Role of polysomnography in parameter adjusment and ventilation monitoring

The primary objective of this review is to evaluate the role of polysomnography in the adjustment of ventilatory parameters and the monitoring of non‑invasive ventilation in patients with chronic hypercapnic respiratory failure. Polysomnography is examined because daytime assessments and simplified nocturnal monitoring often fail to capture sleep‑dependent respiratory events, patient-ventilator asynchrony and interface‑related complications. However, routine polysomnography both for initiation and re-titrating/monitoring during follow up is not feasible in our daily practice. The reviewed evidence from observational studies and randomized trials demonstrate that polysomnographic titration can reduce patient-ventilator asynchrony and improve sleep quality and adherence, particularly in neuromuscular diseases and complex cases. In contrast, in stable patients with chronic obstructive pulmonary disease or obesity hypoventilation syndrome, simplified or automated titration strategies yield comparable outcomes. The available data support a selective, tiered use of polysomnography, reserving it for complex or refractory situations rather than routine NIV management.