Auto CPAP system and method for preventing patient disturbance using airflow profile information

• US 5,645,053 A
• Filed: 01/29/1993
• Issued: 07/08/1997
• Est. Priority Date: 11/14/1991
• Status: Expired due to Term

• Current Assignee: University Technologies International, Inc.
• Original Assignee: University Technologies International, Inc.
• Inventors: Feroah, Thomas Richard, Remmers, John Edward
• Primary Examiner(s): Asher, Kimberly L.
• Application Number:
  US08/093,131
• Time in Patent Office: 1,621 Days
• Field of Search: 128/204.21, 128/204.23, 128/204.26
• US Class Current: 128/204.23
• CPC Class Codes: A61M 16/026 specially adapted for predicting, e.g. for determining an information representative of a flow limitation during a ventilation cycle by using a root square technique or a regression analysis
• 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 2205/3553 remote, e.g. between patient's home and doctor's office
• CPC Class Codes: A61M 2205/3561 local, e.g. within room or hospital

Abstract

The present invention relates to systems and methods for automatically and continuously regulating the level of nasal pressure to an optimal value during OSA (Obstructive Sleep Apnea) treatment. OSA therapy is implemented by a device which automatically re-evaluates an applied pressure and continually searches for a minimum pressure required to adequately distend a patient'"'"'s pharyngeal airway. For example, this optimal level varies with body position and stage of sleep throughout the night. In addition, this level varies depending upon the patient'"'"'s body weight and whether or not alcohol or sleeping medicine has been ingested.

Claims

1. Method for adaptively providing continuous positive airway pressure in an upper airway system said method comprising the steps of:

detecting airflow in the upper airway system in predetermined increments of time during a breath to provide an airflow profile for the breath;

averaging said airflow information over a plurality of breaths;

distinguishing respiratory and non-respiratory components of said airflow using said averaged airflow information;

using non-respiratory airflow information to identify periods of inspiration and expiration and to provide a respiratory airflow profile;

extracting from the respiratory airflow profile information a first peak inspiratory airflow and a first airflow profile;

introducing a pressure change to a second pressure, which produces a second peak inspiratory airflow and a second airflow profile;

comparing the first and second peak inspiratory airflow and the first and second airflow profile; and

preventing a patient disturbance from occurring by setting pressure in said upper airway system using said comparison.

2. Method according to claim 1, wherein said step of extracting further includes a step of:

determining an inspiratory airflow profile for said at least one period of inspiration.

3. Method according to claim 2, wherein said step of determining an inspiratory airflow profile further includes the step of:

calculating a roundness feature and a flatness feature for said at least one period of inspiration.

4. Method according to claim 3, wherein said step of determining further includes the steps of:

establishing a predetermined airflow limit from at least said roundness feature, said flatness feature and a peak airflow signal, said predetermined airflow limit being adjusted in accordance with predetermined limit modifiers.

5. Method according to claim 4, further comprising the step of:

updating said predetermined airflow limit modifiers in response to patient sleep stage and detected respiratory instabilities.

6. Method according to claim 4, wherein said first and second predetermined airflow profiles correspond to peak airflow limits when said roundness and flatness features have not changed by more than a predetermined amount.

7. Method according to claim 1, further comprising the step of:

identifying test periods suitable for adjusting said upper airway pressure, said step of identifying test periods further including the step of detecting respiratory instabilities which would render said test periods inaccurate.

8. Method according to claim 7, wherein said step of identifying test periods further includes the step of:

initiating a test period when respiratory instabilities have been detected for a predetermined number of inspiration and expiration periods.

9. Method according to claim 7, wherein said step of detecting respiratory instabilities further includes the step of:

determining that predetermined upper airway system performance indices are within predetermined physiological ranges.

10. Method according to claim 9, wherein said step of determining further includes the step of:

detecting respiratory variation, apnea or hypoventilation.

11. Method according to claim 1, wherein said step of distinguishing the non-respiratory component further includes the step of:

detecting airflow leaks in an airflow path connected with said upper airway system.

12. Method according to claim 1, further including the step of:

storing extracted features and incremental pressure adjustments in memory.

13. Method according to claim 1 further comprising the step of:

incorporating an additional external input from an oxygen saturation monitor or a snoring monitor.

14. Method according to claim 1 further comprising the step of:

incorporating an additional external input from a monitor of pressure, sound, oxygen saturation or body position.

