Causal relationship between Pickwick’s syndrome and obstructive sleep apnea
Another cause of Pickwick’s syndrome has been identified – obstructive sleep apnea syndrome .
In general, these two conditions are very related. On the one hand, patients with sleep apnea often develop Pickwick’s syndrome, on the other hand, in patients with this syndrome, the prevalence of obstructive sleep apnea is 90%.
Patients with Pickwick’s syndrome are overweight, have severe respiratory failure, and suffer from daytime sleepiness. The cause of such disorders is chronic alveolar hypoventilation , which occurs against the background of severe obesity. Excessive body weight in patients with Pickwick’s syndrome leads to an increase in intra-abdominal pressure, restriction of movements of the diaphragm and lungs, which leads to a violation of gas exchange in them. In the prone position, fat deposits further compress the diaphragm and make it difficult to breathe. Oxygen deficiency affects the functioning of brain cells in the first place. During the day, patients with Pickwick’s syndrome are lethargic and drowsy.
Sleep apnea episodes are very characteristic of Pickwick’s syndrome. Obstructive sleep apnea was originally described in patients with Pickwick’s syndrome, so the conditions have become associated with each other and, ultimately, aggravate each other.
The fact is that Pickwick’s syndrome is characterized by the presence of severe abdominal obesity and fat deposition in the neck, the progression of which leads to a narrowing of the airways at the level of the pharynx and the progression of sleep apnea syndrome. Sleep disorders are accompanied by episodes of hypoxemia, so the secretion of hormones changes. This applies to the secretion of growth hormone, insulin, testosterone and catecholamines. The secretion of growth hormone, which regulates the balance between fat and muscle mass in an adult, decreases, which contributes to the accumulation of adipose tissue. Thus, obesity aggravates the course of obstructive sleep apnea, an increase in hypoxia, and also exacerbates the lack of somatotropic hormone. A vicious cycle is created, which is almost impossible to break without the right treatment for sleep apnea.
The high mortality rate in Pickwick’s syndrome is associated with cessation of breathing during sleep and pathological changes in the heart and lungs. Without adequate treatment, mortality reaches 70%, so early detection of obstructive sleep apnea syndrome is of great importance for urgent therapy aimed at eliminating respiratory disorders, hypoxia and associated metabolic and hormonal disorders.
It has been noticed that after CPAP therapy, there is a tendency to restore the production of growth hormone and somatomedin , which is released from the liver under the influence of growth hormone and is involved in the metabolism of fats and carbohydrates. The ongoing CPAP therapy slows down the progression of respiratory and heart failure in patients with Pickwick’s syndrome, significantly reduces the risk of cardiovascular complications, primarily myocardial infarction, stroke and sudden death.
The effectiveness of the treatment of breathing disorders during sleep in Pickwick’s syndrome depends on the initial severity of the disease, the frequency and duration of the procedures. Given the severity of the condition of patients with Pickwick’s syndrome, it is optimal to conduct CPAP therapy every night during the entire sleep. It will also be useful to use the device for 5 hours a night, but at least 5 times a week. It should be noted that after the termination of CPAP therapy, the aftereffect remains for several more days , but with its complete cancellation, a relapse is noted.