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February 21, 1986

The Cardiopulmonary Failure of Sleep-Disordered Breathing

Author Affiliations

From the Medical Intensive Care Unit, Section of Pulmonary and Critical Care Medicine, Department of Medicine, the University of Chicago.

JAMA. 1986;255(7):930-933. doi:10.1001/jama.1986.03370070084031

SLIGHTLY more than 100 years following the publication of the Pick-wick Papers, wherein Charles Dickens described the hypersomnolent and obese character Joe, the term pickwickian syndrome was applied to a group of patients exhibiting obesity, hypersomnolence, hypoventilation, and erythrocytosis.1 Since this descriptive report, a large amount of information regarding the clinical spectrum, pathophysiology, and treatment of various forms of sleep-induced breathing disorders has been generated,2 requiring increased clinical awareness of methods of diagnosis and treatment. Sleep-induced breathing disorders include the following: sleep apnea syndromes, such as central, obstructive, and mixed apnea; primary alveolar hypoventilation; periodic or irregular breathing patterns; and nocturnal hypoxemia in chronic obstructive pulmonary disease (COPD) or neuromuscular disorders (NMD).

Apneas are defined as the complete cessation of ventilation and may be analyzed by polysomnography3—the simultaneous recording during sleep of an electroencephalogram (to characterize sleep stage and pattern), measures of airflow (by means of