15. Method for adaptively providing continuous positive airway pressure in an upper airway system said method comprising the steps of:

detecting airflow in the upper airway system in predetermined increments of time during a breath to provide an airflow profile for the breath;

averaging said airflow information over a plurality of breaths;

partitioning said airflow into respiratory and non-respiratory components using said averaged airflow information;

using non-respiratory airflow information to identify periods of inspiration and expiration and to provide respiratory airflow profile;

extracting from the respiratory airflow profile information features comprising peak inspiratory airflow, flatness and/or roundness;

introducing a pressure change for a single breath and determining for that breath the peak inspiratory airflow and either flatness or roundness;

comparing the peak inspiratory airflow and the flatness or roundness for the single breath with the same features extracted from said respiratory airflow profile information for said plurality of breaths; and

preventing a patient disturbance from occurring by adjusting pressure in said upper airway system in response to the comparison of said features.

16. Method according to claim 15, wherein said step of adjusting further includes steps of:

identifying a critical pressure at which a significant obstruction occurs during said inspiration; and

identifying an optimum pressure for eliminating said obstruction during said inspiration.

17. Method according to claim 16, wherein said step of identifying a critical pressure and an optimum pressure further includes the step of:

introducing incremental pressure perturbations into said upper airway system;

extracting characteristic features of said upper airway system during inspiration;

using said extracted characteristics to identify the optimum pressure and the critical pressure.

18. Method according to claim 15, wherein said step of adjusting is performed by identifying relative changes in airflow during said step of detecting.

19. Method according to claim 15, wherein said step of adjusting further includes steps of:

extracting features indicative of airflow resistance in said upper airway system.

20. System for providing continuous positive airway pressure in an upper airway system said system comprising:

means for detecting airflow in an tipper airway system of a patient;

means for generating pressure in said tipper airway system in response to a command pressure;

means for extracting peak inspiratory airflow information and airflow profile information for a plurality of breaths at a first pressure;

means for determining a second peak inspiratory airflow and a second airflow profile for at least one breath at a second pressure;

means for comparing the first and second peak inspiratory airflow and the first and second airflow profile; and

means for preventing a patient disturbance from occurring by adaptively controlling said pressure generating means in response to said comparison means.

21. System according to claim 20, wherein said adaptive control means further includes:

means for averaging airflow information over a predetermined period of time and for determining non-respiratory flow using said averaged information; and

means for identifying periods of inspiration and expiration using said non-respiratory flow information.

22. System according to claim 21, wherein said adaptive control means identifies said critical pressure as a pressure at which a predetermined upper airway obstruction occurs during said inspiration.

23. System according to claim 22, wherein said adaptive control means extracts features indicative of airflow resistance in said upper airway system to identify said critical pressure and to set said command pressure.

24. System according to claim 23, wherein said extracted features include flatness, roundness and peak flow.

25. System according to claim 20 wherein said adaptive control means further includes:

means for incorporating an additional external input from an oxygen saturation monitor or a snoring monitor.

26. System according to claim 20 wherein said adaptive control means further includes:

means for incorporating an additional external input from a monitor of pressure, sound, oxygen saturation or body position.

27. Method for adaptively providing continuous positive airway pressure in an upper airway system, said method comprising the steps of:

detecting airflow in the upper airway system in predetermined increments of time during a breath to provide an airflow profile for the breath;

averaging said airflow information over a plurality of breaths;

partitioning said airflow into respiratory and non-respiratory components using said averaged airflow information;

using non-respiratory airflow information to identify periods of inspiration and expiration and to provide respiratory airflow profile;

extracting from the respiratory airflow profile information a first profile shape at a first pressure;

introducing a pressure change for a single breath and determining for that single breath a second profile shape;

comparing the first profile shape and the second profile shape; and

preventing a patient disturbance from occurring by adjusting pressure in said upper airway system in response to said comparison.

28. Method according to claim 27, wherein said step of determining an inspiratory airflow profile further includes the step of:

calculating a roundness feature and a flatness feature for said at least one period of inspiration.

29. Method according to claim 28, wherein said step of determining further includes the steps of:

establishing a predetermined airflow limit from at least said roundness feature, said flatness feature and a peak airflow signal, said predetermined airflow limit being adjusted in accordance with predetermined limit modifiers.

30. Method according to claim 29, further comprising the step of:

updating said predetermined airflow limit modifiers in response to patient sleep stage and detected respiratory instabilities.

31. Method according to claim 27, further comprising the step of:

identifying test periods suitable for adjusting said upper airway pressure, said step of identifying test periods further including the step of detecting respiratory instabilities which would render said test periods inaccurate.

32. Method according to claim 31, wherein said step of identifying test periods further includes the step of:

initiating a test period when respiratory instabilities have been detected for a predetermined number of inspiration and expiration periods.

33. Method according to claim 27, further including the step of:

storing extracted features and incremental pressure adjustments in memory.

34. Method according to claim 27 further comprising the step of:

incorporating an additional external input from an oxygen saturation monitor or a snoring monitor.

