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

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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 . . .