Coordinated therapy for disordered breathing including baroreflex modulation

• US 20050288729A1
• 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 7,596,413 B2
• Time in Patent Office: Days
• US Class Current: 607/42
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36114 Cardiac control, e.g. by vagal stimulation stimulating the heart A61N1/362
• CPC Class Codes: A61N 1/36117 for treating hypertension

Abstract

An approach to providing disordered breathing therapy involves the use of a plurality of therapy devices to deliver a coordinated disordered breathing therapy regimen to the patient. The plurality of disordered breathing devices includes at least a therapy device that delivers an electrical stimulation therapy modulating a patient'"'"'s baroreflex response. Other therapy devices may include a cardiac electrical stimulation device, an external respiratory therapy device, and/or other therapy devices used in the treatment of disordered breathing. A therapy controller coordinates the therapies delivered by the plurality of therapy devices.

Claims

1. A disordered breathing therapy method, comprising:

delivering a plurality of therapies to treat disordered breathing, including at least an electrical stimulation therapy modulating a patient'"'"'s baroreflex response; and

coordinating delivery of the plurality of disordered breathing therapies.

2. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions.

3. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions of a pulmonary artery.

4. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions of a carotid sinus.

5. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions of an aortic arch.

6. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions of an atrial chamber.

7. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions of a ventricular chamber.

8. The method of claim 1, wherein delivering the baroreflex therapy modulating the patient'"'"'s baroreflex response comprises electrically stimulating one or more baroreceptor regions of a ligamentum arteriosum.

9. The method of claim 1, wherein delivering the baroreflex therapy comprises electrically stimulating one or more afferent nerves.

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

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

12. The method of claim 1, wherein delivering the baroreflex therapy comprises delivering the baroreflex therapy to increase respiration rate.

13. The method of claim 1, wherein delivering the plurality disordered breathing therapies comprises delivering a cardiac electrical stimulation therapy.

14. The method of claim 13, wherein delivering the cardiac electrical stimulation therapy comprises electrically stimulating one or more cardiac chambers.

15. The method of claim 13, wherein delivering the cardiac electrical stimulation therapy comprises electrically stimulating multiple sites within a cardiac chamber.

16. The method of claim 13, wherein delivering the cardiac electrical stimulation therapy comprises delivering a sub-capture threshold cardiac electrical stimulation therapy.

17. The method of claim 13, wherein delivering the cardiac electrical stimulation therapy comprises delivering a cardiac pacing therapy.

18. The method of claim 17, wherein delivering the cardiac pacing therapy comprises delivering overdrive pacing therapy.

19. The method of claim 17, wherein delivering the cardiac pacing therapy comprises delivering bi-ventricular pacing therapy.

20. The method of claim 17, wherein delivering the cardiac pacing therapy comprises delivering dual chamber pacing therapy.

21. The method of claim 1, wherein delivering the plurality of disordered breathing therapies comprises delivering an external respiration therapy.

22. The method of claim 21, wherein delivering the external respiration therapy comprises delivering a positive airway pressure therapy.

23. The method of claim 1, wherein delivering the plurality of therapies to treat disordered breathing comprises delivering the plurality of therapies to treat apnea.

24. The method of claim 1, wherein delivering the plurality of therapies to treat disordered breathing comprises delivering the plurality of therapies to treat hypopnea.

25. The method of claim 1, wherein delivering the plurality of therapies to treat disordered breathing comprises delivering the plurality of therapies to treat sleep disordered breathing.

26. The method of claim 1, wherein coordinating delivery of the plurality of disordered breathing therapies comprises shifting from one therapy to another therapy.

27. The method of claim 1, wherein coordinating delivery of the plurality of disordered breathing therapies comprises modifying at least one therapy of the plurality of therapies to enhance therapy efficacy.

28. The method of claim 1, wherein coordinating delivery of the plurality of disordered breathing therapies comprises modifying at least one therapy to reduce an impact of the plurality of disordered breathing therapies on the patient.

29. The method of claim 1, wherein coordinating delivery of the plurality of disordered breathing therapies comprises shifting from a first therapy to one or more other therapies based on patient usage of the first therapy.

30. A disordered breathing therapy system, comprising:

a plurality of therapy devices, each therapy device of the plurality of therapy devices configured to deliver a disordered breathing therapy differing from disordered breathing therapies delivered by other therapy devices of the plurality of therapy devices, at least one of the therapy devices comprising;

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

a baroreflex stimulator coupled to the baroreflex electrodes and configured to deliver an electrical stimulation therapy modifying a patient'"'"'s baroreflex response; and

a therapy controller coupled to the plurality of therapy devices, the therapy controller configured coordinate a disordered breathing therapy regimen delivered by the plurality of therapy devices.

31. The system of claim 30, wherein the baroreflex stimulator is configured to modify the baroreflex electrical stimulation therapy.

32. The system of claim 30, wherein the baroreflex stimulator is configured to modify the baroreflex electrical stimulation therapy by adjusting an amplitude of the baroreflex electrical stimulation therapy.