35. Method according to claim 27 further comprising the step of:

incorporating an additional external input from a monitor of pressure, sound, oxygen saturation or body position.

36. Method according to claim 27, wherein said step of identifying a critical pressure and an optimum pressure further includes the step of:

introducing incremental pressure perturbations into said upper airway system;

extracting characteristic features of said upper airway system during inspiration;

using said extracted characteristics to identify the optimum pressure and the critical pressure.

37. System for providing continuous positive airway pressure in an upper airway system, said system comprising:

means for detecting airflow in an upper airway system of a patient;

means for generating pressure in said upper airway system in response to a command pressure;

means for partitioning said airflow into respiratory and non-respiratory components;

means for identifying periods of inspiration and expiration using non-respiratory airflow in formation;

means for extracting respiratory airflow profile shape for a plurality of breaths at a first pressure;

means for determining a second respiratory airflow profile shape for a single breath at a second pressure;

means for comparing the first and second airflow profile shapes; and

means for preventing a patient disturbance from occurring by adaptively controlling said pressure generating means in response to said comparison means.

38. System according to claim 37, wherein said adaptive control means further includes:

means for averaging airflow information over a predetermined period of time and for determining non-respiratory flow using said averaged information.

39. Method for adaptively providing continuous positive airway pressure in an upper airway system, said method comprising the steps of:

detecting airflow in the upper airway system in predetermined increments of time during a breath to provide an airflow profile for the breath;

averaging said airflow information over a plurality of breaths;

partitioning said airflow into respiratory and non-respiratory components using said averaged airflow information;

using non-respiratory airflow information to identify periods of inspiration and expiration and to provide respiratory airflow profile;

extracting from the respiratory airflow profile information a peak inspiratory airflow;

introducing a pressure change for at least one breath and determining for that pressure the peak inspiratory airflow;

comparing the peak inspiratory airflow for the pressure change with the peak inspiratory airflow extracted from said respiratory airflow profile information for said plurality of breaths; and

preventing a patient disturbance from occurring by adjusting pressure in said upper airway system in response to said comparison.

40. Method according to claim 39, wherein said step of determining an inspiratory airflow profile further includes the step of:

calculating a roundness feature and a flatness feature for said at least one period of inspiration.

41. Method according to claim 39, further comprising the step of:

identifying test periods suitable for adjusting said upper airway pressure, said step of identifying test periods further including the step of detecting respiratory instabilities which would render said test periods inaccurate.

42. Method according to claim 41, wherein said step of identifying test periods further includes the step of:

initiating a test period when respiratory instabilities have been detected for a predetermined number of inspiration and expiration periods.

43. Method according to claim 39, further including the step of:

storing extracted features and incremental pressure adjustments in memory.

44. Method according to claim 39 further comprising the step of:

incorporating an additional external input from an oxygen saturation monitor or a snoring monitor.

45. Method according to claim 39 further comprising the step of:

incorporating an additional external input from a monitor of pressure, sound, oxygen saturation or body position.

46. Method for adaptively providing continuous positive airway pressure in an upper airway, said method comprising the steps of:

detecting airflow in an upper airway system to provide an airflow profile for each breath;

identifying the onset of inspiration by detecting an increase in slope of the airflow profile;

determining respiratory airflow and non-respiratory airflow;

continuously calculating the averaged respiratory airflow as a moving average airflow over a first period of time comprising a plurality of breaths;

using the moving average airflow and a weighted average of non-respiratory airflow over a second shorter period of time comprising a plurality of previous breaths to determine a corrected moving average airflow;

adjusting the corrected moving average airflow using a ratio of the existing average respiratory airflow divided by mask pressure;

changing the mask pressure and re-initializing the averaged respiratory airflow to equal the new mask pressure times said ratio; and

adjusting pressure in said upper airway system using the re-initialized averaged respiratory airflow information.

47. Method according to claim 46, wherein said step of determining an inspiratory airflow profile further includes the step of:

calculating a roundness feature and a flatness feature for said at least one period of inspiration.

48. Method according to claim 46, further comprising the step of:

identifying test periods suitable for adjusting said upper airway pressure, said step of identifying test periods further including the step of detecting respiratory instabilities which would render said test periods inaccurate.

49. Method according to claim 48, wherein said step of identifying test periods further includes the step of:

initiating a test period when respiratory instabilities have been detected for a predetermined number of inspiration and expiration periods.

50. Method according to claim 46, further including the step of:

storing extracted features and incremental pressure adjustments in memory.

51. Method according to claim 46 further comprising the step of:

incorporating an additional external input from an oxygen saturation monitor or a snoring monitor.

52. Method according to claim 46 further comprising the step of:

incorporating an additional external input from a monitor of pressure, sound, oxygen saturation or body position.