System and method for discrimination of central and obstructive disordered breathing events

• US 7,510,531 B2
• Filed: 04/15/2004
• Issued: 03/31/2009
• Est. Priority Date: 09/18/2003
• Status: Expired due to Fees

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Stahmann, Jeffrey E., Hartley, Jesse W., Hatlestad, John D., Lee, Kent, Zhu, Qingsheng, Ni, Quan
• Primary Examiner(s): Hindenburg; Max
• Assistant Examiner(s): Toth; Karen E
• Application Number:
  US10/824,776
• Publication Number:
  US 20050074741A1
• Time in Patent Office: 1,811 Days
• Field of Search: 600529-543
• US Class Current: 600/534
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• 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 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/11 Measuring movement of the entire body or parts thereof, e.g. head or hand tremor, mobility of a limb for measuring pulse A61B5/02 ;A61B5/1038 takes precedence; motion detection to correct for motion artifacts in physiological signals A61B5/721
• CPC Class Codes: A61B 5/113 occurring during breathing
• CPC Class Codes: A61B 5/1135 by monitoring thoracic expansion
• CPC Class Codes: A61B 5/291 for electroencephalography [EEG]
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/398 Electrooculography [EOG], e.g. detecting nystagmus; Electroretinography [ERG]
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/7264 Classification of physiological signals or data, e.g. using neural networks, statistical classifiers, expert systems or fuzzy systems neural networks per se G06N3/00; expert systems per se G06N5/00
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

Disordered breathing events may be classified as central, obstructive or a combination of central an obstructive in origin based on patient motion associated with respiratory effort. Central disordered breathing is associated with disrupted respiration with reduced respiratory effort. Obstructive disordered breathing is associated with disrupted respiration accompanied by respiratory effort. A disordered breathing classification system includes a disordered breathing detector and a respiratory effort motion sensor. Components of the disordered breathing classification system may be fully or partially implantable.

Claims

1. A method for classifying disordered breathing in a patient, comprising:

detecting a disordered breathing event;

sensing motion associated with respiratory effort during the disordered breathing event; and

classifying the disordered breathing event based on the sensed motion, wherein at least one of detecting, sensing, and classifying is performed at least in part implantably;

wherein classifying the disordered breathing event comprises classifying the disordered breathing event as a mixed central and obstructive disordered breathing event if the motion associated with respiratory effort is equal to or above a motion threshold during a first portion of the disordered breathing event and the motion associated with respiratory effort is below the motion threshold during a second portion of the disordered breathing event.

2. The method of claim 1, wherein at least two of detecting, sensing, and classifying are performed at least in part implantably.

3. The method of claim 1, wherein all of detecting, sensing, and classifying are performed at least in part implantably.

4. The method of claim 1, wherein the disordered breathing event comprises sleep disordered breathing.

5. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on respiration patterns.

6. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on transthoracic impedance measurements.

7. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on respiratory system conditions.

8. The method of claim 1, wherein sensing the motion associated with respiratory effort during the disordered breathing event comprises sensing chest wall motion associated with the respiratory effort.

9. The method of claim 1, wherein sensing the motion associated with respiratory effort during the disordered breathing event comprises sensing abdominal motion associated with respiratory effort.

10. The method of claim 1, wherein sensing the motion associated with respiratory effort during the disordered breathing event comprises distinguishing the motion associated with respiratory effort from other types of motion.

11. The method of claim 1, wherein classifying the disordered breathing event comprises classifying the disordered breathing event as a central disordered breathing event.

12. The method of claim 1, wherein classifying the disordered breathing event comprises classifying the disordered breathing event as an obstructive disordered breathing event.

13. The method of claim 1, wherein classifying the disordered breathing event comprises classifying the disordered breathing event as an obstructive disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is equal to or above a second motion threshold.

14. The method of claim 1, wherein classifying the disordered breathing event comprises classifying the disordered breathing event as a central disordered breathing event if motion associated with respiratory effort is below a second motion threshold.

15. The method of claim 1, wherein classifying the disordered breathing event comprises discriminating between central disordered breathing and obstructive disordered breathing.

16. The method of claim 1, further comprising storing information associated with the disordered breathing event.

17. The method of claim 1, further comprising transmitting information associated with the disordered breathing event.

18. The method of claim 1, further comprising displaying information associated with the disordered breathing event.

19. The method of claim 1, further comprising using the classification of the disordered breathing event to evaluate disordered breathing trends.

