Method of improving sleep disordered breathing
First Claim
1. A method of improving sleep in a patient with a centrally mediated sleep disorder by using a system comprising an external stimulator and one or more electrodes configured for implantation in a diaphragm for stimulation of the diaphragm, the method comprising:
- adapting stimulation parameters to support respiration during sleep,stimulating the diaphragm in a therapeutic regimen with the one or more electrodes to support respiration after the onset of sleep, the regimen including the adapted stimulation parameters, the stimulation operating independently of any intrinsic respiratory effort of the patient, the stimulation comprising one or more stimulation pulses configured to initiate a breath and support the breath to completion; and
after implementing the therapeutic regimen, evaluating the patient again for presence of sleep disordered breathing by any one or more diagnostic criteria including morning headaches, daytime sleepiness, polysomnography (PSG) recordings consistent with disordered sleep, diaphragm electromyography (EMG) recordings during sleep consistent with disordered sleep, or pulmonary function test data consistent with disordered sleep.
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Accused Products
Abstract
A diaphragm pacing stimulatory method and a system to implement the method are provided to improve respiratory function and the quality of sleep in patients whose sleep is compromised by poor respiration. The diaphragm pacing method includes adaptations that make it particularly compatible with the onset of sleep and sustaining sleep. Embodiments of the method are operated independently of breathing effort the patient may make during sleep. Patients for whom the invention is appropriate include those with a neuromuscular disease, such as amyotrophic lateral sclerosis (ALS). System elements include an external electrical stimulator coupled to one or more implanted electrodes that stimulate diaphragm contraction. The system and method provide for a pacing of the diaphragm, improved breathing, and improved sleep. Features of improved sleep include longer sleep time, an increased amount of REM sleep, and fewer episodes of wakefulness and restlessness.
219 Citations
20 Claims
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1. A method of improving sleep in a patient with a centrally mediated sleep disorder by using a system comprising an external stimulator and one or more electrodes configured for implantation in a diaphragm for stimulation of the diaphragm, the method comprising:
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adapting stimulation parameters to support respiration during sleep, stimulating the diaphragm in a therapeutic regimen with the one or more electrodes to support respiration after the onset of sleep, the regimen including the adapted stimulation parameters, the stimulation operating independently of any intrinsic respiratory effort of the patient, the stimulation comprising one or more stimulation pulses configured to initiate a breath and support the breath to completion; and after implementing the therapeutic regimen, evaluating the patient again for presence of sleep disordered breathing by any one or more diagnostic criteria including morning headaches, daytime sleepiness, polysomnography (PSG) recordings consistent with disordered sleep, diaphragm electromyography (EMG) recordings during sleep consistent with disordered sleep, or pulmonary function test data consistent with disordered sleep. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17)
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18. A method of improving sleep in a patient with a centrally mediated sleep disorder by using a system comprising an external stimulator and one or more electrodes configured for implantation in a diaphragm for stimulation of the diaphragm, the method comprising:
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adapting stimulation parameters to support respiration during sleep, stimulating the diaphragm in a therapeutic regimen with the one or more electrodes to support respiration after the onset of sleep, the regimen including the adapted stimulation parameters, the stimulation operating independently of any intrinsic respiratory effort of the patient, the stimulation comprising one or more stimulation pulses configured to initiate a breath and support the breath to completion; and in the event of a finding of continued presence of sleep-disordered breathing, revising the adapted stimulation parameters, and implementing a revised therapeutic regimen for the patient based on the revised parameters, the regimen comprising stimulating the diaphragm with the one or more electrodes to support respiration.
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19. A method of improving sleep in a patient with a centrally mediated sleep disorder by using a system comprising an external stimulator and one or more electrodes configured for implantation in a diaphragm for stimulation of the diaphragm, the method comprising:
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adapting stimulation parameters to support respiration during sleep, stimulating the diaphragm in a therapeutic regimen with the one or more electrodes to support respiration after the onset of sleep, the regimen including the adapted stimulation parameters, the stimulation operating independently of any intrinsic respiratory effort of the patient, the stimulation comprising one or more stimulation pulses configured to initiate a breath and support the breath to completion; and wherein the stimulating the diaphragm after onset of sleep comprises determining the onset of sleep by monitoring a level of one or more physiological parameters and determining when they fall below a threshold value, the parameters including any of a diaphragm EMG, an EEG, or body movement.
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20. A method of improving sleep in a patient with a centrally mediated sleep disorder by using a system comprising an external stimulator and one or more electrodes configured for implantation in a diaphragm for stimulation of the diaphragm, the method comprising:
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adapting stimulation parameters to support respiration during sleep, stimulating the diaphragm in a therapeutic regimen with the one or more electrodes to support respiration after the onset of sleep, the regimen including the adapted stimulation parameters, the stimulation operating independently of any intrinsic respiratory effort of the patient, the stimulation comprising one or more stimulation pulses configured to initiate a breath and support the breath to completion; and detecting the onset of sleep and adapting the stimulation parameters in response to the detection of the onset of sleep.
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Specification