USING RESPIRATION DISTRESS MANIFESTATIONS FOR HEART FAILURE DETECTION

• US 20080262360A1
• Filed: 04/17/2007
• Published: 10/23/2008
• Est. Priority Date: 04/17/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Zhang, Yi, Hatlestad, John D., Dalal, Yousufali, Lewicke, Aaron
• Granted Patent: US 9,943,234 B2
• Time in Patent Office: Days
• US Class Current: 600/484
• 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 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61B 5/1116 Determining posture transitions
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy

Abstract

Systems and methods for diagnosing one or more respiration distress manifestations by implantably recognizing their occurrence and evaluating information about the same to provide an indication of present or impending worsening heart failure are discussed. Using information produced by an implantable respiration sensor circuit and an implantable physiological sensor circuit, such as at least one of a physical activity sensor circuit or a posture sensor circuit, an implantable or external processor circuit may detect a respiration disturbance and an associated subsequent arousal from stable state occurrence and thereafter evaluate over time arousal from stable state occurrences to provide the indication of present or impending worsening heart failure. In one example, information about a fluid level within a subject is used in determining the indication of worsening heart failure. In various examples, a regimen is initiated or adjusted in response to the indication of present or impending worsening heart failure.

Claims

1. A system comprising:

an implantable medical device including,

a respiration sensor circuit configured for producing a respiration signal indicative of a respiration or a respiration related parameter of a subject; and

a physiological sensor circuit that includes at least one of a physical activity sensor circuit configured for producing a physical activity signal indicative of a physical activity level of the subject or a posture sensor circuit configured for producing a posture signal indicative of a posture of the subject; and

an implantable or external processor circuit including an input to receive information about the respiration signal and at least one of the physical activity signal or the posture signal, the processor circuit configured for detecting a respiration disturbance using the respiration signal and configured for detecting an associated subsequent arousal from stable state occurrence from at least one of the physical activity signal or the posture signal, the processor circuit further configured for evaluating over time, at least in part, arousal from stable state occurrences for providing an indication of present or impending worsening heart failure.

2. The system of claim 1, comprising a clock circuit configured for producing at least one timestamp associated with at least one of the respiration signal, the physical activity signal, or the posture signal.

3. The system of claim 2, comprising a memory configured for storing information about the timestamp and at least one of the respiration signal, the physical activity signal, or the posture signal with which the timestamp is associated.

4. The system of claim 1, comprising a regimen control circuit configured for adjusting a regimen provided to the subject using, at least in part, information about at least one of the detected respiration disturbance, the detected arousal from stable state occurrence, or the indication of present or impending worsening heart failure.

5. The system of claim 1, comprising an external user-interface device communicatively coupled to the implantable medical device and including a user-detectable indication of an evaluation over time of at least one of the respiration disturbance, the arousal from stable state occurrence, or the indication of present or impending worsening heart failure.

6. The system of claim 5, wherein the external user-interface includes a user input device configured for receiving programming information from a user and communicating the programming information to the implantable medical device.

7. The system of claim 1, comprising a fluid detector circuit configured for producing an indication of a fluid level within the subject;

and wherein the processor is configured to receive the indication of the fluid level for use in determining the indication of present or impending worsening heart failure.

8. The system of claim 7, wherein the fluid detector circuit includes an external weight scale comprising a communication circuit configured for directly or indirectly communicating fluid level information to the processor circuit.

9. The system of claim 1, comprising a stable state detector including at least one of a sleep detector circuit configured for determining whether the subject is asleep or awake, the physical activity sensor, or the posture sensor.

10. The system of claim 1, wherein the respiration sensor circuit is configured to produce the respiration signal in response to a detected change in a fluid level within the subject.

11. The system of claim 1, wherein the respiration sensor circuit is configured to produce the respiration signal in response to a detected change in lung volume.

12. The system of claim 1, wherein the respiration sensor circuit is configured to produce the respiration signal in response to a detected change in respiration rate.

13. The system of claim 1, wherein the respiration signal produced by the respiration sensor circuit includes information about at least one of a respiration rate, a tidal volume, a heart rate, or a heart rate variability.

14. The system of claim 1, wherein the physical activity sensor circuit is configured to produce the physical activity signal in response to a detected increase in the physical activity level.

15. The system of claim 1, wherein the posture sensor circuit is configured to produce the posture signal in response to a detected change in the posture to a more upright position.

16. A method comprising:

implantably detecting a respiration disturbance followed by detecting an associated arousal from stable state occurrence, wherein detecting the arousal from stable state occurrence includes detecting information about at least one of a physical activity level or a posture of a subject; and

determining an indication of present or impending worsening heart failure by evaluating over time, at least in part, arousal from stable state occurrences.

17. The method of claim 16, comprising detecting a fluid accumulation within the subject and using information about the fluid accumulation in determining the indication of present or impending worsening heart failure.

18. The method of claim 16, comprising detecting a stable state, including detecting at least one of a stable sleep state, a stable physical activity level, or a stable posture position.

19. The method of claim 16, comprising evaluating over time a paroxysmal nocturnal dyspnea occurrence.

20. The method of claim 19, comprising determining the indication of present or impending worsening heart failure by also detecting at least one of an apnea occurrence or a Cheyne-Stokes breathing occurrence.

21. The method of claim 20, wherein determining the indication of present or impending worsening heart failure includes weighting the evaluation of at least one of the paroxysmal nocturnal dyspnea occurrence, the apnea occurrence, or the Cheyne-Stokes breathing occurrence.

22. The method of claim 16, comprising displaying a trending or counting of at least one of the respiration disturbance, the arousal from stable state occurrence, or the indication of present or impending worsening heart failure.

23. The method of claim 16, comprising initiating or adjusting a regimen in response to the indication of present or impending worsening heart failure.

24. The method of claim 16, wherein detecting the respiration disturbance includes detecting a lung volume oscillation and decay.

25. The method of claim 16, wherein detecting the respiration disturbance includes detecting an increase in respiration rate.

26. The method of claim 16, wherein detecting the respiration disturbance includes detecting an increase in heart rate or a change in heart rate variability.

27. The method of claim 16, wherein detecting the arousal from stable state includes detecting at least one of an increase in the physical activity level or a change in the posture to a more upright position.