Minute ventilation-based disordered breathing detection

• US 8,936,556 B2
• Filed: 09/22/2009
• Issued: 01/20/2015
• Est. Priority Date: 09/24/2008
• Status: Active Grant

• Current Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Original Assignee: Cardiac Pacemakers Incorporated (Boston Scientific Corporation)
• Inventors: Lee, Kent, Zhang, Yi, Emerson, Paul F., Hartley, Jesse W., Hatlestad, John D., Kwok, Jonathan T., Shao, Weiguang
• Primary Examiner(s): Mallari, Patricia
• Assistant Examiner(s): CATINA, MICHAEL ANTHONY
• Application Number:
  US12/564,741
• Publication Number:
  US 20100100000A1
• Time in Patent Office: 1,946 Days
• Field of Search: 600/529, 600533-536, 600/538
• US Class Current: 600/538
• CPC Class Codes: A61B 5/029 Measuring or recording blood output from the heart, e.g. minute volume A61B8/065 takes precedence
• 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 5/11 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 5/24 Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
• CPC Class Codes: A61B 5/318 Heart-related electrical modalities, e.g. electrocardiography [ECG]
• CPC Class Codes: A61B 5/369 Electroencephalography [EEG] devices for psychotechnics A61B5/16
• CPC Class Codes: A61B 5/389 Electromyography [EMG]
• CPC Class Codes: A61B 5/4818 Sleep apnoea

Abstract

A respiration pattern of a number of respiration cycles is detected and breath intervals (BI) and tidal volume (TVOL) measurements of each of the respiration cycles are respectively determined. An unevenly sampled instantaneous minute ventilation (iMV) signal is produced using the BI and TVOL measurements, and an evenly sampled iMV signal (resampled iMV signal) is produced using the unevenly sampled iMV signal. Disordered breathing is detected based on a comparison between a baseline threshold and the resampled iMV signal.

Claims

1. A method for detecting disordered breathing implemented by an implantable device and at least in part within a patient, comprising:

the implantable device having a processor, the processor configured to execute instructions for;

detecting a respiration pattern of a plurality of respiration cycles;

determining breath intervals (BI) and tidal volume (TVOL) measurements of each of the respiration cycles;

producing an unevenly sampled instantaneous minute ventilation (iMV) signal using the BI and TVOL measurements;

producing an evenly sampled iMV signal using the unevenly sampled iMV signal;

determining if each respiration cycle meets predetermined quality criteria for the iMV based at least in part on a short term average MV signal value, a long term moving average MV signal value, and a predetermined quality threshold; and

detecting disordered breathing based on a comparison between a baseline threshold and the resampled iMV signal using only respiration cycles that meet the predetermined quality criteria;

wherein the baseline threshold corresponds to a current midterm baseline threshold, and wherein an updated midterm baseline threshold is periodically calculated using a weighted short term average MV signal value and a weighted previous midterm baseline value; and

one or more of a cardiac rhythm management device, a drug delivery device, and a neurostimulation device delivering therapy to the patient based on the detected disordered breathing.

2. The method of claim 1, further comprising:

producing, only for each respiration cycle that meets the predetermined quality criteria for purposes of detecting disordered breathing, the iMV signal and the resampled iMV signal;

calculated the updated midterm baseline threshold using only breaths that meet the predetermined quality criteria; and

wherein the predetermined quality criteria comprises a breathing interval quality criterion based on the breathing interval of a current breath and the breathing interval of at least a previous breath, and the tidal volume of at least one previous breath.

3. The method of claim 1, wherein the baseline threshold is computed concurrently with detection of the patient'"'"'s disordered breathing after detection of at least two respiration cycles.

4. The method of claim 1, wherein producing the iMV signal comprises multiplying instantaneous tidal volume and breath interval, and interpolating the iMV signal to produce a uniformly sampled iMV signal indicative of the resampled iMV signal.

5. The method of claim 1, further comprising determining that the patient is asleep, and performing disordered breathing detection after determining that the patient is asleep.

