Two cases of Pickwick syndrome are reported.
Case 1) A 14-year-old man, weighting 106 kg, was admitted to the hospital with complaints of daytime sleepiness and dyspnea. Pa02 and PaCO2 in day time were 41.0 Torr and 80.6 Torr respectively, and monitoring records of oxygen saturation showed periodic hypopnea and hemoglobin desaturation at night. Since the site of upper airway obstruction to cause respiratory compromise was suspected to be the pharyngeal isthmus, uvulopalatopharyngoplasty (UPPP) was performed. His post-operative recovery was good and speedy.
Case2 ) A 57-year-old woman with complaints of sleep apnea and obesity came to our clinic. A markedly high PaCO2 tension (78-5 Torr) and low Pa02 tension (29.7 Torr) was measured during spontaneous breathing without any sign of dyspnea. We performed a polysomnographic study. The esophageal pressure and the mesopharyngeal pressure was 40 cm H20 (mean) and 10 cm H20, respectively. This indicated that the site of airway obstruction is around the base of the tongue, which supports the indication of midline partial gossectomy. However she refused the operation because of no subjective dyspnea. Over the following a year course was complicated with congestion of the liver and disseminated intravasucular coagulation and eventually the patient died. Chronic course of Pickwick syndromis not well known, but this case may indicate that persistent hypercapnea will lead to be insensitive to hypercapnea.
