Kuban's letter focuses on the problem of nosologic semantics in sleep disorders. We agree that the true pathogenesis of hypersomnia in "Pickwickian syndrome" is not understood in most instances and would also agree that there are many obese patients with true sleep-deprivation symptoms. We do not agree that all Pickwickians are sleep deprived because of airway obstruction; we are aware of only one clearly defined and well-studied case in the literature that supports this concept.1 This same article mentions another case in which true sleep deprivation could not be proved.We believe that the term "Pickwickian syndrome" should be applied to obese, hypercapnic, cyanotic individuals, often with right-sided heart failure and polycythemia, because there clearly is a different mechanism for the hypersomnia in these patients.
Spira H, Scheinberg P. Recurrent Hypersomnia Secondary to Sleep Apnea-Reply. Arch Neurol. 1978;35(11):772–773. doi:10.1001/archneur.1978.00500350076020
Customize your JAMA Network experience by selecting one or more topics from the list below.