Detection of disordered breathing

• US 20040111040A1
• Filed: 12/04/2002
• Published: 06/10/2004
• Est. Priority Date: 12/04/2002
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Kim, Jaeho, Hartley, Jesse W., Hatlestad, John D., Lee, Kent, Ni, Quan, Stahmann, Jeff E.
• Granted Patent: US 7,252,640 B2
• Time in Patent Office: Days
• US Class Current: 600/534
• 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 5/4806 Sleep evaluation A61B5/4821 takes precedence; devices for inducing sleep A61M21/02
• CPC Class Codes: A61B 5/4809 Sleep detection, i.e. determining whether a subject is asleep or not
• 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

Devices and methods for detecting disordered breathing involve determining that the patient is asleep and sensing one or more signals associated with disordered breathing indicative of sleep-disordered breathing while the patient is asleep. Sleep-disordered breathing is detected using the sensed signals associated with disordered breathing. The sensed signals associated with disordered breathing may also be used to acquire a respiration pattern of one or more respiration cycles. Characteristics of the respiration pattern are determined. The respiration pattern is classified as a disordered breathing episode based on the characteristics of the respiration pattern. One or more processes involved in the detection of disordered breathing are performed using an implantable device.

Claims

1. A method for detecting sleep-disordered breathing in a patient, comprising:

determining that the patient is asleep;

sensing, while the patient is asleep, one or more signals associated with sleep-disordered breathing; and

detecting sleep-disordered breathing using the one or more sensed signals, wherein at least one of determining, sensing and detecting is performed at least in part implantably.

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

3. The method of claim 1, wherein each of determining, sensing and detecting is performed at least in part implantably.

4. The method of claim 1, wherein determining that the patient is asleep further comprises:

sensing one or more sleep-related signals; and

determining that the patient is asleep using the one or more sleep-related signals.

5. The method of claim 1, wherein determining that the patient is asleep comprises determining that the patient is asleep based on a time of day.

6. The method of claim 1, wherein determining that the patient is asleep comprises determining that the patient is asleep based on a predetermined time interval from a previous period of sleep.

7. The method of claim 1, wherein determining that the patient is asleep comprises determining that the patient is asleep using a patient activity signal.

8. The method of claim 1, wherein determining that the patient is asleep comprises determining that the patient is asleep using a respiration signal.

9. The method of claim 1, wherein determining that the patient is asleep comprises determining that the patient is asleep using a patient posture signal.

10. The method of claim 1, wherein determining that the patient is asleep further comprises:

adjusting a sleep threshold associated with a first sleep-related signal using a second sleep-related signal;

comparing the first sleep-related signal to the adjusted threshold; and

detecting sleep based on the comparison.

11. The method of claim 10, further comprising establishing the sleep threshold associated with the first sleep-related signal.

12. The method of claim 10, wherein the first sleep-related signal is associated with patient movement.

13. The method of claim 10, wherein the second sleep-related signal is associated with patient respiration.

14. The method of claim 10, wherein detecting sleep further comprises confirming sleep using a third sleep-related signal.

15. The method of claim 1, wherein sensing the one or more signals associated with disordered breathing comprises sensing a signal associated with respiration.

16. The method of claim 1, wherein sensing the one or more signals associated with disordered breathing comprises sensing a signal associated with transthoracic impedance.

17. The method of claim 1, wherein detecting the sleep-disordered breathing comprises detecting sleep apnea.

18. The method of claim 1, wherein detecting the sleep-disordered breathing comprises detecting hypopnea.

19. The method of claim 1, further comprising storing information about the sleep disordered breathing for subsequent retrieval.

20. The method of claim 1, further comprising displaying information about the sleep-disordered breathing.

21. A method of detecting sleep-disordered breathing of a patient, comprising:

determining that the patient is asleep;

sensing, while the patient is asleep, one or more signals associated with sleep-disordered breathing;

establishing one or more sleep-disordered breathing indices associated with sleep-disordered breathing;

comparing the one or more indices to the one or more sensed signals; and

detecting sleep-disordered breathing based on the comparison, wherein at least one of determining, sensing, establishing comparing and detecting is performed at least in part implantably.

