Pickwickian syndrome

Early morning headaches and daytime somnolence are a result of his nocturnal hypoventilation, hypercapnia, and intermittent episodes of sleep apnoea and wakening. Patients classically have episodes of snoring followed by episodes of upper airway obstruction and apnoea. They should be treated as with any patient with COPD but should be encouraged to lose weight and may benefit from non-invasive ventilation at night which maintains the patency of the upper airway and thus oxygenation, whilst avoiding the apnoea and hypercapnia.