The Cardiopulmonary Failure of Sleep-Disordered Breathing

SLIGHTLY more than 100 years following the publication of thePick-wick Papers, wherein Charles Dickens described the hypersomnolent and obese character Joe, the termpickwickian syndromewas applied to a group of patients exhibiting obesity, hypersomnolence, hypoventilation, and erythrocytosis.¹Since 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,²requiring 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 bypolysomnography³—the simultaneous recording during sleep of an electroencephalogram (to characterize sleep stage and pattern), measures of airflow (by means of