System and method for detecting abnormal respiration via respiratory parameters derived from intracardiac electrogram signals

• US 7,361,146 B1
• Filed: 05/01/2006
• Issued: 04/22/2008
• Est. Priority Date: 11/24/2004
• Status: Active Grant

• Current Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Original Assignee: Pacesetter Incorporated (Abbott Laboratories Incorporated)
• Inventors: Bharmi, Rupinder, Bornzin, Gene A.
• Primary Examiner(s): Marmor, II; Charles A.
• Assistant Examiner(s): Natnithithadha; Navin
• Application Number:
  US11/416,317
• Time in Patent Office: 722 Days
• Field of Search: 600/481, 600/483, 600/484, 600500-503, 600508-529, 607 17- 26
• US Class Current: 600/484
• CPC Class Codes: A61B 2562/0219 Inertial sensors, e.g. accelerometers, gyroscopes, tilt switches
• CPC Class Codes: A61B 5/0031 Implanted circuitry
• CPC Class Codes: A61B 5/02405 Determining heart rate variability
• CPC Class Codes: A61B 5/08 Detecting, measuring or recording devices for evaluating the respiratory organs A61B5/0205 takes precedence
• CPC Class Codes: A61B 5/0803 Recording apparatus specially adapted therefor
• CPC Class Codes: A61B 5/0816 Measuring devices for examining respiratory frequency measuring frequency of electric signals G01R23/00
• 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 5/145 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 5/349 Detecting specific parameters of the electrocardiograph cycle
• CPC Class Codes: A61B 5/353 Detecting P-waves
• CPC Class Codes: A61B 5/355 Detecting T-waves
• CPC Class Codes: A61B 5/366 Detecting abnormal QRS complex, e.g. widening
• CPC Class Codes: A61B 5/411 Detecting or monitoring allergy or intolerance reactions to an allergenic agent or substance
• CPC Class Codes: A61B 5/4818 Sleep apnoea
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/365 controlled by a physiological parameter, e.g. heart potential evoked response A61N1/371
• CPC Class Codes: A61N 1/37 Monitoring; Protecting

Abstract

Techniques are provided for tracking patient respiration based upon intracardiac electrogram (IEGM) signals or other electrical cardiac signals. Briefly, respiration patterns are detected based upon cycle-to-cycle changes in morphological features associated with individual electrical events with the IEGM signals. For example, slight changes in the peak amplitudes of QRS-complexes, P-waves or T-waves are tracked to identify cyclical variations representative of patient respiration. Alternatively, the integrals of the morphological features of the individual events may be calculated for use in tracking respiration. In any case, once respiration patterns have been identified, episodes of abnormal respiration, such as apnea, hyperpnea, nocturnal asthma, or the like, may be detected and therapy automatically delivered. In particular, techniques for detecting abnormal respiration based on various respiratory parameters derived from the IEGM—such as respiration depth and respiration power—are described.

Claims

1. A method for detecting abnormal respiration within a patient using an implantable medical device, the method comprising:

sensing cardiac electrical signals, identifying individual cardiac cycles therein, and identifying one or more selected electrical events within the individual cardiac cycles;

detecting one or more parameters associated with individual selected electrical events of the cardiac cycle and detecting patient respiration based on cycle-to-cycle changes in the detected parameters associated with the individual selected electrical events; and

detecting abnormal respiration by identifying individual respiratory cycles within the patient respiration, detecting one or more parameters associated with the individual respiratory cycles, including an inter-breath interval and a depth of respiration, detecting any significant changes in the parameters associated with the individual respiratory cycles, and evaluating the significant changes to detect abnormal respiration.

2. The method of claim 1 wherein the cardiac electrical signals are derived from one or more of unipolar leads and bipolar leads.

3. The method of claim 1 wherein the electrical events include depolarization events.

4. The method of claim 3 wherein the depolarization events include one or more of intrinsic atrial depolarization events (P-waves), atrial evoked responses (AER), intrinsic ventricular depolarization events (QRS-complexes), ventricular evoked responses (VER) and premature ventricular events (PVEs).

5. The method of claim 1 wherein the electrical events include repolarization events.

6. The method of claim 1 wherein the parameters associated with the electrical events comprise one or more of maximum amplitude, peak-to-peak amplitude, width and integral.

7. The method of claim 6 wherein the integral is a paced depolarization integral (PDI).

8. The method of claim 1 and further comprising:

detecting one or more intervals associated with combinations of electrical events; and

wherein

detecting patient respiration comprises processing a combination of cycle-to-cycle changes in the detected intervals and cycle-to-cycle changes in the detected parameters.

9. The method of claim 1 wherein detecting patient respiration based on cycle-to-cycle changes in the detected parameters associated with the individual selected electrical events includes

identifying baselines associated with the detected parameters;

and

correcting for changes in the baselines.

10. The method of claim 1 wherein identifying individual respiratory cycles within patient respiration comprises detecting cyclical variations in a patient respiration pattern representative of individual breaths.

11. The method of claim 10 wherein detecting one or more parameters associated with the individual respiratory cycles further includes detecting a standard deviation of the depth of respiration, and a median of depth of respiration.

12. The method of claim 11 wherein detecting the depth of respiration includes calculating a value representative of an integral of patient respiration during individual respiratory cycles.

13. The method of claim 11 further including detecting at least one parameter associated with multiple respiratory cycles.

14. The method of claim 13 wherein the parameter associated with multiple respiratory cycles represents power of respiration.

15. The method of claim 1 wherein detecting significant changes in the parameters associated with the individual respiratory cycles includes detecting one or more of gradual or abrupt changes.

16. The method of claim 1 wherein the abnormal respiration includes one or more of apnea, hypopnea, hyperpnea, asthma, Cheyne-Stokes Respiration (CSR).

17. The method of claim 1 further comprising delivering therapy upon detection of an episode of abnormal respiration.

18. A system for detecting respiration within a patient for use within an implantable medical device, the system comprising:

sensing circuitry operative to sense intracardiac electrogram (IEGM) signals;

an IEGM-based respiration detector operative to detect features associated with individual electrical events within the electrical cardiac signals and to detect patient respiration based on cycle-to-cycle changes in the features of the individual events; and

an IEGM-based abnormal respiration detector operative to identifying individual respiratory cycles within the patient respiration, detect one or more parameters associated with the individual respiratory cycles including an inter-breath interval and a depth of respiration, detect any significant changes in the parameters associated with the individual respiratory cycles, and evaluating the significant changes to detect abnormal respiration.

19. An implantable system comprising:

means for sensing electrical cardiac signals;

means for detecting patient respiration based on cycle-to-cycle changes in the electrical cardiac signals;

means for identifying individual respiratory cycles within the patient respiration;

means for detecting parameters associated with individual respiratory cycles including an inter-breath interval and a depth of respiration; and

means for detecting abnormal respiration based on changes in parameters associated with individual respiratory cycles.