Method and apparatus for modifying delivery of a therapy in response to onset of sleep

• US 20040176809A1
• Filed: 12/15/2003
• Published: 09/09/2004
• Est. Priority Date: 06/07/2001
• Status: Active Grant

• Current Assignee: Medtronic Incorporated (Medtronic Plc)
• Original Assignee: Medtronic Incorporated (Medtronic Plc)
• Inventors: Jensen, Donald N., Mongeon, Luc R., Cho, Yong Kyun
• Granted Patent: US 7,206,635 B2
• Time in Patent Office: Days
• US Class Current: 607/14
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration
• CPC Class Codes: A61N 1/3702 Physiological parameters A61N1/365 takes precedence; evoked response A61N1/371

Abstract

A method and apparatus for providing a therapy to the patient that includes a therapy component configured to provide the therapy to the patient, sensing circuitry sensing a parameter of the patient, and a microprocessor coupled to the therapy component and the sensing circuitry to determine onset of a first state of the patient in response to the sensed physiologic parameter, and to determine whether the onset of the first state is detected for a predetermined time period.

Claims

1. An implantable medical device capable of being implanted in a patient, comprising:

a therapy component configured to provide a therapy to the patient;

sensing circuitry sensing a parameter of the patient; and

a microprocessor coupled to the therapy component and the sensing circuitry to detect onset of a first state of the patient in response to the sensed physiologic parameter, and to determine whether the onset of the first state is detected for a predetermined time period.

2. The device of claim 1, wherein delivery of the therapy is cancelled in response to the onset off the first state not being detected within the predetermined time period.

3. The device of claim 1, wherein the therapy component senses intrinsic signals of the patient and the microprocessor detects a predetermined event in response to the sensed intrinsic signals.

4. The device of claim of 3, wherein the predetermined time period corresponds to a period of time prior to detection of the predetermined event.

5. The device of claim 4, wherein the period of time is between approximately 15 and 30 minutes.

6. The device of claim 1, wherein the first predetermined time period corresponds to a period of time since the detected onset of the first state.

7. The device of claim 6, wherein the period of time is between approximately 20 and 60 minutes.

8. The device of claim 6, wherein the therapy component senses intrinsic signals of the patient and the microprocessor detects a predetermined event in response to the sensed intrinsic signals and determines whether the predetermined event is detected subsequent to the onset of the first state being detected for the first predetermined time period.

9. The device of claim 1, wherein the parameter corresponds to minute ventilation values indicative of a minute ventilation of the patient, and wherein the microprocessor generates a threshold corresponding to a transition of the patient between the first state and a second state in response to the minute ventilation values, generates a first distribution rate of a plurality of the sensed minute ventilation values and a second distribution rate of a plurality of the sensed minute ventilation values, determines the first state is sustained in response to one of the first distribution rate not being greater than the second distribution, and the first distribution rate being greater than the second distribution and not being greater than the threshold, and determines, in response to the first state being sustained, an elapsed time since the detected onset of the first state, wherein the onset of the first state is determined to be detected for the first predetermined time period in response to the elapsed time being greater than or equal to the first predetermined time period.

10. The device of claim 9, wherein the therapy component senses intrinsic signals of the patient, and wherein the microprocessor detects a predetermined event in response to the sensed intrinsic signals, and determines whether the predetermined event is detected subsequent to the onset of the first state being detected for the first predetermined time period.

11. The device of claim 9, wherein the microprocessor determines, in response to the first state not being sustained, whether a second predetermined time period has expired, and reduces the first predetermined time period in response to the second predetermined time period being expired.

12. The device of claim 11, wherein the therapy component senses intrinsic signals of the patient and wherein the microprocessor determines, in response to the first state being sustained and the elapsed time subsequently not being greater than or equal to the first predetermined time period, whether a predetermined delivery time has been reached and the second predetermined time period has expired, detects a predetermined event in response to the sensed intrinsic signals, determines, in response to the predetermined delivery time being reached and the second predetermined time period having expired, whether the predetermined event is detected, and delivers the therapy in response to the predetermined event being detected.

13. The device of claim 1, wherein the parameter corresponds to minute ventilation values indicative of a minute ventilation of the patient, and wherein the microprocessor generates a first threshold and a second threshold corresponding to a transition of the patient between the first state and a second state in response to the minute ventilation values, generates a first distribution rate of a plurality of the sensed minute ventilation values received during first time intervals of predetermined time intervals including a first current time interval m and first preceding time intervals m−

1 and a second distribution rate of a plurality of the sensed minute ventilation values received during second time intervals of the predetermined time intervals including a second time interval n and second preceding time intervals n−

1, and detects onset of the first state in response to the second distribution rate being less than the first threshold, an abrupt transition between the first state and the second state, and the second distribution rate being greater than or equal to the first distribution rate.

