Adaptive baroreflex stimulation therapy for disordered breathing

• US 20050288728A1
• Filed: 06/08/2004
• Published: 12/29/2005
• Est. Priority Date: 06/08/2004
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lee, Kent, Libbus, Imad, Ni, Quan
• Granted Patent: US 7,747,323 B2
• Time in Patent Office: Days
• US Class Current: 607/42
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/3614 based on impedance measurement

Abstract

An approach to providing disordered breathing therapy includes delivering electrical stimulation therapy modifying a patient'"'"'s baroreflex response. Disordered breathing therapy may be delivered in response to prediction or detection of disordered breathing events. Various conditions affecting the patient may be evaluated and the baroreflex therapy modified. The therapy may be modified to improve therapy efficacy, to reduce an impact to the patient and/or to mitigate therapy interactions.

Claims

1. A method of delivering disordered breathing therapy to a patient, comprising:

delivering electrical stimulation therapy modifying a patient'"'"'s baroreflex response to treat disordered breathing;

sensing one or more conditions affecting the patient; and

adapting the electrical stimulation therapy based on the one or more conditions.

2. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions.

3. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions of a pulmonary artery.

4. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions of a carotid sinus.

5. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions of an aortic arch.

6. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions of an atrial chamber.

7. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions of a ventricular chamber.

8. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more baroreceptor regions of a ligamentum arteriosum.

9. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more cardiac fat pads.

10. The method of claim 1, wherein delivering the electrical stimulation therapy comprises electrically stimulating one or more afferent nerves.

11. The method of claim 1, wherein delivering the electrical stimulation therapy comprises delivering the electrical stimulation therapy to increase tidal volume.

12. The method of claim 1, wherein delivering the electrical stimulation therapy that modifies the baroreflex response comprises delivering the electrical stimulation therapy to increase respiration rate.

13. The method of claim 1, wherein sensing the one or more conditions comprises sensing one or more physiological conditions.

14. The method of claim 1, wherein sensing the one or more conditions comprises sensing a cardiac system condition.

15. The method of claim 1, wherein sensing the one or more conditions comprises sensing a respiratory system condition.

16. The method of claim 1, wherein sensing the one or more conditions comprises sensing a muscle system condition.

17. The method of claim 1, wherein sensing the one or more conditions comprises sensing a nervous system condition.

18. The method of claim 1, wherein sensing the one or more conditions comprises sensing non-physiological conditions.

19. The method of claim 1, wherein sensing the one or more conditions comprises sensing an environmental condition.

20. The method of claim 1, wherein sensing the one or more conditions comprises sensing a contextual condition.

21. The method of claim 1, further comprising detecting the disordered breathing, wherein delivering the electrical stimulation therapy modifying the patient'"'"'s baroreflex response to treat the disordered breathing comprises delivering the electrical stimulation therapy modifying the patient'"'"'s baroreflex response to mitigate the detected disordered breathing.

22. The method of claim 21, wherein detecting the disordered breathing comprises:

determining respiration patterns; and

detecting the disordered breathing based on the respiration patterns.

23. The method of claim 21, wherein detecting the disordered breathing comprises:

comparing a respiration volume to a threshold value; and

detecting the disordered breathing based on the comparison.

24. The method of claim 1, wherein adapting the electrical stimulation therapy comprises adjusting one or more characteristics of the electrical stimulation.

25. The method of claim 24, wherein adjusting the one or more characteristics of the electrical stimulation comprises adjusting an electrical stimulation amplitude.

26. The method of claim 24, wherein adjusting the one or more characteristics of the electrical stimulation comprises adjusting a frequency of the electrical stimulation.

27. The method of claim 24, wherein adjusting the one or more characteristics of the electrical stimulation comprises adjusting a duty cycle of the electrical stimulation.

28. The method of claim 24, wherein adjusting the one or more characteristics of the electrical stimulation comprises adjusting a burst pattern of the electrical stimulation.

29. The method of claim 1, wherein adapting the electrical stimulation therapy comprises:

evaluating therapy efficacy; and

adapting the electrical stimulation therapy to adjust therapy efficacy.

30. The method of claim 1, wherein adapting the electrical stimulation therapy comprises:

evaluating an impact of the electrical stimulation therapy to the patient; and

adapting the electrical stimulation therapy to adjust an impact to the patient.

31. The method of claim 1, wherein adapting the electrical stimulation therapy comprises adapting the electrical stimulation therapy to with respect to a blood pressure limit.

32. The method of claim 1, wherein adapting the electrical stimulation therapy adapting the therapy to adjust therapy interactions.

33. The method of claim 1, wherein adapting the electrical stimulation therapy comprises withholding the electrical stimulation therapy.

34. A method of providing disordered breathing therapy to a patient, comprising:

predicting disordered breathing in a patient; and

delivering a preventative therapy modifying a baroreflex response to treat the predicted disordered breathing.

