To the Editor.—
The recent clinical note by Spira and Scheinberg (Arch Neurol 34:513-514, 1977) in which they state that Pickwickian patients are not sleep-deprived but have a syndrome caused by hypoventilation and hypercapnia perpetuates conflicting and ambiguous terminology used for the sleep-disordered, obese, "Pickwickian" group of patients. Pickwickian syndrome should not be placed in contradistinction to other sleep-deprivation syndromes on the basis of a different etiology. The etiology of the so-called Pickwickian syndrome is, simply stated, unknown, and my experience, as well as that of others, suggests that upper airway obstruction and resulting sleep deprivation does indeed play a pathogenetic role.1-7The legitimate clinical entity is derived from the report by Burwell et al8 of a case reminiscent of an adolescent boy in Dicken's Pickwick Papers with obesity and somnolence, but the syndrome includes cyanosis, pulmonary hypertension, alveolar hypoventilation, and polycythemia. Pickwickian syndrome in the less strict sense
Kuban K. Recurrent Hypersomnia Secondary to Sleep Apnea. Arch Neurol. 1978;35(11):772. doi:10.1001/archneur.1978.00500350076019
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