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<bold>Background:</bold> obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are highly prevalent disorders. The incidence of obesity hypoventilation syndrome (OHS) is increasing in synchrony with the obesity pandemic worldwide. In clinical practice, the consequences of three diseases combination are mainly attributed to one of them, mostly to COPD, resulting in inappropriate diagnosis and treatment. <bold>Objective:</bold> the aim of this study was to reveal the frequency of simultaneous presence of OSA, COPD and OHS among patients studied in sleep laboratory. <bold>Methods:</bold> respiratory polygraphy, post-bronchodilator spirometry, arterial blood gases were performed. <bold>Results:</bold> among 303 patients with OSA (AHI≥15/h) concomitant COPD and OHS were diagnosed in 43 patients (14.2%), 37 males and 6 females. Compared with pure OSA, subjects with three diseases were older (53.6±9.6 vs 49.4± 12.0. p<0.03), more hypoxemic (PaO2 80.5±6.3 vs 94.1±1.9, p< 0.000) and hypercapnic (PaCO2 58.6±11.2 vs 38.2±5.3, p<0.000) at daytime with deep desaturation at sleep (lowest SpO2 51.4±11.7 vs 73.0±12.1, p<000). Out of 43 subjects, 35 patients, including all 6 females, had a history of acute-on-chronic respiratory failure with admission to intensive care unit. <bold>Conclusion:</bold> more than 14% of patients with OSA have simultaneous COPD and OHS which allows to introduce the concept of the “triple disease syndrome”. This syndrome is characterized by chronic respiratory failure with a tendency to develop acute-on-chronic respiratory failure if remains undiagnosed and untreated.