20. The method of claim 1, further comprising delivering a therapy to treat disordered breathing based on the classification of the disordered breathing event.

21. The method of claim 1, further comprising modifying a therapy delivered to the patient based on the classification of the disordered breathing event.

22. The method of claim 21, wherein the modified therapy is a disordered breathing therapy.

58. The method of claim 1, wherein the disordered breathing event comprises Cheyne-Stokes respiration.

59. The method of claim 1, wherein the disordered breathing event comprises periodic breathing.

60. The method of claim 1, wherein the disordered breathing event comprises apnea.

61. The method of claim 1, wherein the disordered breathing event comprises hypopnea.

62. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on blood gas level.

63. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on cardiovascular system conditions.

64. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on cardiopulmonary conditions.

65. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on nervous system conditions.

66. The method of claim 1, wherein detecting the disordered breathing event comprises detecting the disordered breathing event based on non-physiological conditions.

23. A system for classifying disordered breathing, comprising:

a disordered breathing detector configured to detect a disordered breathing event;

a motion sensor configured to sense motion associated with respiratory effort of a patient during the disordered breathing event; and

a disordered breathing classification processor coupled to the motion sensor and the disordered breathing detector, the disordered breathing classification processor configured to classify the disordered breathing event based on the respiratory effort motion, wherein at least one of the disordered breathing detector, the motion sensor, and the disordered breathing classification processor is at least in part implantable;

wherein the disordered breathing classification processor is configured to classify the disordered breathing event as an obstructive disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is equal to or above a motion threshold during a first portion of the disordered breathing event and classify the disordered breathing event as a central disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is below the motion threshold during a second portion of the disordered breathing event.

24. The system of claim 23, wherein at least two of the disordered breathing detector, the motion sensor, and the disordered breathing classification processor are at least in part implantable.

25. The system of claim 23, wherein the disordered breathing detector, the motion sensor, and the disordered breathing classification processor are at least in part implantable.

26. The system of claim 23, wherein the disordered breathing detector comprises a sensor configured to sense patient respiration.

27. The system of claim 26, wherein the respiration sensor comprises a transthoracic impedance sensor.

28. The system of claim 23, wherein the disordered breathing detector comprises a sensor configured to sense respiration system conditions.

29. The system of claim 23, wherein the motion sensor comprises an accelerometer.

30. The system of claim 23, wherein the motion sensor is configured to sense chest wall motion.

31. The system of claim 23, wherein the motion sensor is configured to sense abdominal motion.

32. The system of claim 23, wherein the disordered breathing classification processor is configured to classify the disordered breathing event as a mixed central and obstructive disordered breathing event.

33. The system of claim 23, wherein the disordered breathing classification processor is configured to discriminate between central and obstructive disordered breathing.

34. The system of claim 23, wherein the disordered breathing classification processor is configured to classify the disordered breathing event as an obstructive disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is equal to or above a second motion threshold.

35. The system of claim 23, wherein the disordered breathing classification processor is configured to classify the disordered breathing event as a central disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is below a second motion threshold.

36. The system of claim 23, wherein the disordered breathing classification processor is configured to distinguish between the motion associated with respiratory effort and other types of motion.

37. The system of claim 23, wherein at least one of the motion sensor and the disordered breathing detector is wirelessly coupled to the disordered breathing classification processor.

38. The system of claim 23, wherein at least one of the motion sensor, the disordered breathing detector, and the disordered breathing classification processor is mechanically coupled to a cardiac rhythm management device.

39. The system of claim 23, wherein at least one of the motion sensor, the disordered breathing detector, and the disordered breathing classification processor is mechanically coupled to a positive airway pressure device.

40. The system of claim 23, wherein at least one of the motion sensor, the disordered breathing detector, and the disordered breathing classification processor is coupled to a patient management system.

41. The system of claim 23, further comprising a memory coupled to the disordered breathing classification processor and configured to store information about the disordered breathing event.

42. The system of claim 23, further comprising a display device coupled to the disordered breathing classification processor and configured to display information about the disordered breathing event.

