RESPIRATORY STIMULATION FOR TREATING PERIODIC BREATHING

• US 20090099621A1
• Filed: 10/10/2008
• Published: 04/16/2009
• Est. Priority Date: 10/10/2007
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lin, Zheng, Kwok, Jonathan, Stahmann, Jeffrey E., Lee, Kent, Pu, Yachuan, Beck, Kenneth C.
• Granted Patent: US 8,428,711 B2
• Time in Patent Office: Days
• US Class Current: 607/42
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601

Abstract

A system and method for treating and/or preventing is described for treating periodic breathing characterized by cyclical hyperventilation and hypoventilation, examples of which include Cheyne-Stokes respiration and central sleep apnea. The system could also be used in the treatment of other conditions involving an impairment of respiratory drive.

Claims

1. A system, comprising:

one or more neurostimulators adapted for disposition near nervous or muscular tissue involved with respiration;

a control unit interfaced to the neurostimulator;

one or more respiratory sensors interfaced to the control unit for detecting respiratory activity;

wherein the control unit is programmed to recognize pathological periodic breathing as characterized by cyclical hypoventilation and hyperventilation from the detected respiratory activity; and

,

wherein the control unit is programmed to actuate the neurostimulator and deliver compensatory respiratory neurostimulation in a manner that counteracts the periodic breathing.

2. The system of claim 1 wherein the control unit is programmed to deliver compensatory respiratory neurostimulation as excitatory stimulation of the diaphragm and/or phrenic nerve in order to augment respiratory drive during hypoventilation or provide backup ventilation in the case of apnea.

3. The system of claim 1 wherein the control unit is programmed to deliver compensatory respiratory neurostimulation as inhibitory stimulation to the diaphragm and/or phrenic nerve in order to diminish respiration during hyperventilation.

4. The system of claim 1 wherein the respiratory sensor is configured to measure a physiological variable related to respiration as selected from transthoracic impedance between external or internal electrodes, chest or abdominal wall motion, phrenic nerve activity, blood pH, blood oxygen concentration, blood carbon dioxide concentration, blood pressure, activity level and/or body posture via an accelerometer, phrenic nerve activity, airflow, heart sounds, sensed electrical activity, blood flow, and blood circulation time.

5. The system of claim 1 wherein the control unit is programmed to interpret the measurement physiological variables by multiple respiratory sensors, predict the onset of periodic breathing, and deliver compensatory respiratory neurostimulation as a preventive measure.

6. The system of claim 1 wherein the control unit is programmed to only deliver compensatory respiratory neurostimulation when a permitting condition is met, wherein the permitting condition is selected from a specified time of day, a measured activity level being within a specified range, and a sensed body posture being within a specified range.

7. The system of claim 1 wherein the neurostimulator is an implantable satellite unit that receives commands from the control unit via RF telemetry.

8. The system of claim 1 wherein the control unit further comprises a magnetically or tactilely actuated switch for starting or stopping delivery of respiratory stimulation.

9. The system of claim 1 wherein the control unit is programmed to perform a safety check that involves determining if the therapy is actually exacerbating the periodic respiratory pattern.

10. The system of claim 9 wherein the control unit is programmed to perform a safety check that involves determining if vital signs are worsening,

11. The system of claim 10 wherein the control unit is programmed to inhibit therapy for a programmed interval if the safety check is failed.

12. The system of claim 11 wherein the programmed interval is set to a predetermined value.

13. The system of claim 11 wherein the programmed interval specifies that therapy is to be inhibited until a specified condition exists/

14. A method, comprising:

disposing one or more neurostimulators near nervous or muscular tissue involved with respiration;

disposing one or more respiratory sensors in order to detect respiratory activity;

recognizing pathological periodic breathing as characterized by cyclical hypoventilation and hyperventilation from the detected respiratory activity; and

,

actuating the neurostimulator to deliver compensatory respiratory neurostimulation in a manner that counteracts the periodic breathing.

15. The method of claim 14 further comprising delivering compensatory respiratory neurostimulation as excitatory stimulation of the diaphragm and/or phrenic nerve in order to augment respiratory drive during hypoventilation or provide backup ventilation in the case of apnea.

16. The method of claim 14 further comprising delivering compensatory respiratory neurostimulation as inhibitory stimulation to the diaphragm and/or phrenic nerve in order to diminish respiration during hyperventilation.

17. The method of claim 14 wherein the physiological variable related to respiration as selected from transthoracic impedance between external or internal electrodes, chest or abdominal wall motion, phrenic nerve activity, blood pH, blood oxygen concentration, blood carbon dioxide concentration, blood pressure, activity level and/or body posture via an accelerometer, phrenic nerve activity, airflow, heart sounds, sensed electrical activity, blood flow, and blood circulation time.

18. The method of claim 14 further comprising interpreting the measurement physiological variables by multiple respiratory sensors, predicting the onset of periodic breathing, and delivering compensatory respiratory neurostimulation as a preventive measure.

19. The method of claim 14 further comprising only delivering compensatory respiratory neurostimulation when a permitting condition is met, wherein the permitting condition is selected from a specified time of day, a measured activity level being within a specified range, and a sensed body posture being within a specified range.

20. The method of claim 14 wherein the neurostimulator is an implantable satellite unit that receives commands via RF telemetry.