The cases of obesity has been increasing with rapid pace, especially of class III obesity. Obesity induced hypoventilation syndrome (OHS) or Pickwickian syndrome is as a combination of obesity and hypercapnia in absence of other known causes of hypoventilation. Clinically, patients are presented with symptoms like excessive daytime sleepiness, fatigue, morning headaches because of complex interactions among impaired respiratory mechanics, abnormal central ventilatory control, possible sleep-disordered breathing, and neuro hormonal deficiencies.


A 48 year old obese male was presented with chief complaints of difficulty in breathing, breathlessness on exertion and recurrent sleeping episodes even while sitting or standing with snores. Diagnostic test such as ABG, ECG and sleep study were recommended. Arrhythmia with elevated CO2 level & decreased level of O2 indicating hypercapnia with hypoxemia, along with sleep apnea, and class III obesity, confirmed OHS.


Patient was put on regular treatment with nocturnal air pressure using CPAP and regular measurement of ABG. After improvement in levels of ABG and ECG, discharge was planned with advice of healthy life style modification, regular exercise for reduction of weight, continuous use of CPAP as and when required and regular review in OPD after every fifteen days.


Respiratory distress are generally misdiagnosed with condition like COPD and asthma which may lead to worsening of the condition. Adherence to positive air pressure oxygen therapy to correct the hypercapnia and sleep apnea, weight loss and regular exercise with life style modification are the approaches for the management of OHS.