Cardiac Monitoring And Therapy Using A Device For Providing Pressure Treatment Of Sleep Disordered Breathing

• US 20080045813A1
• Filed: 02/24/2005
• Published: 02/21/2008
• Est. Priority Date: 02/25/2004
• Status: Active Grant

• Current Assignee: ResMed Pty Ltd. (ResMed Incorporated)
• Original Assignee: Resmed Limited (ResMed Incorporated)
• Inventors: Farrugia, Steven Paul, Martin, Dion Charles Chewe, Chan, Christine Wei Chih, Phuah, Chee Keong
• Granted Patent: US 8,794,236 B2
• Time in Patent Office: Days
• US Class Current: 600/301
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/087 Measuring breath flow
• CPC Class Codes: A61B 5/363 Detecting tachycardia or bradycardia
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/4836 Diagnosis combined with treatment in closed-loop systems or methods A61B5/0036 takes precedence
• CPC Class Codes: A61M 16/0003 Accessories therefor, e.g. sensors, vibrators, negative pressure
• CPC Class Codes: A61M 16/0051 with alarm devices
• CPC Class Codes: A61M 16/0069 the speed thereof being controlled by respiratory parameters, e.g. by inhalation
• CPC Class Codes: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 16/0875 Connecting tubes
• CPC Class Codes: A61M 2016/0027 pressure meter
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2205/3303 Using a biosensor
• CPC Class Codes: A61M 2205/3344 Measuring or controlling pressure at the body treatment site
• CPC Class Codes: A61M 2205/3379 Masses, volumes, levels of fluids in reservoirs, flow rates
• CPC Class Codes: A61M 2205/50 with microprocessors or computers
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/40 Respiratory characteristics

Abstract

A method of using CPAP equipment to sense cardiogenic oscillations in a patient'"'"'s airflow, and to monitor and treat the patient'"'"'s cardiac condition. The apparatus diagnoses cardiac morbidity conditions, such as the existence of arrhythmias or other cardiac abnormalities, and influences and optimizes cardiac stroke volume. The apparatus further monitors pulse-transit time, changes in the heart pre-ejection period, and the duration of the cardiac cycle.

Claims

1. A method of determining a patient'"'"'s cardiac condition by using a CPAP apparatus for treating sleep disordered breathing, comprising the steps of:

sensing the patient'"'"'s cardiogenic pressure or flow oscillations; and

using the sensed cardiogenic oscillations to determine the patient'"'"'s cardiac condition.

2. The method of claim 1 wherein the occurrence of a central apnea event is identified by determining the occurrence of cardiogenic oscillations during a period of no airflow and wherein the patient'"'"'s cardiac condition is determined based upon the known association of central apneas and cardiac morbidity.

3. The method of claim 1 wherein cardiogenic oscillations in only the middle to later portion of exhalation are used to determine the patient'"'"'s cardiac condition.

4. The method of claim 3 wherein the middle to later portion of exhalation is determined by tracking the recent averaged lapsed time of prior breathing cycles and using such time in conjunction with the detection of the start of a breathing cycle.

5. The method of claim 1 further comprising the step of sending a signal to the patient, care provider or physician, or recording an arrhythmia event for later observation, upon determining the existence of an arrhythmia event.

6. The method of claim 1 further comprising the step of determining cardiac timing from the time between cardiogenic oscillations.

7. The method of claim 1 further comprising the step of adjusting the patient'"'"'s stroke volume by examining the amplitude of the cardiogenic oscillations and in accordance therewith adjusting the CPAP treatment pressure.

8. The method of claim 1 further comprising the step of analyzing the cardiogenic oscillations to determine the patient'"'"'s pulse transit time.

9. The method of claim 1 further comprising the step of analyzing the cardiogenic oscillations against ECG waveforms to determine changes in the patient'"'"'s pre-ejection period.

10. The method of claim 1 further comprising the step of assisting cardiac function in accordance with the determined cardiac condition by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

11. The method of claim 1 further comprising the step of assisting cardiac function by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion. Or arterial (aortic) tone?

12. The method of claim 1 further comprising the step of using cardiogenic oscillation information for managing triggering of a bi-level CPAP apparatus.

13. A method of determining a patient'"'"'s cardiac condition and providing cardiac treatment by using a CPAP apparatus for treating sleep disordered breathing, comprising the steps of:

sensing the patient'"'"'s cardiogenic pressure or flow oscillations; and

using the sensed cardiogenic oscillations to determine the patient'"'"'s cardiac condition and adjust the pressure delivered by the CPAP apparatus to treat the patient'"'"'s cardiac condition.

14. The method of claim 13 wherein the occurrence of a central apnea event is identified by determining the occurrence of cardiogenic oscillations during a period of no airflow and wherein the patient'"'"'s cardiac condition is determined based upon the known association of central apneas and cardiac morbidity.

15. The method of claim 13 wherein cardiogenic oscillations in only the middle to later portion of exhalation are used to determine the patient'"'"'s cardiac condition.

16. The method of claim 15 wherein the middle to later portion of exhalation is determined by tracking the recent averaged lapsed time of prior breathing cycles and using such time in conjunction with the detection of the start of a breathing cycle.

17. The method of claim 13 further comprising the step of sending a signal to the patient, care provider or physician, or recording an arrhythmia event for later observation, upon determining the existence of an arrhythmia event.

