Obesity and breathlessness often go hand in hand. However, this excess body weight can affect your breathing pattern in a complication called obesity hypoventilation syndrome (OHS). Excess fat deposits in your chest wall could exert pressure on your respiratory system, mainly on the lungs. This could severely affect your breathing and eventually lead to a build-up of carbon dioxide in your blood. Popularly known as Pickwickian Syndrome in medical circles, it reminds one of Joe from Charles Dickens’s The Pickwick Papers, who shows common symptoms experienced by people with OHS, including severe obesity and excessive sleepiness.
Dr Ravi Chandra MRK, consultant, internal medicine, pulmonology, Mazumdar Shaw Medical Centre, Narayana Health City, defines obesity hypoventilation syndrome as a triad of three components — obesity (excessive fat deposit in the chest walls), hypercapnia (excess carbon dioxide in the blood) and sleep-disordered breathing.
“Obesity hypoventilation syndrome is not a lung disorder,” emphasises Dr Chandra. It’s a systemic disorder, and its root cause is obesity, which affects the lungs and other organs of the human body, he adds.
What is obesity hypoventilation syndrome?
Dr Giridhar Adapa, endocrinologist, Manipal Hospital, Vijayawada, Andhra Pradesh, explains, “Obesity hypoventilation syndrome occurs when the excess body weight pressurises the chest wall and makes it difficult for people with obesity to breathe normally. In Pickwickian syndrome, one deals with hypercapnia.”
What causes obesity hypoventilation syndrome?
Dr Chandra explains obesity leads to the accumulation of fat deposits in the chest walls. This increases the pressure on the chest and reduces its ability to expand properly while breathing.”
When the chest wall becomes heavy due to fat deposition, it leads to hypoventilation. As a result, the chest wall does not effectively move air when people try to ventilate or breathe. This causes reduced oxygen levels and increased carbon dioxide levels in the blood. Over time, the high carbon dioxide levels build up, making the blood more acidic.
He adds that obesity hypoventilation syndrome can lead to weight gain. When the blood becomes more acidic, the body starts becoming resistant to hormones such as insulin and leptin. Leptin helps to regulate appetite; however, in the case of leptin resistance, people with obesity hypoventilation syndrome never reach satiety (fullness), which eventually leads to overeating.
Symptoms of Pickwickian syndrome
The earliest symptoms of high carbon dioxide levels in your blood can be a throbbing headache, particularly in the morning, says Dr Chandra. “Those with sleeping disorders may face trouble breathing while asleep,” he adds.
Dr Adapa says people with obesity hypoventilation syndrome usually have a BMI level higher than 30 and a high waist-hip ratio. He adds that people with Pickwickian syndrome can experience common symptoms including obstructive sleep apnea, extreme sleepiness, shortness of breath and severe snoring.
Is OHS a serious condition?
Obesity hypoventilation syndrome causes extreme metabolic stress on the body. While the heart and brain constantly require high levels of oxygen to work, this condition leads to hypoxic stress (low oxygen level) causing strain on the heart that can lead to hypertension, explains Dr Chandra.
Dr Adapa says, If OHS is left untreated, it can lead to pulmonary hypertension, increasing the risk of right-side heart failure.
Managing obesity hypoventilation syndrome
The first step to prevent the risk of Pickwickian syndrome is to work towards maintaining a healthy weight, says Dr Adapa.
According to Dr Chandra, individuals with high BMI should opt for lifestyle modifications to reduce weight, such as adding an exercise routine, following sleep hygiene for adequate rest, dietary control and consulting a dietician or nutritionist to help plan a healthy diet.
He further adds that taking breathing assistance with a CPAP machine will help maintain adequate oxygen levels at night. It involves wearing a mask over the nose and mouth during sleep. The mask connects to a CPAP machine, which keeps a constant track of breathing in individuals with OHS while providing consistent air pressure to increase the oxygen level in the body, helping in better sleep.
Takeaway
Obesity hypoventilation syndrome or Pickwickian syndrome is a severe complication occurring due to excessive weight and breathing-related sleep disorder. However, maintaining a healthy weight through lifestyle modifications will help to reduce the risk.
