 9 articles (03/2022 - 03/2016)
4.	Díaz-Cambriles, Trinidad: 9 articles (03/2022 - 03/2016)
5.	Egea, Carlos: 9 articles (03/2022 - 03/2016)
6.	González, Mónica: 9 articles (03/2022 - 03/2016)
7.	Romero, Auxiliadora: 9 articles (03/2022 - 03/2016)
8.	Corral, Jaime: 8 articles (03/2022 - 03/2016)
9.	Spanish Sleep Network: 8 articles (03/2022 - 10/2016)
10.	Piper, Amanda J: 8 articles (01/2022 - 01/2006)

Drugs and Biologics

Drugs and Important Biological Agents (IBA) related to Obesity Hypoventilation Syndrome:

1.	Carbon DioxideIBA 09/01/2021 - "Obesity hypoventilation syndrome (OHS) is a condition commonly found in severely obese patients in which they fail to breathe deeply or rapidly enough to offset the body's need for oxygen consumption and carbon dioxide release. " 11/01/2014 - "Obesity hypoventilation syndrome in Japan and independent determinants of arterial carbon dioxide levels." 07/01/1999 - "To define the role of breathing control in the pathogenesis of carbon dioxide (CO(2)) retention in patients with obesity hypoventilation syndrome. " 07/01/1999 - "[The role of breathing control disorder in the development of carbon dioxide retention in patients with obesity hypoventilation syndrome]." 06/01/2007 - "Long-term nocturnal non-invasive mechanical ventilation (NIMV) is an effective treatment for obesity-hypoventilation syndrome (OHS), improving central carbon dioxide (CO(2)) sensitivity. "
2.	Hormones (Hormone)IBA 05/02/1992 - "It is treated by weight reduction (pickwickian syndrome), hormones, or recently, with continuous positive pressure apparatus. " 07/01/2001 - "In most patients, surgically induced weight loss will correct hypertension, type II diabetes mellitus, sleep apnea, obesity hypoventilation syndrome, gastroesophageal reflux, venous stasis disease, urinary incontinence, female sexual hormone dysfunction, pseudotumor cerebri, degenerative joint disease pains, as well as improved self-image and employability."
3.	Opioid Analgesics (Opioids)IBA 01/01/2020 - "Additional perioperative precautions are necessary in patients with severe morbid obesity, metabolic syndrome, untreated or severe obstructive sleep apnoea syndrome, or obesity hypoventilation syndrome; patients receiving home ventilatory support or postoperative opioid therapy; and obese patients undergoing open operations, long procedures or revisional surgery. " 10/01/2014 - "Although the gold standard for the treatment of OSA, CPAP may not be the optimal modality to treat more complex sleep disordered breathing such as Cheyne-Stokes respirations, opioid-induced central apnea, and complex sleep disordered breathing related to chronic hypoventilation syndromes (obesity-hypoventilation syndrome, restrictive thoracic disease due to neuromuscular or thoracic cage disease, chronic obstructive pulmonary disease). "
4.	Medroxyprogesterone Acetate (Depo-Provera)FDA LinkGeneric 10/01/1975 - "We conclude that sublingual medroxyprogesterone acetate therapy is useful in the management of the Pickwickian syndrome." 10/01/1975 - "Ten patients with the Pickwickian syndrome, characterized by obesity, hypoxemia, hypercapnia, polycythemia, and cor pulmonale, underwent long-term treatment as outpatients with medroxyprogesterone acetate. "
5.	Oxygen (Dioxygen)IBA 01/01/2021 - "The air that we (do not) breathe: lower adipose tissue oxygen availability in patients with obesity hypoventilation syndrome?" 10/15/2016 - "Low flow supplemental oxygen is commonly prescribed to patients with obesity hypoventilation syndrome (OHS). " 10/15/2016 - "The Effect of Supplemental Oxygen in Obesity Hypoventilation Syndrome." 05/01/2011 - "Oxygen for obesity hypoventilation syndrome: a double-edged sword?" 01/01/2017 - "Obesity hypoventilation syndrome should be considered when oxygen desaturation index, apnea hypopnea index and sleep time with SpO2 <90% are high."