22. The method of claim 21, wherein establishing the one or more sleep-disordered breathing indices comprises modifying the sleep-disordered breathing indices based on a condition of the patient.

23. The method of claim 22, wherein the condition of the patient comprises a cardiopulmonary disease condition.

24. The method of claim 21, further comprising adapting a sensitivity of a particular sleep-disordered breathing index based on one or more previously detected episodes of sleep-disordered breathing.

25. The method of claim 24, wherein adapting the sensitivity of the particular sleep-disordered breathing index comprises adapting the sensitivity based on a frequency of the one or more previously detected episodes of sleep-disordered breathing.

26. The method of claim 24, wherein adapting the sensitivity of the sleep-disordered breathing index comprises adapting the sensitivity based on a severity of the one or more previously detected episodes of sleep-disordered breathing.

27. The method of claim 24, wherein adapting the sensitivity of the sleep-disordered breathing index comprises adapting the sensitivity based on a an interval between two or more previously detected episodes of sleep-disordered breathing.

32. The method of claim 26, wherein detecting a respiration pattern comprises measuring transthoracic impedance.

28. A method for detecting sleep-disordered breathing of a patient, 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 sleep-disordered breathing based on the one or more characteristics of the respiration pattern, wherein at least one of detecting, determining and classifying is performed at least in part implantably.

29. The method of claim 28, further comprising determining that the patient is asleep.

30. The method of claim 28, wherein at least two of detecting, determining, and classifying is performed at least in part implantably.

31. The method of claim 28, wherein at each of detecting, determining, and classifying is performed at least in part implantably.

33. The method of claim 28, wherein classifying the respiration pattern as sleep-disordered breathing comprises:

establishing a sleep-disordered breathing index;

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

detecting sleep-disordered breathing based on the comparison.

34. The method of claim 33, wherein establishing the sleep-disordered breathing index comprises modifying the sleep-disordered breathing index based on a condition of the patient.

35. The method of claim 34, wherein the condition of the patient comprises a cardiopulmonary disease condition.

36. The method of claim 33, further comprising adapting a sensitivity of the sleep-disordered breathing index based on one or more previously detected episodes of sleep-disordered breathing.

37. The method of claim 36, wherein adapting the sensitivity of the sleep-disordered breathing index comprises adapting the sensitivity based on a frequency of the one or more previously detected episodes of sleep-disordered breathing.

38. The method of claim 36, wherein adapting the sensitivity of the sleep-disordered breathing index comprises adapting the sensitivity based on a severity of the one or more previously detected episodes of sleep-disordered breathing.

39. The method of claim 38, wherein adapting the sensitivity of the sleep-disordered breathing index comprises adapting the sensitivity based on an interval between two or more previously detected episodes of sleep-disordered breathing.

40. The method of claim 28, wherein:

determining the one or more characteristics of the respiration pattern comprises determining a non-breathing interval; and

classifying the respiration pattern as sleep-disordered breathing comprises classifying the respiration pattern as apnea by comparing the non-breathing interval to a predetermined sleep apnea interval.

41. The method of claim 28, wherein:

determining the one or more characteristics of the respiration pattern comprises determining a non-breathing interval; and

classifying the respiration pattern as sleep-disordered breathing comprises classifying the respiration pattern as severe sleep apnea by comparing the non-breathing interval to a predetermined severe sleep apnea interval.

42. The method of claim 28, wherein:

determining the one or more characteristics of the respiration pattern comprises determining a tidal volume of each respiration cycle and a duration of the respiration pattern; and

classifying the respiration pattern as sleep-disordered breathing comprises classifying the respiration pattern as hypopnea by comparing the tidal volume of each respiration cycle to a tidal volume index and comparing the duration of the respiration pattern to a predetermined duration threshold.