33. The system of claim 30, wherein the baroreflex stimulator is configured to modify the baroreflex electrical stimulation therapy by adjusting a frequency of the baroreflex electrical stimulation signal.

34. The system of claim 30, wherein the baroreflex stimulator is configured to modify the baroreflex electrical stimulation therapy by adjusting a duty cycle of the baroreflex electrical stimulation signal.

35. The system of claim 30, wherein the baroreflex stimulator is configured to initiate delivery of the baroreflex electrical stimulation therapy.

36. The system of claim 30, wherein the baroreflex stimulator is configured to terminate delivery of the baroreflex electrical stimulation therapy.

37. The system of claim 30, wherein the plurality of therapy devices comprises a cardiac therapy device configured to delivery cardiac electrical stimulation therapy to treat disordered breathing, the cardiac therapy device comprising:

one or more cardiac electrodes configured to electrically couple to a heart; and

a cardiac pulse generator coupled to the one or more cardiac electrodes and configured to deliver the cardiac electrical stimulation therapy to the heart.

38. The system of claim 37, wherein the cardiac pulse generator is configured to deliver electrical stimulation to one or more chambers of the heart.

39. The system of claim 37, wherein the cardiac pulse generator is configured to deliver electrical stimulation to one or more sites within a particular heart chamber.

40. The system of claim 37, wherein the cardiac pulse generator is configured to deliver pacing pulses to the heart.

41. The system of claim 37, wherein the cardiac pulse generator is configured to deliver sub-capture threshold electrical stimulation to the heart.

42. The system of claim 30, wherein the plurality of therapy devices comprises a respiratory therapy device configured to delivery respiratory therapy to treat disordered breathing.

43. The system of claim 42, wherein the respiratory therapy device comprises a positive airway pressure device.

44. The system of claim 30, wherein the therapy controller is configured to reduce at least a first disordered breathing therapy delivered to the patient and increase at least a second disordered breathing therapy delivered to the patient to coordinate delivery of the disordered breathing therapy regimen.

45. The system of claim 30, wherein the therapy controller is configured to terminate a first disordered breathing therapy and initiate a second disordered breathing therapy to coordinate delivery of the disordered breathing therapy regimen.

46. The system of claim 30, further comprising a sensing system coupled to the therapy controller and configured to sense one or more conditions affecting the patient, wherein the therapy controller is configured to modify at least one disordered breathing therapy based on the sensed conditions.

47. The system of claim 30, further comprising:

a sensing system configured to sense one or more conditions indicative of disordered breathing;

a disordered breathing detection circuitry configured to detect disordered breathing based on the sensed conditions, wherein the therapy controller is configured to modify at least one disordered breathing therapy based on the detection of disordered breathing.

48. The system of claim 30, further comprising:

a sensing system configured to sense one or more conditions predictive of disordered breathing;

a disordered breathing detection circuitry configured to predict disordered breathing based on the sensed conditions, wherein the therapy controller is configured to modify at least one disordered breathing therapy based on the prediction of disordered breathing.

49. The system of claim 30, further comprising:

a sensing system configured to sense one or more conditions associated with sleep;

a sleep detector configured to detect sleep based on the sensed conditions, wherein the therapy controller is configured to modify at least one disordered breathing therapy based on the detection of sleep.

50. The system of claim 30, further comprising a sensing system configured to sense one or more conditions associated with therapy efficacy, wherein the therapy controller is configured to evaluate the sensed conditions and modify the disordered breathing therapy regimen to adjust therapy efficacy.

51. The system of claim 30, further comprising a sensing system configured to sense one or more conditions associated with an impact of the therapy on the patient, wherein the therapy controller is configured to evaluate the sensed conditions and modify the disordered breathing therapy regimen to adjust the impact of the therapy on the patient.

52. The system of claim 30, wherein the therapy controller is configured to modify the disordered breathing therapy regimen to increase a useful life of at least one therapy device.

53. The system of claim 30, wherein the therapy controller is configured to coordinate the disordered breathing therapy regimen based on patient usage of one or more particular disordered breathing therapies.

54. A disordered breathing therapy system, comprising:

means for delivering a plurality of therapies to treat disordered breathing, including at least an electrical stimulation therapy modulating a patient'"'"'s baroreflex response; and

means for coordinating delivery of the plurality of disordered breathing therapies.

55. The system of claim 54, further comprising means for electrically stimulating one or more baroreceptor regions.

56. The system of claim 54, further comprising means for delivering a cardiac electrical stimulation therapy.

57. The system of claim 54, further comprising means for delivering an external respiration therapy.

58. The system of claim 54, further comprising means for shifting from one therapy to another therapy.

59. The system of claim 54, further comprising modifying at least one therapy of the plurality of therapies to enhance therapy efficacy.

60. The system of claim 54, means for shifting from a particular disordered breathing therapy to one or more other disordered breathing therapies based on patient usage of the particular disordered breathing therapy.