Association between obesity and hypersomnolence has long been recognized. We know of Joe, the fat boy, from the work of Charles Dickens, The Pickwick Papers, who was markedly obese and tended to fall asleep uncontrollably during the day. The understanding on obesity hypoventilation syndrome has increased since Auchincloss first described the syndrome in 1955 eventually being known as Pickwickian syndrome. In 1981 Guilleminault described how severe kyphoscoliosis resulted in alterations in sleep states, coining the term Quasimodo syndrome. Fast forward to present, these syndromes collide, we have a new face nobody has seen before, severe obesity, kyphoscoliosis and obstructive sleep apnea all occurring in a single patient. Here we will present a preternatural mix of severe obesity, severe kyphoscoliosis and severe obstructive sleep apnea. We have a ménage a trois. A Threesome so to speak of three distinct disease entities overlapping to cause profound pathologic alterations.