6.	GasesIBA 02/01/2017 - "Obesity hypoventilation syndrome is even harder to recognize preoperatively as arterial blood gases are generally not obtained prior to elective noncardiac surgery. " 09/01/1972 - "Lung volumes, mechanics of breathing and changes in arterial blood gases in obese patients and in Pickwickian syndrome." 07/01/2019 - "Comparison of arterial and venous blood gases in patients with obesity hypoventilation syndrome and neuromuscular disease." 05/15/2014 - "We measured overnight polysomnography (PSG), arterial blood gases, and Epworth Sleepiness Scale in 55 severe SDB patients with obesity hypoventilation syndrome or overlap syndrome (COPD+ obstructive sleep apnea) before and ∼3 months after positive airway pressure (PAP) treatment. " 11/01/2021 - "To decrease morbidity and mortality by achieving timely access to NIV for patients with hypoventilation, particularly those with obesity hypoventilation syndrome, we make the following key suggestions: (1) given the significant technological advances, we advise acceptance of surrogate noninvasive end-tidal and transcutaneous Pco2 and venous blood gases in lieu of arterial blood gases; (2) not requiring Pco2 measures while on prescribed oxygen; (3) not requiring a sleep study to avoid delays in care in patients being discharged from the hospital; (4) remove spirometry as a requirement; and (5) not requiring BPAP without a backup rate failure to approve BPAP spontaneous/timed. "
7.	Acetazolamide (Diamox)FDA LinkGeneric 11/01/2010 - "Hypercapnic respiratory failure in obesity-hypoventilation syndrome: CO₂ response and acetazolamide treatment effects." 10/01/2023 - "We searched Medline, EMBASE and CENTRAL from inception to March 2022 for randomised controlled trials comparing acetazolamide to placebo in patients with chronic obstructive pulmonary disease, obesity hypoventilation syndrome or obstructive sleep apnoea, hospitalised with acute respiratory deterioration complicated by metabolic alkalosis. " 01/01/2017 - "Effects of early administration of acetazolamide on the duration of mechanical ventilation in patients with chronic obstructive pulmonary disease or obesity-hypoventilation syndrome with metabolic alkalosis. " 10/01/2023 - "Acetazolamide for metabolic alkalosis complicating respiratory failure with chronic obstructive pulmonary disease or obesity hypoventilation syndrome: a systematic review." 11/01/2010 - "Obesity hypoventilation syndrome: bicarbonate concentration and acetazolamide."
8.	Interleukin-6 (Interleukin 6)IBA 12/01/2000 - "The aim of this study was to examine the relationship between IL-6 levels in healthy volunteers (control group) and three different groups of obese patients: patients without obstructive sleep apnea syndrome (OSAS), patients with OSAS, and patients with obesity hypoventilation syndrome (OHS) (daytime baseline oxygen saturation of <93%). "
9.	GlucocorticoidsIBA 01/01/2018 - "Most common causes of secondary hypertension identified in our study group were: glucocorticoid intake (n = 14), obesity hypoventilation syndrome (n = 6), obstructive sleep apnea (n = 2) and preeclamspia (n = 2). "
10.	Analgesics (Analgesic Drugs)IBA 03/01/2012 - "The ongoing debate on the relevance of obesity, for example in terms of obstructive sleep apnea syndrome, obesity hypoventilation syndrome, and other related respiratory disturbances, in relation to the choice of analgesic techniques, especially interscalene block, patient-controlled intravenous analgesia and patient monitoring, demands large-scale, well-designed studies to resolve it. "

