The Pickwick Papers and Sleep Apnea

Joe the fat boy from the Pickwick Papers

Joe the “fat boy” from the Pickwick Papers, Illustration by Kyd (Joseph Clayton Clarke)

Obesity Hypoventilation Syndrome (OHS), a condition related to sleep apnea, was first called Pickwickian Syndrome. It’s named after The Pickwick Papers by Charles Dickens because the novel features a character that has all the classic symptoms of the condition.

The object that presented itself to the eyes of the astonished clerk, was a boy–a wonderfully fat boy–habited as a serving lad, standing upright on the mat, with his eyes closed as if in sleep.

Joe is constantly hungry, very red in the face and is always falling asleep in the middle of tasks.

“Sleep!” said the old gentleman, ‘he’s always asleep. Goes on errands fast asleep, and snores as he waits at table.”

“How very odd!” said Mr. Pickwick.

“Ah! odd indeed,” returned the old gentleman; “I’m proud of that boy–wouldn’t part with him on any account–he’s a natural curiosity!”

OHS occurs when severely overweight people don’t breathe rapidly enough or deeply enough. The lack of proper breathing leads to the oxygen levels in their blood being low and the carbon dioxide levels being too high. Some people with OHS also develop sleep apnea. People with sleep apnea stop breathing for short times while they’re sleeping. The disruptive pattern can occur many times during a single night and can put a strain on the heart.

People with OHS and sleep apnea can be very drowsy during the day and fall asleep during inappropriate times. Sleep apnea makes people tired because of lack of a good night’s sleep. OHS causes sleepiness because of the high levels of carbon dioxide in the blood.

In 1956 a poker-playing businessman developed similar symptoms to Joe of The Pickwick Papers. People studying his condition named it “Pickwickian Syndrome” because in describing Joe, Dickens had perfectly described the main symptoms of the condition. Here’s a quote from the original study:

Finally an experience which indicated the severity of his disability led him to seek hospital care. The patient was accustomed to playing poker once a week and on this crucial occasion he was dealt a hand of three aces and two kings. According to Hoyle this hand is called a “full house.” Because he had dropped off to sleep he failed to take advantage of this opportunity. [Italics original]. A few days later he entered…hospital.

Dickens would no doubt have appreciated the humor in the medical report.

It’s now more common to use the term OHS to refer to this condition. If you think that you may have OHS please speak to your doctor immediately as this can be a serious health issue.

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