Hypopnea

Hypopnea (mostly spelled hypopnœa) is a medical term for a disorder which involves episodes of overly shallow breathing or an abnormally low respiratory rate. Hypopnea is less severe than apnea (which is the complete cessation of breathing). It may likewise result in a decreased amount of air movement into the lungs and can cause oxygen levels in the blood to drop. It more commonly is due to partial obstruction of the upper airway.

During sleep, hypopnea is classed as a sleep disorder. With moderate to severe hypopnea, sleep is disturbed such that patients may get a full night's sleep but still not feel rested because they did not get the right kind of sleep. The disruption in breathing causes a drop in blood oxygen level, which may in turn disrupt the stages of sleep.

Daytime hypopnea events are mostly limited to those with severely compromised respiratory muscles, as occurs in certain neuromuscular diseases. Daytime hypopnea can also cause a drop in blood oxygen level.

Etymology
Hypopnea comes from the Greek roots hypo- (meaning low, under, beneath, down, below normal) and pnoe (meaning breathing). Literally it means underbreathing.

General information
In the context of diagnosis and treatment of sleep disorders, a hypopnea event is not considered to be clinically significant unless there is a 30% (or greater) reduction in flow lasting for 10 seconds or longer and an associated 4% (or greater) desaturation in the person's O2 levels, or if it results in arousal or fragmentation of sleep.

The direct consequence of hypopnea (as well as apnea) is that the CO2 in the blood increases and the oxygen level in the patient’s blood decrease is proportionate to the severity of the airway obstruction. This disruptive pattern of breathing generates disruptive sleep patterns, the consequences of which being that those individuals may exhibit increased fatiguability, lethargy, decreased ability to concentrate, increased irritability, and morning headaches. Basically, those individuals are extremely tired due to their inability to get a good night’s sleep.

Hypopneas can be either central (i.e., as part of a waxing and waning in breathing effort) or obstructive in origin. During an obstructive hypopnea, in comparison to an obstructive apnea, the airway is only partially closed. However, this closure is still enough to cause a physiological effect (i.e., an oxygen desaturation and/or an increase in breathing effort terminating in arousal).

A hypopnea index (HI) can be calculated by dividing the number of hypopnea events during the sleep period by the number of hours of sleep. The apnea-hypopnea index (AHI) is an index of severity that combines apneas and hypopneas. Combining them both gives an overall severity of sleep apnea including sleep disruptions and desaturations (a low level of oxygen in the blood). The apnea-hypopnea index, like the apnea index and hypopnea index, is calculated by dividing the number of apneas and hypopneas by the number of hours of sleep. Another index that is used to measure sleep apnea is the respiratory disturbance index (RDI). The respiratory disturbance index is similar to the apnea-hypopnea index; however, it also includes respiratory events that do not technically meet the definitions of apneas or hypopneas, but do disrupt sleep.

Causes
Among the causes of hypopnea are:


 * anatomical defects such as nasal septum deformation or congenital narrowness of nasal meatus and the gullet
 * acute tonsillitis and/or adenoiditis
 * obesity or being overweight
 * neuromuscular disease or any condition that entails weakened respiratory muscles
 * use of sedatives (sleeping pills, etc.)
 * alcohol abuse
 * smoking
 * aging;
 * others, most of which are also typical causes of airway obstruction, snoring and sleep apnea.

Symptoms
The most common hypopnea symptom is excessive sleepiness, which results from constant sleep interruption. People with hypopnea due to airflow obstruction often have loud, heavy snoring that is interrupted with choking sounds or loud snorts followed by periods of silence, because not enough air can flow into the lungs through the mouth and nose. The periods of silence can last 20 seconds or longer and can happen many times each hour, resulting in poor sleep and reduced levels of oxygen in the blood.

Other symptoms of hypopnea may include depression, forgetfulness, mood or behavior changes, trouble concentrating, loss of energy, nervousness, and morning headaches. Not all people with hypopnea experience all of these symptoms and not everyone who has these symptoms has hypopnea.

Consequences
Hypopnea is a disorder that may result in excessive daytime sleepiness and compromised quality of life, including traffic accidents, diminished productivity in the work place and emotional problems.

Cardiovascular consequences of hypopnea may include myocardial infarction, stroke, psychiatric problems, impotence, cognitive dysfunction, hypertension, coronary heart disease, and memory loss.

Treatment
One treatment for hypopnea is continuous positive airway pressure (CPAP). CPAP is a treatment in which the patient wears a mask over the nose and/or mouth. An air blower forces air through the upper airway. The air pressure is adjusted so that it is just enough to maintain the oxygen saturation levels in the blood. For people with neuromuscular disorders, the most common treatment is the use of (BPAP or BIPAP) or other non-invasive ventilation.

Another treatment is a custom fitted oral appliance. The American Academy of Sleep Medicine's protocol for obstructive sleep apnea (OSA) recommends oral appliances for those who prefer them to CPAP and have mild to moderate sleep apnea or those that do not respond to/cannot wear a CPAP. Severe cases of OSA may be treated with an oral appliance if the patient has had a trial run with a CPAP. Oral Appliances should be custom made by a dentist with training in dental sleep medicine.

Mild hypopnea can often be treated by losing weight or by avoiding sleeping on one's back. Also quitting smoking, and avoiding alcohol, sedatives and hypnotics (soporifics) before sleep can be quite effective.

Surgery is generally a last resort in hypopnea treatment, but is a site-specific option for the upper airway. Depending on the cause of obstruction, surgery may focus on the soft palate, the uvula, tonsils, adenoids or the tongue. There are also more complex surgeries that are performed with the adjustment of other bone structures - the mouth, nose and facial bones.