Fatty Infiltration of Respiratory Muscles in the Pickwickian Syndrome

THE associated features of marked obesity, somnambulance, muscular twitching, cyanosis, secondary polycythemia and hypertrophy and failure of the right ventricle have been described1 2 3 4 5 and termed the Pickwickian syndrome.6 It has been observed that increase of abdominal girth by any means decreases expiratory reserve.1 It has also been proposed that obesity, through some unknown mechanism, leads to shallow respiration, and the combination of these two results in alveolar hypoventilation.7 8 9 10 The mechanism for decreased respiration has not been delineated. Burwell et al.6 suggested the possibility of fat infiltration of respiratory muscles, but there was seemingly no evidence to support this. Relatively few . . .