Method and apparatus for continuous adjustment of positive airway pressure for treating obstructive sleep apnea

• US 5,335,654 A
• Filed: 05/07/1992
• Issued: 08/09/1994
• Est. Priority Date: 05/07/1992
• Status: Expired due to Term

• Current Assignee: New York University
• Original Assignee: New York University
• Inventors: Rapoport, David M.
• Primary Examiner(s): Burr, Edgar S.
• Assistant Examiner(s): RACITI, ERIC
• Application Number:
  US07/879,578
• Time in Patent Office: 824 Days
• Field of Search: 128/204.18, 128/204.21, 128/204.23, 128/204.26, 128/205.18, 128/207.18, 128/716, 128/717, 128/718, 128/719, 128/720, 128/721, 128/722, 128/723 , 128/724, 128/725, 128/726
• US Class Current: 128/204.23
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/6803 Head-worn items, e.g. helmets, masks, headphones or goggles
• CPC Class Codes: A61M 16/00 Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes stimulating the respiratory movement by mechanical, pneumatic or electrical means, iron lungs combined with gas breathing means A61H31/00
• 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 16/0677 Gas-saving devices therefor
• CPC Class Codes: A61M 16/0866 Passive resistors therefor
• CPC Class Codes: A61M 2016/0036 in the breathing tube and used in both inspiratory and expiratory phase
• CPC Class Codes: A61M 2016/0039 in the inspiratory circuit
• CPC Class Codes: A61M 2230/005 Parameter used as control input for the apparatus
• CPC Class Codes: A61M 2230/08 Other bio-electrical signals
• CPC Class Codes: A61M 2230/205 partial oxygen pressure (P-O2)
• CPC Class Codes: A61M 2230/62 Posture
• CPC Class Codes: A61M 39/228 with a tubular diaphragm constrictable by radial fluid force

Abstract

In the treatment of obstructive sleep apnea, a CPAP flow generator is employed to direct air to a nasal mask fitted to a patient. The airflow from the generator is monitored, and the flow and/or pressure is increased when the waveform of the airflow exhibits characteristics corresponding to flow limitation. The generator may be controlled to repetitively test for waveform variations, in order to adjust the CPAP flow to the minimum level the does not produce flow limitation.

Claims

1. A method for optimizing the positive airway pressure to a patient, comprising the steps of:

a) applying an initial level of continuous positive airway pressure to a patient, which is then optimized by;

b) continuously monitoring the inspiratory flow of air to the patient;

c) defining an inspiratory waveform contour of said inspiratory flow for each breath;

d) analyzing each said inspiratory waveform contour to determine the presence or absence of patient airway obstruction; and

e) increasing said pressure when the contour of said waveform corresponding to inspiration indicates patient airway obstruction, and decreasing said pressure when said waveform corresponding to patient inspiration does not indicate patient airway obstruction.

2. The method of claim 1, wherein step e comprises increasing said pressure when the contour of said waveform corresponding to inspiration for a predetermined duration indicates patient airway obstruction, and decreasing said pressure when said waveform corresponding to patient inspiration for a predetermined duration does not indicate patient airway obstruction.

3. The method of claim 2, wherein said predetermined duration is sufficient to define a plurality of inspiratory waveform contours.

4. The method of claim 1, wherein said pressure is increased when the contour of said waveform corresponding to inspiration includes a plateau.

5. The method of claim 1, wherein said pressure is increased when a portion of the contour of said waveform corresponding to inspiration is flattened.

6. The method of claim 1, wherein said pressure is increased when the contour of said waveform corresponding to inspiration deviates from a substantially sinusoidal shape.

7. An apparatus for the treatment of patient airway obstruction, comprising an air source arranged for directing airflow to a patient and establishing an initial level of continuous positive airway pressure to the patient, a flow sensor to sense airflow to the patient, a signal processor operatively connected to said flow sensor for defining an inspiratory waveform contour of said airflow to the patient, and a controller operatively connected to said signal processor, wherein said signal processor further having means for determining the presence or absence of patient airway obstruction from said inspiratory waveform contour, and said controller having means for adjusting the pressure to the patient in response to the determination by said signal processor of the presence or absence of upper airway obstruction.

8. The apparatus of claim 7, wherein said controller further comprises means for increasing the pressure to the patient in response to a determination by said signal processor of the presence of patient airway obstruction for a predetermined duration, and said controller further having means for decreasing the pressure to the patient in response to a determination by said signal processor of the absence of patient airway obstruction for a predetermined duration.

9. The apparatus of claim 7, wherein said signal processor further comprises means for determining the presence of patient airway obstruction when the contour of said waveform corresponding to inspiration includes a plateau.

10. The apparatus of claim 7, wherein said signal processor further comprises means for determining the presence of patient airway obstruction when a portion of the contour of said waveform corresponding to inspiration is flattened.

11. The apparatus of claim 7, wherein said signal processor further comprises means for determining the presence of patient airway obstruction when the contour of said waveform corresponding to inspiration deviates from a substantially sinusoidal shape.

12. An apparatus for the treatment of obstructive sleep apnea, comprising:

a source of air;

means for directing an airflow from said source to a patient and establishing an initial level of continuous positive airway pressure to a patient;

sensing means for sensing the airflow to the patient;

means in operative relationship for defining an inspiratory waveform contour; and

means responsive to the inspiratory waveform contour for adjusting said pressure to the patient.

13. The apparatus of claim 12, wherein said means responsive to the inspiratory waveform contour has means for increasing said pressure when said inspiratory waveform contour indicates patient airway obstruction, and for decreasing said pressure when said inspiratory waveform contour does not indicate patient airway obstruction.