43. The method of claim 28, wherein:

determining the one or more characteristics of the respiration pattern comprises determining a breathing interval; and

classifying the respiration pattern as sleep-disordered breathing comprises classifying the respiration pattern as apnea by comparing the breathing interval to a predetermined duration threshold.

44. The method of claim 28, further comprising storing information about the sleep-disordered breathing.

45. The method of claim 28, further comprising displaying information about the sleep-disordered breathing.

46. A method for detecting disordered breathing of a patient, 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, wherein at least one of detecting, determining and classifying is performed at least in part implantably.

47. The method of claim 46, wherein detecting the respiration pattern comprises detecting the respiration pattern while the patient is awake.

48. The method of claim 46, wherein detecting a respiration pattern comprises measuring transthoracic impedance.

49. The method of claim 46, wherein classifying the respiration pattern as disordered breathing comprises:

establishing a disordered breathing index;

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

detecting disordered breathing based on the comparison.

50. The method of claim 49, further comprising adapting a sensitivity of the disordered breathing index based on one or more previously detected episodes of disordered breathing.

51. The method of claim 46, wherein classifying the respiration pattern as disordered breathing comprises classifying the respiration pattern as periodic breathing.

52. The method of claim 46, wherein classifying the respiration pattern as disordered breathing comprises classifying the respiration pattern as Cheyne-Stokes breathing.

53. A sleep-disordered breathing detection device, comprising:

a sensor system configured to sense one or more signals indicative of sleep-disordered breathing;

a sleep detector for determining that a patient is asleep; and

a sleep-disordered breathing detector coupled to the sensor system and the sleep detector, the sleep-disordered breathing detector arranged to detect sleep-disordered breathing based on an output of the sleep detector and the one more signals indicative of sleep sleep-disordered breathing, wherein at least one of the sensor system, sleep detector, and the sleep-disordered breathing detector uses an implantable component.

54. The device of claim 53, wherein at least two of the sensor system, sleep detector, and the sleep-disordered breathing detector uses an implantable component.

55. The device of claim 53, wherein at each of the sensor system, sleep detector, and the sleep-disordered breathing detector uses an implantable component.

56. The device of claim 53, wherein the sleep detector is configured to adjust a sleep threshold associated with a first sleep-related signal using a second sleep related signal, compare the first sleep-related signal to the adjusted threshold, and detect sleep based on the comparison.

57. The device of claim 53, wherein the first sleep-related signal is associated with patient movement.

58. The device of claim 56, wherein the sleep detector comprises an accelerometer, and the first sleep-related signal comprises an accelerometer signal produced by the accelerometer.

59. The device of claim 56, wherein the second sleep-related signal is associated with patient respiration.

60. The device of claim 56, wherein the second sleep-related signal comprises a transthoracic impedance signal.

61. The device of claim 56, wherein the sleep detector is configured to confirm sleep using a third sleep-related signal.

62. The device of claim 53, wherein the sleep-disordered breathing detector is configured to detect apnea.

63. The device of claim 53, wherein the sleep-disordered breathing detector is configured to detect hypopnea.

64. The device of claim 53, wherein the sleep-disordered breathing detector is configured to detect episodes of sleep-disordered breathing comprising both apnea and hypopnea.

65. The device of claim 53, wherein the sleep-disordered breathing detector is configured to establish one or more sleep-disordered breathing indices associated with sleep-disordered breathing, compare the one or more indices to the one or more sensed signals, and detect sleep-disordered breathing based on the comparison.

66. The device of claim 65, wherein the sleep-disordered breathing detector is configured to adapt a sensitivity of a sleep-disordered breathing index based on one or more previously detected episodes of sleep-disordered breathing.

67. A device for detecting sleep-disordered breathing of a patient, comprising:

a sensor system configured to detect a respiration pattern of one or more respiration cycles; and

a detector system coupled to the sensor system and configured to determine one or more characteristics of the respiration pattern and classify the respiration pattern as sleep-disordered breathing using the one or more characteristics of the respiration pattern, wherein at least one of the sensor system and the detector system uses an implantable component.

