Reversal of the Pickwickian Syndrome by Long-Term Use of Nocturnal Nasal-Airway Pressure

Abstract

Chronic hypercapnia and daytime hypersomnolence in the obese patient without intrinsic lung disease — the so-called Pickwickian syndrome — has long been associated with periodic breathing.¹ The recognition that obstructive sleep apnea with functional upper-airway obstruction is the mechanism of such periodic breathing² has led to its implication in the development of chronic hypercapnia. The current definitive treatment for severe obstructive sleep apnea is tracheostomy.³ However, medical and psychosocial problems frequently interfere with the acceptance of tracheostomy by both patient and physician, especially when symptoms have been long-standing.^{3 , 4} Recently, a noninvasive therapeutic method — continuous positive airway pressure applied through . . .