DETECTION OF APNEAE AND HYPOPNEAE IN AN ACTIVE IMPLANTABLE MEDICAL DEVICE

• US 20070156059A1
• Filed: 07/05/2006
• Published: 07/05/2007
• Est. Priority Date: 07/05/2005
• Status: Active Grant

• Current Assignee: Sorin CRM SAS (MicroPort Scientific Corp.)
• Original Assignee: Ela Medical SAS (MicroPort Scientific Corp.)
• Inventors: Vincent, Elodie, Vitali, Luca
• Granted Patent: US 7,848,792 B2
• Time in Patent Office: Days
• US Class Current: 600/529
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/1107 Measuring contraction of parts of the body, e.g. organ, muscle apparatus for measuring work or force in general G01L
• CPC Class Codes: A61B 5/1118 Determining activity level
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61N 1/36542 controlled by body motion, e.g. acceleration

Abstract

An active implantable medical device for diagnosis and/or therapy that is able to detect the occurrence of apnea and hypopnea. The detection of an occurrence of respiratory apneae or hypopneae is performed by collecting the patient'"'"'s endocardial acceleration (EA), and determining at least one parameter, i.e., a peak acceleration, (PEA I, PEA II) that is a function of this collected endocardial acceleration. An apnea or hypopnea alert signal is then conditionally delivered as a function of the value taken by this (these) parameter(s).

Claims

1. An active implantable medical device for detection of the occurrence of apneae and hypopneae, comprising:

means for collecting a patient'"'"'s endocardial acceleration (EA), and

means for analysis, able to;

determine at least one parameter having a value that is function of said collected endocardial acceleration; and

conditionally deliver an apnea or hypopnea alert signal as a function of the value taken by said at least one parameter.

2. The device of claim 1, wherein said at least one parameter is function of at least one of the two endocardial acceleration peaks occurring during a given cycle, said two peaks comprising a first peak (PEA I) during the isovolumetric ventricular contraction phase and a second peak (PEA II) during the isovolumetric ventricular relaxation phase.

3. The device of claim 2, wherein said function of said at least one parameter is:

(i) an average, and/or

(ii) the variation, and/or

(iii) a difference, or a ratio, between a long term average and a short term average, of the values of endocardial acceleration peak(s) collected over a plurality of successive cycles.

4. The device of claim 2, wherein said function of said at least one parameter is an interval between a QRS complex and at least one of the two endocardial acceleration peaks, and/or the time interval between said first and second endocardial acceleration peaks.

5. The device of claim 1, wherein the means for analysis further comprises means able to compare said at least one parameter to a first predetermined threshold (S) and deliver said alert signal (ALM) in response to a crossing of said threshold.

6. The device of claim 5, wherein:

said at least one parameter is function of a ratio (R) between a long term average and a short term average of the values of endocardial acceleration peak(s) collected over a plurality of successive cycles, and

said means for analysis further comprise means able to compare said ratio to a first predetermined threshold (S) and deliver said alert signal (ALM) in response to a crossing of this threshold.

7. The device of claim 6, wherein the means for analysis are able to deliver said alert signal after crossing of said first threshold only if said first threshold remains crossed during one of a predetermined minimum duration and a predetermined minimum number of heart cycles.

8. The device of claim 6, wherein the means for analysis further comprises means able, after crossing of said first threshold, to detect a reverse crossing of said first threshold followed by crossing of a second threshold, said second threshold being higher than the first threshold, and to deliver a signal of confirmation of the apnea or hypopnea episode at the crossing of this second threshold.

9. The device of claim 8, wherein the means for analysis are able to deliver said signal of confirmation of apnea or hypopnea episode only if the crossing of said second threshold occurs during one of a predetermined maximum duration and a predetermined maximum number of heart cycles, following said reverse crossing of said first threshold.

10. The device of claim 1, wherein the means for analysis further comprises a state machine or neuronal network able to compare a plurality of said parameters to a plurality of predetermined thresholds, to detect the crossing of the different thresholds, to analyze the sequence of these crossings and deliver said alert signal upon detection of one or more predetermined sequence(s) of crossings.

11. The device of claim 1, wherein the means for analysis further comprises means able to apply to endocardial acceleration, an autocorrelation processing, morphologic analysis, frequential analysis, wavelet analysis.

12. The device of claim 1, wherein:

the means for detection further comprises means for collecting a patient'"'"'s heart rate, and

the means for analysis further comprises means able to conditionally deliver the alert signal as a function of both patient'"'"'s heart rate and the value taken by said at least one parameter.