Therapies and Procedures

1.	Therapeutics 07/01/1983 - "We conclude that nasal CPAP therapy during sleep is an effective noninvasive therapy for patients with the Pickwickian syndrome, and may lead to a stable remission of the underlying severe disordered breathing in sleep." 04/01/2019 - "This study aimed to assess the outcomes of bi-level positive airway pressure (BIPAP) therapy among patients with obesity hypoventilation syndrome (OHS). " 01/01/2016 - "The aim of this study is to evaluate the presence of neurocognitive dysfunctions, depression and anxiety and the effect of positive airway pressure (PAP) therapy on these alterations in Obesity Hypoventilation Syndrome (OHS) patients. " 11/28/2023 - "Using intra-breath oscillometry in obesity hypoventilation syndrome to detect tidal expiratory flow limitation: a potential marker to optimize CPAP therapy." 03/01/2021 - "Adherence to Positive Airway Pressure Therapy in Obesity Hypoventilation Syndrome."
2.	Noninvasive Ventilation 03/01/2015 - "[Noninvasive ventilation: efficacy of a new ventilatory mode in patients with obesity-hypoventilation syndrome]." 03/01/2016 - "Mid- and Long-Term Efficacy of Non-Invasive Ventilation in Obesity Hypoventilation Syndrome: The Pickwick's Study." 01/01/2023 - "Cost-effectiveness of outpatient versus inpatient non-invasive ventilation setup in obesity hypoventilation syndrome: the OPIP trial." 01/01/2020 - "Obesity hypoventilation syndrome (OHS) is treated with either non-invasive ventilation (NIV) or CPAP, but there are no long-term cost-effectiveness studies comparing the two treatment modalities. " 01/01/2018 - "Despite a significant association between obesity hypoventilation syndrome (OHS) and cardiac dysfunction, no randomised trials have assessed the impact of non-invasive ventilation (NIV) or CPAP on cardiac structure and function assessed by echocardiography. "
3.	Continuous Positive Airway Pressure 01/01/2019 - "Concerns regarding the use of continuous positive airway pressure to treat stable patients with obesity hypoventilation syndrome." 10/01/2013 - "The use of continuous positive airway pressure (CPAP) treatment in patients with obesity hypoventilation syndrome (OHS) and obstructive sleep apnoea (OSA) was evaluated, and factors that might predict CPAP treatment failure were determined. " 10/01/2013 - "Continuous positive airway pressure in clinically stable patients with mild-to-moderate obesity hypoventilation syndrome and obstructive sleep apnoea." 05/01/2008 - "An emerging application is to treat obesity-hypoventilation syndrome, particularly in continuous positive airway pressure (CPAP) failures. " 06/01/2007 - "Positive airway pressure titration in obesity hypoventilation syndrome: continuous positive airway pressure or bilevel positive airway pressure."
4.	Positive-Pressure Respiration (Positive End-Expiratory Pressure) 01/01/2013 - "Impact of different backup respiratory rates on the efficacy of noninvasive positive pressure ventilation in obesity hypoventilation syndrome: a randomized trial." 06/01/2007 - "Our objective was to study the long-term effects of non-invasive positive pressure ventilation (NPPV) on lung function and gas exchange in patients with the obesity hypoventilation syndrome (OHS). " 09/12/2017 - "[Clinical practices of noninvasive positive pressure ventilation in stable obesity-hypoventilation syndrome]." 04/01/2013 - "Backup respiratory rate during noninvasive positive pressure ventilation in obesity hypoventilation syndrome: can this difficult puzzle be resolved?" 02/01/2011 - "Instantaneous restoration of cardiac output by noninvasive positive pressure ventilation in a patient with obesity hypoventilation syndrome."
5.	Artificial Respiration (Mechanical Ventilation) 01/01/2017 - "Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome." 01/01/2017 - "Long-term home mechanical ventilation due to obesity hypoventilation syndrome." 01/01/2016 - "Gender differences in patients starting long-term home mechanical ventilation due to obesity hypoventilation syndrome." 02/01/2015 - "Noninvasive mechanical ventilation in patients with obesity hypoventilation syndrome. " 02/01/2013 - "Non-invasive mechanical ventilation in obesity hypoventilation syndrome: are multimodal therapeutic strategies disease essential?"