Pickwickian Syndrome
(a.k.a. Obesity-Hypoventilation Syndrome)
A deputy received a call from dispatch regarding a male that was found non-responsive at his residence.
Arriving at the residence, EMS, who had responded to the 911 call, stated that the subject was a 32 year-old male with morbid obesity. They also stated that according to his wife he had gained approximately 70 pounds in the past four months.
Inspection of the body revealed a morbidly obese male in bed covered by a sheet. Examination of the body showed no signs of trama or foul play - lividity was appropriate for position the body was found - there was no rigor - the body was warm to the touch.
According to the subject's wife, they had gone to bed at around 10:30pm lastnight. She stated that the subject snored very loudly everynight and would sometimes stop breathing and then gasp for a breath. She many times would leave the room and sleep in another bedroom as she was not able to sleep because of the noise from his snoring. She had left the bedroom around 2:30am and went into the living room to sleep. She awoke at 6:00am, went in to the bedroom to get ready for work. She noticed he was not snoring so went over to the bed to wake him. He was unresponsive to her when she asked him if he was getting up for work. She stated that she then realized he was not breathing and called 911.
The body was transported to the morgue for further examination by the Forensic Pathologist. When a weight was taken at the morgue, the subject weighed 411 lbs. After Forensic examination, the diagnosis as to the cause of death was Pickwickian Syndrome - also known as Obesity-Hypoventilation Syndrome.
Pickwickian Syndrome is caused by extreme obesity. This syndrome relates to the breathing abilities of the patient. Symptoms include sleep apnea and shortness of breath. In severe cases the lack of oxygen taken in will cause a bluish tint to the skin. It is named after a character in Charles Dickens novel "The Pickwick Papers" because of one of the main characters who has these symptoms.
Sleep apnea is a sleep disorder characterized by temporary, recurrent interruptions of breathing (respiration) during sleep. Symptoms of this disorder include periodic wakefulness during the night, excessive sleepiness during the day, and loud snoring during sleep. People with this disorder are frequently overweight. Diagnosis and treatment of sleep apnea can avoid serious medical problems that may arise as a consequence of oxygen deprivation in untreated individuals. Sleep apnea occurs in three different forms: obstructive, central, and mixed.
An individual's rate of respiration is regulated by group of nerve cells in the brain that control the rhythm of breathing in response to changing oxygen levels in the blood (respiratory drive). In some apneas, the respiratory drive is abnormal. Obstructive sleep apnea (upper airway apnea), the most common form of sleep apnea, results from the blockage of the respiratory passages during sleep. Affected individuals may struggle to breathe and experience increased respiratory effort. Respiratory drive is unaffected in people with this form of sleep apnea but the blockage prevents them from breathing normally. Obstructive apnea is more likely than central apnea to be associated with snorting and arousal from sleep.
In the rare central sleep apnea, the brain does not send adequate signals to the diaphragm and lungs during sleep, resulting in low respiratory drive. In this form of sleep apnea, breathing stops and does not resume until the oxygen-deprived brain finally sends impulses to the diaphragm and lungs. In infants, central sleep apnea is defined as lasting 20 seconds or more.
Mixed sleep apnea is a combination of improper brain signals and obstruction of the respiratory passages. In some cases, sleep apnea is referred to as "Pickwickian Syndrome." In these cases, obstructive apnea is combined with obesity and an abnormally short neck. Infantile sleep apnea affects children less than one year old, and its cause is unknown.