13. The device of claim 1, wherein:

the means for detection further comprises means for collecting the respiratory activity, able to provide a signal of patient'"'"'s ventilatory activity, and

the means for analysis further comprises means able to conditionally deliver the alert signal as a function of both the patient'"'"'s ventilatory activity signal and the value taken by said at least one parameter.

14. The device of claim 2, wherein:

the means for detection further comprises means for the detection of at least one phase of exercise and/or sleep, able to provide a signal of patient'"'"'s status, and

the means for analysis further comprises means able to conditionally deliver the alert signal as a function of both the patient'"'"'s status signal and the value taken by said at least one parameter.

15. An active implantable medical device for detecting apneae and hypopneae, comprising:

means for collecting the patient'"'"'s endocardial acceleration (EA);

means for determining at least one parameter value that is a function of said collected endocardial acceleration,

means for comparing said determined parameter to a first threshold; and

means for delivering an alert signal corresponding to an apnea or a hypopnea in response to said at least one parameter value crossing said threshold.

16. The device of claim 15 wherein said function further comprises an average of said at least one parameter value over a plurality of successive cycles.

17. The device of claim 15 wherein said function further comprises a variation of said at least one parameter value over a plurality of successive cycles.

18. The device of claim 15 wherein said function further comprises a defined relationship between a long term average of said at least one parameter value over a first plurality of cycles and a short term average of said at least one parameter value over a second plurality of cycles, said second plurality of cycles being less than said first plurality of cycles, said defined relationship being one of a difference and a ratio of said long term and short term averages.

19. The device of claim 15 wherein said at least one parameter value is a function of an endocardial acceleration peak (PEA I) measured during the isovolumetric ventricular contraction phase.

20. The device of claim 19 further comprising means for detecting a QRS complex in said patient'"'"'s electrogram, wherein said at least one parameter value is a function of an interval between a QRS complex and said endocardial acceleration peaks.

21. The device of claim 15 wherein said at least one parameter value is a function of an endocardial acceleration peak (PEA II) measured during the isovolumetric ventricular relaxation phase.

22. The device of claim 21 further comprising means for detecting a QRS complex in said patient'"'"'s electrogram wherein said at least one parameter value is a function of an interval between a QRS complex and said endocardial acceleration peaks.

23. The device of claim 15 wherein said at least one parameter is a function of a time interval between a first endocardial acceleration peak measured during the isovolumetric ventricular contraction phase and a second endocardial acceleration peak measured during the isovolumetric relaxation phase.

24. The device of claim 18, wherein:

said at least one parameter is function of a ratio (R) between a long term average and a short term average of the values of endocardial acceleration peak(s) collected over a plurality of successive cycles, and

said means delivering an alert signal is able to compare said ratio to a first predetermined threshold (S) and deliver said alert signal (ALM) at the crossing of said first threshold.

25. The device of claim 15, wherein the means for delivering said alert signal further comprises means for delivering said alert signal in response to said first threshold remaining crossed during a predetermined minimum duration, or over a predetermined minimum number of heart cycles.

26. The device of claim 15, wherein the means for delivering an alert signal further comprises means for detecting, after crossing of said first threshold, a reverse crossing of said first threshold followed by crossing of a second threshold, higher than said first threshold, and means for delivering a signal of confirmation of an apnea or hypopnea episode in response to said crossing of this second threshold.

27. The device of claim 26, wherein the means for delivering said signal of confirmation operates only if the crossing of said second threshold occurs during one of a predetermined maximum duration and a predetermined maximum number of heart cycles, following said reverse crossing of the first threshold.

28. The device of claim 15, further comprising means for collecting the patient'"'"'s heart rate, wherein said means for delivering said alert signal is able to conditionally deliver said alert signal as a function of both the patient'"'"'s heart rate and at least one parameter value.

29. The device of claim 15 further comprising means for collecting the respiratory activity, able to provide a signal of said patient'"'"'s ventilatory activity, and wherein said means for delivering said alert signal is as a function of both the patient'"'"'s ventilatory activity signal and the at least one parameter value.

30. The device of claim 15 further comprising means for detecting at least one phase of exercise and/or sleep, and providing a signal corresponding to the patient'"'"'s status indicative of whether the patient is in a sleep phase or an exercise phase, and the means for delivering said alert signal is able to conditionally deliver the alert signal as a function of both the patient'"'"'s status signal and the at least one parameter value.

31. The device of claim 15, wherein the at least one parameter value further comprises a plurality of parameters values, and said threshold further comprises a plurality of predetermined thresholds, said device further comprising a state machine or neuronal network able to compare said plurality of said parameters values to said plurality of predetermined thresholds, to detect the crossing of the different thresholds, to analyze any sequence of these crossings and to deliver said alert signal upon detection of one or more predetermined sequence(s) of crossings.