The Need for Titration With Polysomnography of Noninvasive Positive Pressure Ventilation in a Patient With Hypoventilation Syndrome With Kyphoscoliosis

Attended noninvasive positive airway pressure (PAP) with polysomnography (PSG) is recommended for determining the level of ventilatory support and bilevel PAP required for patients with chronic alveolar hypoventilation syndromes. We present a case of a 24-year-old male with kyphoscoliosis who presented with dyspnea. The patient was diagnosed with chronic alveolar hypoventilation and had bilevel PAP titrated by referring to tidal volume and arterial gas analysis during the day. After further titration with PSG there was stable ventilation during non-rapid eye movement sleep but unstable on entering rapid eye movement sleep.