The Obesity-Hypoventilation Syndrome (OHS) may occur in severely obese patients. It may be related to the increased work of breathing associated with displacing a large mass of fat.
Synonym: Pickwickian syndrome (after Samuel Pickwick from the Pickwick Papers by Charles Dickens)
Clinical features:
(1) obesity, typically morbid obesity
(2) chronic fatigue
(3) hypersomnolence
(4) dyspnea on simple exertion
(5) morning headaches
Laboratory findings:
(1) hypercapnia while awake (PaCO2 > 45 mm Hg)
(2) increase in PaCO2 by > 10 mm Hg when asleep
(3) hypoxemia (SaO2 < 90%) while awake
(4) hypoxemia (SaO2 < 90%) while asleep
(5) respiratory acidosis while asleep (pH < 7.3)
(6) oximetry while asleep shows persistent desaturation of oxyhemoglobin
Common concurrent conditions:
(1) obstructive sleep apnea
Complications:
(1) cor pulmonale and right heart failure
(2) polycythemia
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