68. The device of claim 67, wherein each of the sensor system and the detector system uses an implantable component.

69. The device of claim 67, wherein the sensor system is configured to detect the respiration patterns by measuring transthoracic impedance.

70. The device of claim 67, wherein the detector system is configured to establish a sleep-disordered breathing index, compare the one or more characteristics to the sleep-disordered breathing index, and classify the respiration patterns as sleep-disordered breathing based on the comparison.

71. The device of claim 70, wherein the detector system is configured to modify the sleep-disordered breathing index based on a condition of the patient.

72. The device of claim 67, wherein the detector system is configured to adapt a sensitivity of a sleep-disordered breathing index based on one or more previously detected episodes of sleep-disordered breathing.

73. The device of claim 67, wherein the detector system is configured to determine a non-breathing interval.

74. The device of claim 73, wherein the detector system is configured to compare the non-breathing interval to a predetermined sleep apnea interval and classify the respiration pattern as sleep apnea based on the comparison.

75. The device of claim 73, wherein the detector system is configured to compare the non-breathing interval to a predetermined severe sleep apnea interval and classify the respiration pattern as severe sleep apnea based on the comparison.

76. The device of claim 67, wherein the detector system is configured to determine a tidal volume of each respiration cycle and a duration of the respiration pattern.

77. The device of claim 76, wherein the detector system is configured to compare the tidal volume of each respiration cycle to a tidal volume threshold, compare the duration of the respiration pattern to a predetermined duration threshold, and classify the respiration pattern as hypopnea based on the comparison.

78. The device of claim 67, wherein the detector system is configured to determine a respiration rate of the respiration pattern.

79. The device of claim 78, wherein the detector system is configured to compare the respiration rate of the respiration pattern to a predetermined respiration rate index and classify the respiration pattern as sleep-disordered breathing based on the comparison.

80. The device of claim 67, wherein the detector system is configured to determine a breathing interval of each respiration cycle.

81. The device of claim 80, wherein the detector system is configured to compare the breathing interval of each respiration cycle to a predetermined duration threshold and classify the respiration pattern as apnea based on the comparison.

82. A device for detecting disordered breathing of a patient, comprising:

a sensor system configured to detect a respiration pattern of one or more respiration cycles; and

a detector system coupled to the sensor system and configured to determine one or more characteristics of the respiration pattern and classify the respiration pattern as disordered breathing using the one or more characteristics of the respiration pattern, wherein at least one of the sensor system and the detector system uses an implantable component.

83. The device of claim 82, wherein the sensor system is configured to detect the respiration patterns by measuring transthoracic impedance.

84. The device of claim 82, wherein the detector is configured to establish a disordered breathing index, compare the one or more characteristics to the sleep-disordered breathing index, and classify the respiration patterns as disordered breathing based on the comparison.

85. The device of claim 84, wherein the detector system is configured to modify the disordered breathing index based on a condition of the patient.

86. The device of claim 84, wherein the detector system is configured to adapt a sensitivity of the disordered breathing index based on one or more previously detected episodes of disordered breathing.

87. A system for detecting sleep-disordered breathing, comprising:

means for determining that the patient is asleep;

means for sensing, while the patient is asleep, one or more signals indicative of sleep-disordered breathing; and

means for detecting sleep-disordered breathing based on the one or more sensed signals associated with disordered breathing, wherein at least one of the means for determining, means for sensing, and means for detecting uses an implantable component.

88. A disordered breathing detection system, comprising:

means for detecting a respiration pattern of one or more respiration cycles;

means for determining one or more characteristics of the respiration pattern; and

means for classifying the respiration pattern as disordered breathing based on the one or more characteristics of the respiration pattern, wherein at least one of the means for detecting, means for determining and means for classifying uses an implantable component.

89. The system of claim 88, wherein the means for detecting the respiration pattern comprises means for detecting the respiration pattern while the patient is awake.

90. The system of claim 88, wherein the means for detecting the respiration pattern comprises means for detecting the respiration pattern while the patient is asleep.