35. The method of claim 34, further comprising:

detecting a disordered breathing event; and

adjusting the preventative therapy based on the detection of the disordered breathing event.

36. The method of claim 34, wherein adjusting the therapy comprises terminating the therapy.

37. A disordered breathing therapy system, comprising:

one or more electrodes configured to deliver a baroreflex stimulation signal;

a sensing system configured to sense one or more conditions affecting a patient; and

a pulse generator coupled to the one or more electrodes and to the sensing system, the pulse generator configured to control delivery of electrical stimulation therapy using the one or more electrodes, the electrical stimulation therapy modifying a patient'"'"'s baroreflex response to treat disordered breathing, the pulse generator further configured to evaluate the one or more conditions affecting the patient and to adapt the electrical stimulation therapy based on the one or more conditions.

38. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more baroreceptor regions of a pulmonary artery.

39. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more baroreceptor regions of a carotid sinus.

40. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more baroreceptor regions of an aortic arch.

41. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more baroreceptor regions of an atrial chamber.

42. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more baroreceptor regions of a ventricular chamber.

43. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more baroreceptor regions of a ligamentum arteriosum.

44. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more cardiac fat pads.

45. The system of claim 37, wherein the one or more electrodes are configured to electrically couple to one or more afferent nerves.

46. The system of claim 37, wherein the electrical stimulation therapy modifies a patient'"'"'s baroreflex response to increase tidal volume.

47. The system of claim 37, wherein the electrical stimulation therapy modifies a patient'"'"'s baroreflex response to increase respiration rate.

48. The system of claim 37, wherein the sensing system is configured to sense one or more physiological conditions.

49. The system of claim 37, wherein the sensing system is configured to sense non-physiological conditions.

50. The system of claim 37, further comprising a disordered breathing detector coupled to the sensing system and the pulse generator, the disordered breathing detector configured to detect disordered breathing using the one or more sensed conditions, wherein the pulse generator is configured to control delivery of the electrical stimulation therapy modifying the patient'"'"'s baroreflex response to treat the detected disordered breathing.

51. The system of claim 50, wherein:

the sensing system comprises a respiration sensor configured to sense a physiological condition modulated by respiration cycles; and

the disordered breathing detector in configured to determine respiration cycle patterns and detect the disordered breathing based on the respiration cycle patterns.

52. The system of claim 37, further comprising a disordered breathing predictor coupled to the sensing system and the pulse generator, the disordered breathing predictor configured to predict disordered breathing using the one or more sensed conditions, wherein the pulse generator is configured to deliver the electrical stimulation therapy modifying the patient'"'"'s baroreflex response to treat the predicted disordered breathing.

53. The system of claim 52, wherein the disordered breathing predictor is configured to evaluate one or more precursor conditions of disordered breathing and to predict the disordered breathing based on the assessment of the one or more precursor conditions, the one or more precursor conditions associated with an imminent onset of disordered breathing.

54. The system of claim 52, wherein the disordered breathing predictor is configured to evaluate one or more conditions predisposing the patient to disordered breathing and predict the disordered breathing based on the assessment of the one or more predisposing conditions.

55. The system of claim 37, wherein the pulse generator is configured to adjust one or more characteristics of the baroreflex stimulation signal.

56. The system of claim 37, wherein the pulse generator is configured to evaluate therapy efficacy and to adapt the electrical stimulation therapy to adjust the therapy efficacy.

57. The system of claim 37, wherein the pulse generator is configured to evaluate an impact of the therapy on the patient and to adapt the electrical stimulation therapy to adjust the impact to the patient.

58. The system of claim 37, wherein the pulse generator is configured to adapt the electrical stimulation therapy with respect to a blood pressure limit.

59. The system of claim 37, wherein the pulse generator is configured to adapt the electrical stimulation therapy to modify therapy interactions.

60. A system for treating disordered breathing, comprising:

means for delivering electrical stimulation therapy modifying a patient'"'"'s baroreflex response to treat disordered breathing;

means for sensing one or more conditions affecting the patient; and

means for adapting the electrical stimulation therapy based on the one or more conditions.

61. The system of claim 60, further comprising:

means for detecting disordered breathing based on the one or more conditions; and

means for adapting the electrical stimulation therapy to treat the detected disordered breathing.

62. The system of claim 60, further comprising:

means for predicting disordered breathing based on the one or more conditions; and

means for adapting the electrical stimulation therapy to treat the predicted disordered breathing.

63. The system of claim 60, further comprising;

means for evaluating therapy efficacy using the one or more conditions; and

means for adapting the electrical stimulation therapy to adjust therapy efficacy.

64. The system of claim 60, further comprising:

means for evaluating an impact of the electrical stimulation therapy on the patient; and

means for adapting the electrical stimulation therapy to adjust the impact on the patient.