18. The method of claim 13 further comprising the step of determining cardiac timing from the time between cardiogenic oscillations.

19. The method of claim 13 further comprising the step of adjusting the patient'"'"'s stroke volume by examining the amplitude of the cardiogenic oscillations and in accordance therewith adjusting the CPAP treatment pressure.

20. The method of claim 13 further comprising the step of analyzing the cardiogenic oscillations to determine the patient'"'"'s pulse transit time.

21. The method of claim 13 further comprising the step of analyzing the cardiogenic oscillations against ECG waveforms to determine changes in the patient'"'"'s pre-ejection period.

22. The method of claim 13 further comprising the step of assisting cardiac function in accordance with the determined cardiac condition by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

23. The method of claim 13 further comprising the step of assisting cardiac function by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

24. The method of claim 13 further comprising the step of using cardiogenic oscillation information for managing triggering of a bi-level CPAP apparatus.

25. A CPAP apparatus which, in addition to providing CPAP therapy, determines a patient'"'"'s cardiac condition, the apparatus comprising a controller and a sensor for detecting pressure in the patient'"'"'s CPAP mask, wherein the controller:

senses the patient'"'"'s cardiogenic pressure oscillations; and

uses the sensed cardiogenic oscillations to determine the patient'"'"'s cardiac condition.

26. The apparatus of claim 25 wherein the controller:

identifies a central apnea event by determining the occurrence of cardiogenic oscillations during a period of no airflow; and

determines the patient'"'"'s cardiac condition based upon the known association of central apneas and cardiac morbidity.

27. The apparatus of claim 25 wherein the controller uses cardiogenic oscillations in only the middle to later portion of exhalation to determine the patient'"'"'s cardiac condition.

28. The apparatus of claim 27 wherein the controller determines the middle to later portion of exhalation by tracking the recent averaged lapsed time of prior breathing cycles and using such time in conjunction with the detection of the start of a breathing cycle.

29. The apparatus of claim 25 wherein the controller sends a signal to the patient, care provider or physician, or recording an arrhythmia event for later observation, upon determining the existence of an arrhythmia event.

30. The apparatus of claim 25 wherein the controller determines cardiac timing from the time between cardiogenic oscillations.

31. The apparatus of claim 25 wherein the controller adjusts the patient'"'"'s stroke volume by examining the amplitude of the cardiogenic oscillations and in accordance therewith adjusting the CPAP treatment pressure.

32. The apparatus of claim 25 wherein the controller analyzes the cardiogenic oscillations to determine the patient'"'"'s pulse transit time.

33. The apparatus of claim 25 wherein the controller analyzes the cardiogenic oscillations against ECG waveforms to determine changes in the patient'"'"'s pre-ejection period.

34. The apparatus of claim 25 wherein the controller assists cardiac function in accordance with the determined cardiac condition by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

35. The apparatus of claim 25 wherein the controller assists cardiac function by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

36. The apparatus of claim 25 wherein the controller uses cardiogenic oscillation information for managing triggering of the CPAP apparatus.

37. A CPAP apparatus which, in addition to providing CPAP therapy, determines a patient'"'"'s cardiac condition and provides cardiac treatment, the apparatus comprising a controller and a sensor for detecting pressure in the patient'"'"'s CPAP mask, wherein the controller:

senses the patient'"'"'s cardiogenic pressure oscillations; and

uses the sensed cardiogenic oscillations to determine the patient'"'"'s cardiac condition.

38. The apparatus of claim 37 wherein the controller:

identifies the occurrence of a central apnea event by determining the occurrence of cardiogenic oscillations during a period of no airflow; and

determines the patient'"'"'s cardiac condition based upon the known association of central apneas and cardiac morbidity.

39. The apparatus of claim 37 wherein the controller uses cardiogenic oscillations in only the middle to later portion of exhalation are used to determine the patient'"'"'s cardiac condition.

40. The apparatus of claim 39 wherein the controller determines the middle to later portion of exhalation by tracking the recent averaged lapsed time of prior breathing cycles and using such time in conjunction with the detection of the start of a breathing cycle.

41. The apparatus of claim 37 wherein the controller sends a signal to the patient, care provider or physician, or recording an arrhythmia event for later observation, upon determining the existence of an arrhythmia event.

42. The apparatus of claim 37 wherein the controller determines cardiac timing from the time between cardiogenic oscillations.

43. The apparatus of claim 37 wherein the controller adjusts the patient'"'"'s stroke volume by examining the amplitude of the cardiogenic oscillations and in accordance therewith adjusting the CPAP treatment pressure.

44. The apparatus of claim 37 wherein the controller analyzes the cardiogenic oscillations to determine the patient'"'"'s pulse transit time.

45. The apparatus of claim 37 wherein the controller analyzes the cardiogenic oscillations against ECG waveforms to determine changes in the patient'"'"'s pre-ejection period.

46. The apparatus of claim 37 wherein the controller assists cardiac function in accordance with the determined cardiac condition by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

47. The apparatus of claim 37 wherein the controller assists cardiac function by adjusting the CPAP treatment pressure to assist right atria filling, left ventricular ejection, or cardiac perfusion.

48. The apparatus of claim 37 wherein the controller uses cardiogenic oscillation information for managing triggering of a bi-level CPAP apparatus.