6. The method of claim 1, wherein at least one of the steps of the method is performed externally of the patient.

7. The method of claim 1, wherein each of the steps processes of the method is performed implantably.

8. The method of claim 1, comprising discriminating between at least two types of disordered breathing.

9. The method of claim 1, comprising computing an apnea/hypopnea index.

10. The method of claim 1, comprising communicating at least some disordered breathing information from a patient-internal location to a patient-external location.

11. An implantable device for detecting disordered breathing at least in part within a patient, comprising:

an implantable housing;

a sensor system disposed in the housing and configured to detect a respiration pattern of a plurality of respiration cycles; and

a processor coupled to the sensor system, the processor configured to execute program instructions to;

determine breath intervals (BI) and tidal volume (TVOL) measurements of each of the respiration cycles,

produce an unevenly sampled instantaneous minute ventilation (iMV) signal using the BI and TVOL measurements,

produce an evenly sampled iMV signal using the unevenly sampled iMV signal,

detect disordered breathing based on a comparison between a baseline threshold and the resampled iMV signal,

determine if each respiration cycle meets predetermined quality criteria for calculating the iMV based at least in part on a weighted short term average MV signal value, a long term moving average MV signal value, and a predetermined threshold, and

produce, only for each respiration cycle that meets the predetermined quality criteria for purposes of detecting disordered breathing, the iMV signal and the resampled iMV signal,

wherein the baseline threshold is calculated using only breaths that meet the predetermined quality criteria and disordered breathing is detected using only breaths that meet the predetermined quality criteria; and

the implantable device is configured to implement one or more of cardiac rhythm management, drug delivery and neurostimulation therapy based on the detected disordered breathing.

12. The device of claim 11, wherein the processor is configured to multiply instantaneous tidal volume and breath interval, and interpolate the iMV signal to produce a uniformly sampled iMV signal indicative of the resampled iMV signal.

13. The device of claim 11, wherein the predetermined quality criteria comprises a breathing interval quality criterion based on the breathing interval of a current breath and the breathing interval of at least a previous breath, and the tidal volume of at least one previous breath.

14. The device of claim 11, wherein the sensor system comprises a sensor configured to sense a physiologic signal that is modulated by patient respiration.

15. The device of claim 11, wherein the sensor system comprises a transthoracic impedance sensor or an inter-thoracic pressure sensor.

16. The device of claim 11, wherein the processor is configured to compute the baseline threshold using an average of the patient'"'"'s iMV signal samples measured over a predetermined period of time.

17. The device of claim 11, wherein the processor is configured to compute the baseline threshold concurrently with detection of the patient'"'"'s disordered breathing after detection of at least two respiration cycles meeting the predetermined quality criteria.

18. The device of claim 11, wherein the processor is configured to determine that the patient is asleep and to perform disordered breathing detection after determining that the patient is asleep.

19. The device of claim 11, wherein the processor is configured to communicate one or both of respiration information and disordered breathing detection information to a patient-external device.

20. The device of claim 11, wherein the processor is configured to discriminate between at least two types of disordered breathing.

21. The device of claim 11, wherein the processor is configured to compute an apnea/hypopnea index.

22. A device for detecting disordered breathing implemented at least in part within a patient, comprising:

a sensor configured to detect a respiration pattern of a plurality of respiration cycles;

circuitry for determining breath intervals (BI) and tidal volume (TVOL) measurements of each of the respiration cycles;

means for producing an unevenly sampled instantaneous minute ventilation (iMV) signal using the BI and TVOL measurements;

means for producing an evenly sampled iMV signal (resampled iMV signal) using the unevenly sampled iMV signal;

means for determining if each respiration cycle meets predetermined quality criteria for calculating the iMV by comparing a weighted short term average MV signal value and a longer term moving average MV signal value to a predetermined threshold;

means for producing, only for each respiration cycle that meets the predetermined quality criteria for purposes of detecting disordered breathing, the iMV signal and the resampled iMV signal; and

a detector configured to detect disordered breathing based on a comparison between a baseline threshold and the resampled iMV signal,

wherein the baseline threshold is calculated using only breaths that meet the predetermined quality criteria and disordered breathing is detected using only breaths that meet the predetermined quality criteria.