14. A method of providing therapy to a patient having an implantable medical device, comprising:

sensing a physiologic parameter of the patient;

detecting onset of a first state of the patient in response to the sensed parameter; and

determining whether the onset of the first state is detected for a first predetermined time period.

15. The method of claim 14, further comprising canceling the therapy in response to the onset off the first state not being detected within the first predetermined time period.

16. The method of claim 14, further comprising sensing intrinsic signals of the patient and detecting a predetermined event in response to the sensed intrinsic signals, wherein the predetermined time period corresponds to a period of time prior to detection of the predetermined event.

17. The method of claim 16, wherein the period of time is between approximately 15 and 30 minutes.

18. The method of claim 14, wherein the first predetermined time period corresponds to a period of time since the detected onset of the first state.

19. The method of claim 18, wherein the period of time is between approximately 20 and 60 minutes.

20. The method of claim 18, further comprising:

sensing intrinsic signals of the patient and detecting a predetermined event in response to the sensed intrinsic signals; and

determining whether the predetermined event is detected subsequent to the onset of the first state being detected for the first predetermined time period.

21. The method of claim 14, further comprising:

sensing minute ventilation values indicative of a minute ventilation of the patient;

generating a threshold corresponding to a transition of the patient between the first state and a second state in response to the minute ventilation values;

generating a first distribution rate of a plurality of the sensed minute ventilation values and a second distribution rate of a plurality of the sensed minute ventilation values;

determining whether the first distribution rate is greater than the second distribution;

determining whether the first distribution rate is greater than the second threshold;

determining whether the first state is sustained, the first state being determined to be sustained in response to one of the first distribution rate not being greater than the second distribution, and the first distribution rate being greater than the second distribution and not being greater than the threshold; and

determining, in response to the first state being sustained, an elapsed time since the detected onset of the first state, wherein determining whether the onset of the first state is detected for a first predetermined time period comprises determining whether the elapsed time is greater than or equal to the first predetermined time period.

22. The method of claim 21, further comprising:

sensing intrinsic signals of the patient and detecting a predetermined event in response to the sensed intrinsic signals; and

determining whether the predetermined event is detected subsequent to the onset of the first state being detected for the first predetermined time period.

23. The method of claim 14, wherein detecting onset of a first state of the patient in response to the sensed physiologic parameter comprises:

sensing minute ventilation values indicative of a minute ventilation of the patient;

generating a first threshold and a second threshold corresponding to a transition of the patient between the first state and a second state in response to the minute ventilation values;

generating a first distribution rate of a plurality of the sensed minute ventilation values received during first time intervals of predetermined time intervals including a first current time interval m and first preceding time intervals m−

1 and a second distribution rate of a plurality of the sensed minute ventilation values received during second time intervals of the predetermined time intervals including a second time interval n and second preceding time intervals n−

1; and

detecting onset of the first state in response to the second distribution rate being less than the first threshold, an abrupt transition between the first state and the second state, and the second distribution rate being greater than or equal to the first distribution rate.

24. The method of claim 21, further comprising:

determining, in response to the first state not being sustained, whether a second predetermined time period has expired; and

reducing the first predetermined time period in response to the second predetermined time period being expired.

25. The method of claim 24, further comprising:

determining, in response to the first state being sustained and the elapsed time subsequently not being greater than or equal to the first predetermined time period, whether a predetermined delivery time has been reached and the second predetermined time period has expired;

sensing intrinsic signals of the patient and detecting a predetermined event in response to the sensed intrinsic signals;

determining, in response to the predetermined delivery time being reached and the second predetermined time period having expired, whether the predetermined event is detected; and

delivering the therapy in response to the predetermined event being detected.

26. An implantable medical device capable of being implanted in a patient, comprising:

means for sensing a physiologic parameter of the patient;

means for detecting onset of a first state of the patient in response to the sensed parameter; and

means for determining whether the onset of the first state is detected for a first predetermined time period.

27. The device of claim 26, further comprising means for canceling the therapy in response to the onset off the first state not being detected within the first predetermined time period.

