System and method for diagnosing and tracking congestive heart failure based on the periodicity of Cheyne-Stokes Respiration using an implantable medical device

• US 7,070,568 B1
• Filed: 03/02/2004
• Issued: 07/04/2006
• Est. Priority Date: 03/02/2004
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories)
• Inventors: Koh, Steve
• Primary Examiner(s): Nasser, Robert L.
• Assistant Examiner(s): MALLARI, PATRICIA C
• Application Number:
  US10/792,085
• Time in Patent Office: 854 Days
• Field of Search: 607/20
• US Class Current: 600/508
• 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 5/145 Measuring characteristics of blood in vivo, e.g. gas concentration, pH value; Measuring characteristics of body fluids or tissues, e.g. interstitial fluid, cerebral tissuemeasuring of blood pressure or blood flow A61B5/02; non-radiation detecting or locating of foreign bodies in blood A61B5/06
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/7239 using differentiation including higher order derivatives
• CPC Class Codes: A61B 5/7242 using integration
• CPC Class Codes: A61M 5/14276 specially adapted for implantation
• CPC Class Codes: A61N 1/3627 for treating a mechanical deficiency of the heart, e.g. congestive heart failure or cardiomyopathy
• CPC Class Codes: A61N 1/36521 the parameter being derived from measurement of an electrical impedance
• CPC Class Codes: A61N 1/368 comprising more than one electrode co-operating with different heart regions A61N1/3622, A61N1/3627 take precedence

Abstract

Techniques are provided for distinguishing Cheyne-Stokes Respiration (CSR) caused by central sleep apnea (CSA) from CSR caused by congestive heart failure (CHF) and for evaluating the severity of CHF, if present, based up CSR. A time period associated with the CSR is determined based upon separate evaluation of apnea and hyperpnea periods during CSR and then the time period is compared against a time-varying discrimination threshold derived from integrated thoracic impedance signals. If the time period exceeds the threshold, the CSR of the patient is caused by CHF; otherwise, the CSR is caused by CSA. Thereafter, the course of therapy delivered to the patient is controlled based upon the type of CSR. In addition, if the CSR is caused by CHF, the time period associated with CSR is employed to determine the severity of CHF—with longer time periods being associated with more severe CHF.

Claims

1. A system for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the system comprising:

a CSR periodicity determination unit operative to determine a periodicity associated with CSR for the patient;

a CSR periodicity-based CHF evaluation unit operative to evaluate the severity of CHF within the patient based on the periodicity; and

a CHF therapy controller operative to control delivery of therapy to the patient based on the evaluation of the severity of CHF.

2. A system for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the system comprising:

a CSR periodicity determination unit operative to determine a periodicity associated with CSR for the patient;

a CSR periodicity-based CHF evaluation unit operative to evaluate the severity of CHF within the patient based on the periodicity;

an implantable drug pump; and

control circuitry connected to the CSR periodicity-based CHF evaluation unit and to the implantable drug pump and operative to control at least one of the dosage and the type of drug delivered via the drug pump based on the severity of CHF.

3. A method for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the method comprising:

detecting a time period representative of periodic breathing during CSR in the patient by;

detecting an episode of CSR; and

determining the average duration of periods of apnea during the episode of CSR, determining the average duration of periods of breathing between the periods of apnea during CSR, and combining the average duration of periods of apnea with the average duration of periods of breathing; and

evaluating the severity of CHF within the patient based on the periodicity.

4. The method of claim 3 wherein determining the average duration of periods of sleep apnea during CSR and determining the average duration of periods of breathing between the periods of sleep apnea during CSR are performed using one or more of thoracic impedance, AV delay, and R—

R oscillations.

5. A method for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the method comprising:

detecting a periodicity associated with CSR in the patient; and

evaluating the severity of CHF within the patient by comparing the periodicity associated with CSR against a set of values indicative of the severity of CHF.

6. The method of claim 5 further comprising storing a value indicative of the current severity of CHF in a memory.

7. A system for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the system comprising:

a CSR periodicity determination unit operative to determine a periodicity associated with CSR for the patient;

a CSR periodicity-based CHF evaluation unit operative to evaluate the severity of CHF within the patient based on the periodicity;

a pacing pulse generator operative to generate overdrive pacing pulses for delivery to the heart of the patient; and

control circuitry connected to the CSR periodicity-based CHF evaluation unit and to the pacing pulse generator and operative to control the aggressiveness of overdrive therapy based on the severity of CHF.

8. A method for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the method comprising:

detecting a periodicity associated with CSR in the patient;

evaluating the severity of CHF within the patient based on the periodicity; and

delivering therapy to the patient based on the severity of CHF;

wherein an implantable drug pump is provided and wherein delivering therapy comprises delivering CHF drug therapy to the patient using the drug pump and wherein the dosage or the type of drug is selected based on the degree of severity of CHF.

9. A method for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the Patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the method comprising:

detecting a periodicity associated with CSR in the patient;

evaluating the severity of CHF within the patient based on the periodicity; and

delivering long-term therapy in response to the detection of frequent episodes of CRS caused by CHF (CSR-CHF) by delivering overdrive pacing therapy to the heart of the patient with the aggressiveness of overdrive therapy adjusted based on the degree of severity of CHF.

10. A method for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the method comprising;

detecting a periodicity associated with CSR in the patient;

evaluating the severity of CHF within the patient based on the periodicity; and

verifying that the CSR of the patient is caused by CHF and not central sleep apnea (CSA) based on the periodicity.

11. A method for determining the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the method comprising:

tracking a periodicity associated with CSR for the patient;

detecting changes over time in the periodicity associated with CSR; and

detecting one of progression or regression of CHF within the patient over time based on the changes in the periodicity, wherein an increase in a time period of CSR corresponds to progression of CHF.

12. A system for evaluating the severity of congestive heart failure (CHF) within a patient using an implanted medical device wherein the patient also exhibits Cheyne-Stokes Respiration (CSR) caused by CHF, the system comprising:

a CSR periodicity determination unit operative to determine a periodicity associated with CSR for the patient;

a CSR periodicity-based CHF evaluation unit-operative to evaluate the severity of CHF within the patient by comparing the periodicity associated with CSR against a set of values indicative of the severity of CHF.