Autonomic arousal detection system and method

• US 8,606,356 B2
• Filed: 08/17/2004
• Issued: 12/10/2013
• 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: Lee, Kent, Ni, Quan, Hartley, Jesse W., Stahmann, Jeffrey E.
• Primary Examiner(s): MANUEL, GEORGE C
• Application Number:
  US10/920,675
• Publication Number:
  US 20050076908A1
• Time in Patent Office: 3,402 Days
• Field of Search: 600/508, 600/513, 600/544, 600/595, 600/546, 600/547, 607/17, 607/20, 607/42
• US Class Current: 607/17
• CPC Class Codes: A61B 5/0809 by impedance pneumography
• CPC Class Codes: A61B 5/113 occurring during breathing
• CPC Class Codes: A61B 5/4035 Evaluating the autonomic nervous system
• CPC Class Codes: A61B 5/4519 Muscles A61B5/389, A61B5/224 take precedence
• 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: A61M 16/024 including calculation means, e.g. using a processor
• CPC Class Codes: A61M 16/06 Respiratory or anaesthetic masks
• CPC Class Codes: A61M 2205/054 with electrotherapy
• CPC Class Codes: A61M 2205/3569 sublocal, e.g. between console and disposable
• CPC Class Codes: A61M 2205/3592 using telemetric means, e.g. radio or optical transmission
• CPC Class Codes: A61M 2230/04 Heartbeat characteristics, e.g. ECG, blood pressure modulation
• CPC Class Codes: A61M 2230/10 Electroencephalographic signals
• CPC Class Codes: A61M 2230/60 Muscle strain, i.e. measured on the user
• CPC Class Codes: A61M 2230/63 Motion, e.g. physical activity
• CPC Class Codes: A61N 1/3601 of respiratory organs
• CPC Class Codes: A61N 1/36135 using physiological parameters
• CPC Class Codes: A61N 1/3614 based on impedance measurement
• CPC Class Codes: A61N 1/3629 in combination with non-electric therapy
• CPC Class Codes: A61N 1/36514 controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by two or more physical parameters A61N1/36585

Abstract

Various approaches to detecting arousals from sleep involve generating signals modulated by muscle tone, brainwave activity, and/or other nervous system activity associated with a patient'"'"'s autonomic arousal response. Generating the signals and/or detecting autonomic arousals from sleep may be performed using an implantable device. Arousal information may be useful to identify sleep disorder events associated with arousals from sleep, for diagnostic purposes, and/or for therapy adjustment.

Claims

1. A method for acquiring sleep information, comprising:

sensing one or more physiological conditions modulated by a patient'"'"'s autonomic arousal response;

detecting autonomic arousal events occurring during sleep based on the one or more sensed physiological conditions;

detecting one or more sleep disorder events; and

discriminating between autonomic arousal events associated with sleep disorder events and autonomic arousal events not associated with sleep disorder events, wherein at least one of sensing the physiological conditions and detecting the autonomic arousal events is performed at least in part implantably and wherein sensing the one or more physiological conditions comprises sensing muscle tone, and wherein detecting the autonomic arousal events comprises detecting the autonomic arousal events based at least in part on the sensed muscle tone.

2. The method of claim 1, wherein:

sensing the one or more physiological conditions further comprises sensing heart rate; and

detecting the autonomic arousal events further comprises;

determining heart rate variability based on the sensed heart rate; and

detecting the autonomic arousal events based on the heart rate variability.

3. The method of claim 1, wherein:

sensing the one or more physiological conditions further comprises sensing sympathetic nerve activity; and

detecting the autonomic arousal events further comprises detecting the autonomic arousal events based on the sensed sympathetic nerve activity.

4. The method of claim 1, wherein:

sensing the one or more physiological conditions further comprises sensing transthoracic impedance; and

detecting the autonomic arousal events further comprises detecting the autonomic arousal events based on the sensed transthoracic impedance.

5. The method of claim 1, wherein:

sensing the one or more physiological conditions comprises sensing at least one physiological condition that is modulated contemporaneously with an occurrence of an autonomic arousal event; and

detecting the autonomic arousal events comprises detecting the autonomic arousal events contemporaneously with modulation of the physiological condition.

6. The method of claim 1, wherein:

sensing the one or more physiological conditions comprises sensing at least one physiological condition that is modulated by an aggregation of the autonomic arousal events occurring over time; and

detecting the autonomic arousal events comprises detecting the aggregation of autonomic arousal events occurring over time.

7. The method of claim 1, wherein detecting a sleep disorder event is based at least in part on the detected autonomic arousal events.