28. The device of claim 26, further comprising:

means for sensing intrinsic signals of the patient; and

means for detecting a predetermined event in response to the sensed intrinsic signals, wherein the predetermined time period corresponds to a period of time prior to detection of the predetermined event.

29. The device of claim 28, wherein the period of time is between approximately 15 and 30 minutes.

30. The device of claim 26, wherein the first predetermined time period corresponds to a period of time since the detected onset of the first state.

31. The device of claim 30, wherein the period of time is between approximately 20 and 60 minutes.

32. The device of claim 30, further comprising:

means for sensing intrinsic signals of the patient;

means for detecting a predetermined event in response to the sensed intrinsic signals; and

means for determining whether the predetermined event is detected subsequent to the onset of the first state being detected for the first predetermined time period.

33. The device of claim 26, further comprising:

means for sensing minute ventilation values indicative of a minute ventilation of the patient;

means for generating a threshold corresponding to a transition of the patient between the first state and a second state in response to the minute ventilation values;

means for generating a first distribution rate of a plurality of the sensed minute ventilation values and a second distribution rate of a plurality of the sensed minute ventilation values;

means for determining whether the first distribution rate is greater than the second distribution;

means for determining whether the first distribution rate is greater than the second threshold;

means for determining whether the first state is sustained, the first state being determined to be sustained in response to one of the first distribution rate not being greater than the second distribution, and the first distribution rate being greater than the second distribution and not being greater than the threshold; and

means for determining, in response to the first state being sustained, an elapsed time since the detected onset of the first state, wherein the means for determining whether the onset of the first state is detected for a first predetermined time period comprises determining whether the elapsed time is greater than or equal to the first predetermined time period.

34. The device of claim 33, further comprising:

means for sensing intrinsic signals of the patient;

means for detecting a predetermined event in response to the sensed intrinsic signals; and

means for determining whether the predetermined event is detected subsequent to the onset of the first state being detected for the first predetermined time period.

35. The device of claim 26, wherein the means for detecting onset of a first state of the patient in response to the sensed physiologic parameter comprises:

means for sensing minute ventilation values indicative of a minute ventilation of the patient;

means for generating a first threshold and a second threshold corresponding to a transition of the patient between the first state and a second state in response to the minute ventilation values;

means for generating a first distribution rate of a plurality of the sensed minute ventilation values received during first time intervals of predetermined time intervals including a first current time interval m and first preceding time intervals m−

1 and a second distribution rate of a plurality of the sensed minute ventilation values received during second time intervals of the predetermined time intervals including a second time interval n and second preceding time intervals n−

1; and

means for detecting onset of the first state in response to the second distribution rate being less than the first threshold, an abrupt transition between the first state and the second state, and the second distribution rate being greater than or equal to the first distribution rate.

36. The device of claim 33, further comprising:

means for determining, in response to the first state not being sustained, whether a second predetermined time period has expired; and

means for reducing the first predetermined time period in response to the second predetermined time period being expired.

37. The device of claim 36, further comprising:

means for determining, in response to the first state being sustained and the elapsed time subsequently not being greater than or equal to the first predetermined time period, whether a predetermined delivery time has been reached and the second predetermined time period has expired;

means for sensing intrinsic signals of the patient;

means for detecting a predetermined event in response to the sensed intrinsic signals;

means for determining, in response to the predetermined delivery time being reached and the second predetermined time period having expired, whether the predetermined event is detected; and

means for delivering the therapy in response to the predetermined event being detected.

38. A computer readable medium having computer executable instructions for performing a method comprising:

sensing a physiologic parameter of the patient;

detecting onset of a first state of the patient in response to the sensed parameter; and

determining whether the onset of the first state is detected for a first predetermined time period.

39. A computer readable medium having computer executable instructions for performing a method comprising:

sensing minute ventilation values indicative of a minute ventilation of the patient;

generating a first threshold and a second threshold corresponding to a physiologic transition of the patient between a first state and a second state in response to the minute ventilation values;

generating a first distribution rate of a plurality of the sensed minute ventilation values received during first time intervals of predetermined time intervals including a first current time interval m and first preceding time intervals m−

1 and a second distribution rate of a plurality of the sensed minute ventilation values received during second time intervals of the predetermined time intervals including a second time interval n and second preceding time intervals n−

1;

detecting onset of the second state in response to the second distribution rate being less than the first threshold, an abrupt transition between the first state and the second state, and the second distribution rate being greater than or equal to the first distribution rate; and

modifying the therapy in response to the detected onset of the second state.