Adaptive therapy for disordered breathing

• US 8,321,022 B2
• Filed: 03/24/2010
• Issued: 11/27/2012
• Est. Priority Date: 08/18/2003
• 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., Hatlestad, John D., Ni, Quan, Hartley, Jesse, Daum, Douglas R., Lee, Kent
• Primary Examiner(s): Layno, Carl H
• Assistant Examiner(s): Dinga, Roland
• Application Number:
  US12/731,103
• Publication Number:
  US 20100179613A1
• Time in Patent Office: 979 Days
• Field of Search: 607/2, 607/17, 607/20, 607/42, 600534-543
• US Class Current: 607/42
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/091 Measuring volume of inspired or expired gases, e.g. to determine lung capacity
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61B 5/686 Permanently implanted devices, e.g. pacemakers, other stimulators, biochips A61B5/6861 takes precedence
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/3611 Respiration control stimulating respiratory organs A61N1/3601
• CPC Class Codes: A61N 1/362 Heart stimulators heart defibrillators A61N1/39
• CPC Class Codes: A61N 1/3628 using sub-threshold or non-excitatory signals

Abstract

An approach to providing disordered breathing therapy includes detecting disordered breathing and adapting a therapy to mitigate the disordered breathing. The therapy may be adapted to enhance therapy effectiveness, to provide therapy that reduces an impact of the therapy on the patient, or to achieve other therapeutic goals. Cardiac electrical therapy to mitigate the disordered breathing may include various cardiac pacing regimens and/or delivery of non-excitatory electrical stimulation to the heart.

Claims

1. An automated method for providing therapy to a patient, comprising:

detecting, via detector system, patient conditions that include disordered breathing;

delivering a cardiac electrical therapy via a therapy control system to mitigate the disordered breathing;

detecting an interaction between a therapy to treat a cardiac disorder and the cardiac electrical therapy to mitigate the disordered breathing;

assessing an efficacy of the cardiac electrical therapy via the therapy control system based on one or more first conditions of the detected patient conditions;

assessing a negative impact of the cardiac electrical therapy on a patient via the therapy control system based on one or more second conditions of the detected patient conditions, the one or more first conditions differing from the one or more second conditions at least in part;

adapting the cardiac electrical therapy via the therapy control system to a) promote the therapy efficacy, and b) reduce the negative impact of the therapy on the patient; and

delivering the adapted cardiac electrical therapy to the patient, wherein at least one of detecting, adapting, and delivering is performed at least in part implantably.

2. The method of claim 1, further comprising:

using a first group of the patient conditions to detect the disordered breathing; and

using a second group of the patient conditions to adapt the therapy to mitigate the disordered breathing.

3. The method of claim 1, wherein detecting the patient conditions comprises detecting one or more of physiological conditions, respiratory system conditions, respiration patterns, cardiovascular system conditions, nervous system conditions, blood chemistry conditions, non-physiological conditions, contextual conditions, environmental conditions, and body-related conditions.

4. The method of claim 1, wherein detecting the disordered breathing comprises detecting the disordered breathing if a respiration tidal volume falls below a predetermined threshold.

5. The method of claim 1, wherein adapting the therapy comprises adjusting one or more of a pacing rate, a pacing energy, a pacing mode, and a pacing site of the therapy.

6. The method of claim 1, wherein adapting the therapy comprises adapting one or more of an atrial, ventricular, bi-ventricular, and multi-site pacing therapy.

7. The method of claim 1, wherein adapting the therapy to mitigate the disordered breathing comprises adapting the therapy to mitigate one or more of apnea, hypopnea, and Cheyne-Stokes respiration.

8. An automated method for providing therapy to a patient, comprising:

detecting, via a detector system, patient conditions that include disordered breathing comprising;

detecting a respiration pattern of one or more respiration cycles;

determining one or more characteristics of the respiration pattern; and

classifying the respiration pattern as disordered breathing based on the one or more characteristics of the respiration pattern;

delivering a cardiac electrical therapy via a therapy control system to mitigate the disordered breathing;

assessing an efficacy of the therapy via the therapy control system based on one or more first conditions of the detected patient conditions;

assessing a negative impact of the therapy on a patient via the therapy control system based on one or more second conditions of the detected patient conditions, the one or more first conditions differing from the one or more second conditions at least in part;

adapting the cardiac electrical therapy via the therapy control system to a) promote the therapy efficacy, and b) reduce the negative impact of the therapy on the patient; and

delivering the adapted therapy to the patient, wherein at least one of detecting, adapting, and delivering is performed at least in part implantably.

9. The method of claim 8, wherein classifying the respiration pattern comprises classifying one or more of apnea, hypopnea, and Cheyne-Stokes respiration.

10. The method of claim 8, further comprising:

establishing a disordered breathing index;

comparing the one or more of the characteristics of the respiration pattern to the disordered breathing index; and

detecting the disordered breathing based on the comparison.

11. The method of claim 10, further comprising adapting a sensitivity of the disordered breathing index.

12. An automated method for providing therapy to a patient, comprising:

detecting, via a detector system, patient conditions that include disordered breathing;

delivering a cardiac electrical therapy via a therapy control system to mitigate the disordered breathing;

assessing an efficacy of the therapy via the therapy control system based on one or more first conditions of the detected patient conditions;

assessing a negative impact of the therapy on a patient via the therapy control system based on one or more second conditions of the detected patient conditions, the one or more first conditions differing from the one or more second conditions at least in part;

adapting the cardiac electrical therapy via the therapy control system to a) promote the therapy efficacy, and b) reduce the negative impact of the therapy on the patient, by adapting a therapy involving non-excitatory electrical stimulation to a heart; and

delivering the adapted cardiac electrical therapy to the patient, wherein at least one of detecting, adapting, and delivering is performed at least in part implantably.

13. An automated method of providing therapy to a patient, comprising:

detecting, via detector system, patient conditions that include disordered breathing;

delivering a cardiac electrical therapy via a therapy control system to mitigate the disordered breathing;

assessing a negative impact of the therapy on a patient via the therapy control system based on at least one first condition of the detected patient conditions other than sleep fragmentation;

adapting the cardiac electrical therapy via the therapy control system to reduce the negative impact of the therapy on the patient; and

delivering the adapted therapy to the patient via a therapy delivery system, wherein at least one of detecting, adapting, and delivering is performed at least in part implantably.

14. The method of claim 13, further comprising adapting the cardiac electrical therapy toward balancing the negative impact of the therapy with an efficacy of the therapy at mitigating the disordered breathing.

15. The method of claim 13, wherein the negative impact of the therapy comprises a decreased lifetime of the medical device.

16. The method of claim 13, wherein the negative impact of the therapy comprises stress on physiological systems.

17. The method of claim 13, wherein the negative impact of the therapy comprises patient discomfort.

18. The method of claim 13, wherein the negative impact of the therapy comprises interaction with cardiac pacing algorithms.

19. The method of claim 13, further comprising adapting the cardiac electrical therapy to reduce the negative impact on sleep quality caused by the therapy.