8. The method of claim 1, wherein detecting the sleep disorder events comprises detecting disordered breathing events.

9. The method of claim 1, further comprising;

determining a trend of the autonomic arousal events; and

using the autonomic arousal event trend to diagnose a medical disorder.

10. The method of claim 1, further comprising:

delivering therapy to treat sleep disorder events; and

adjusting the therapy based on the autonomic arousal events.

11. The method of claim 10, wherein the therapy comprises a cardiac electrical stimulation therapy.

12. The method of claim 10, wherein the therapy comprises an external respiration therapy.

13. The method of claim 1, wherein discriminating between autonomic arousal events associated with sleep disorder events and autonomic arousal events not associated with sleep disorder events comprises discriminating between autonomic arousal events caused by sleep disorder events and autonomic arousal events not caused by sleep disorder events.

14. A medical system for detecting autonomic arousal events occurring during sleep, comprising:

one or more sensors configured to sense one or more physiological conditions associated with a patient'"'"'s autonomic arousal response;

an implantable arousal detector coupled to the one or more sensors, the arousal detector configured to detect autonomic arousal events based on the one or more physiological conditions;

a sleep disorder event detector configured to detect one or more sleep disorder events; and

a processor coupled to the sleep disorder detector and the arousal detector, the processor configured to discriminate between autonomic arousal events associated with sleep disorder events and autonomic arousal events not associated with sleep disorder events, and wherein the one or more sensors comprise a sensor for sensing changes in muscle tone associated with autonomic arousal, and the implantable arousal detector is configured to detect the autonomic arousal events based at least in part on the sensed changes in muscle tone.

15. The system of claim 14, wherein:

the one or more sensors are configured to generate one or more signals respectively modulated by the one or more physiological conditions; and

the arousal detector is configured to determine a characteristic signature of at least one of the signals and to detect the autonomic arousal events based on the characteristic signature.

16. The system of claim 14, wherein;

the one or more sensors comprises an EEG sensor configured to sense brain wave activity; and

the arousal detector is configured to detect autonomic arousal events based on the brain wave activity.

17. The system of claim 14, wherein the one or more sensors comprises a cardiac sensor configured to sense cardiac electrical activity.

18. The system of claim 14, wherein:

the one or more sensors comprise an EMG sensor configured to sense muscle tone.

19. The system of claim 14, wherein the sleep disorder event detector is configured to detect sleep disorder events based at least in part on the detected arousals from sleep.

20. The system of claim 14, wherein the processor is configured to determine a trend of the detected autonomic arousal events, and wherein the processor is configured to determine a presence of a medical disorder based on the autonomic arousal events.

21. The system of claim 14, further comprising a display device configured to display information about the autonomic arousal events.

22. The system of claim 14, further comprising a memory configured to store information about the autonomic arousal events.

23. The system of claim 14, further comprising a communication system configured to transmit information about the autonomic arousal events.

24. The system of claim 14, further comprising a therapy unit configured to deliver therapy for a sleep disorder and adjust the therapy based on the autonomic arousal events.

25. The system of claim 24, wherein the therapy comprises cardiac electrical stimulation therapy.

26. The system of claim 24, wherein the therapy comprises external respiration therapy.

27. A medical system for detecting autonomic arousal events occurring during sleep, comprising:

one or more sensors configured to sense one or more physiological conditions associated with a patient'"'"'s autonomic arousal response;

an implantable arousal detector coupled to the one or more sensors, the arousal detector configured to detect autonomic arousal events based on the one or more physiological conditions;

a sleep disorder event detector configured to detect one or more sleep disorder events; and

a processor coupled to the sleep disorder detector and the arousal detector, the processor configured to discriminate between autonomic arousal events associated with sleep disorder events and autonomic arousal events not associated with sleep disorder events; and

wherein the one or more sensors do not include a respiration sensor and the processor is configured to use the detected autonomic arousal events as a surrogate for detecting disrupted respiration.

28. A medical system for detecting autonomic arousal events occurring during sleep, comprising:

one or more sensors configured to sense one or more physiological conditions associated with a patient'"'"'s autonomic arousal response;

an implantable arousal detector coupled to the one or more sensors, the arousal detector configured to detect autonomic arousal events based on the one or more physiological conditions;

a sleep disorder event detector configured to detect one or more sleep disorder events; and

a processor coupled to the sleep disorder detector and the arousal detector, the processor configured to discriminate between autonomic arousal events associated with sleep disorder events and autonomic arousal events not associated with sleep disorder events; and

wherein the one or more sensors do not include a limb movement sensor and the processor is configured to use the detected autonomic arousal events as a surrogate for detecting a movement disorder.