43. The system of claim 23, further comprising a therapy unit coupled to the disordered breathing classification processor and configured to deliver therapy to the patient to treat disordered breathing.

44. The system of claim 23, further comprising a therapy delivery unit coupled to the disordered breathing classification processor and configured to modify a therapy delivered to the patient based on the classification of the disordered breathing event.

52. The system of claim 23, wherein the disordered breathing event comprises apnea.

53. The system of claim 23, wherein the disordered breathing detector event comprises hypopnea.

67. The system of claim 26, wherein the respiration sensor comprises a microphone configured to detect snoring sounds.

68. The system of claim 26, wherein the respiration sensor comprises an airflow sensor.

69. The system of claim 26, wherein the respiration sensor comprises a sensor configured to sense blood gas.

70. The system of claim 26, wherein the respiration sensor comprises a sensor configured to sense cardiovascular system conditions.

71. The system of claim 23, wherein the disordered breathing detector comprises a sensor configured to sense nervous system conditions.

72. The system of claim 23, wherein the disordered breathing detector comprises a sensor configured to sense muscle system conditions.

73. The system of claim 23, wherein the disordered breathing detector comprises a sensor configured to sense non-physiological conditions.

74. The system of claim 23, wherein the motion sensor comprises a transthoracic impedance sensor.

75. The system of claim 23, wherein the motion sensor comprises a respiratory band.

76. The system of claim 23, wherein the motion sensor comprises a switch.

77. The system of claim 23, wherein the motion sensor comprises an electromyogram sensor.

45. A disordered breathing classification system, comprising:

means for detecting a disordered breathing event;

means for sensing motion associated with respiratory effort during the disordered breathing event; and

means for classifying the disordered breathing event based on the sensed motion, wherein at least one of the means for sensing, the means for detecting, and the means for classifying is at least partially implantable;

wherein the classifying means is configured to classify the disordered breathing event as a mixed central and obstructive disordered breathing event if the motion associated with respiratory effort is equal to or above a motion threshold during a first portion of the disordered breathing event and the motion associated with respiratory effort is below the motion threshold during a second portion of the disordered breathing event.

46. The system of claim 45, further comprising means for storing information associated with the disordered breathing event.

47. The system of claim 45, further comprising means for transmitting information associated with the disordered breathing event.

48. The system of claim 45, further comprising means for displaying information associated with the disordered breathing event.

49. The system of claim 45, further comprising means for using the classification of the disordered breathing event to evaluate disordered breathing trends.

50. The system of claim 45, further comprising means for delivering a therapy for disordered breathing based on the classification of the disordered breathing event.

51. The system of claim 45, further comprising means for modifying a therapy delivered to the patient based on the classification of the disordered breathing event.

54. A method for classifying disordered breathing in a patient, comprising:

detecting a disordered breathing event;

sensing motion associated with respiratory effort during the disordered breathing event; and

classifying the disordered breathing event based on the sensed motion, wherein at least one of detecting, sensing, and classifying is performed at least in part implantably;

wherein classifying the disordered breathing event comprises classifying the disordered breathing event as an obstructive disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is equal to or above a motion threshold during a first portion of the disordered breathing event and classifying the disordered breathing event as a central disordered breathing event if the motion associated with respiratory effort during the disordered breathing event is below the motion threshold during a second portion of the disordered breathing event.

55. The method of claim 54, further comprising storing information associated with the disordered breathing event.

56. A system for classifying disordered breathing, comprising:

a disordered breathing detector configured to detect a disordered breathing event;

a motion sensor configured to sense motion associated with respiratory effort of a patient during the disordered breathing event; and

a disordered breathing classification processor coupled to the motion sensor and the disordered breathing detector, the disordered breathing classification processor configured to classify the disordered breathing event based on the respiratory effort motion, wherein at least one of the disordered breathing detector, the motion sensor, and the disordered breathing classification processor is at least in part implantable;

wherein the disordered breathing classification processor is configured to classify the disordered breathing event as a mixed central and obstructive disordered breathing event if the motion associated with respiratory effort is equal to or above a motion threshold during a first portion of the disordered breathing event and the motion associated with respiratory effort is below the motion threshold during a second portion of the disordered breathing event.

57. The system of claim 56, further comprising a memory coupled to the disordered breathing classification processor and configured to store information about the disordered breathing event.