Source: https://patents.google.com/patent/US8192376B2/en
Timestamp: 2019-04-25 04:54:03+00:00

Document:
The flow graph of FIG. 5 illustrates a method of using a sleep-wake condition in combination with a REM-modulated condition to classify sleep states according to embodiments of the invention. According to this implementation, the system determines sleep onset and sleep offset by comparing a patient activity signal to a threshold. Various methods of sleep onset and sleep offset detection may be used in connection with the sleep state classification approaches of the present invention. Methods and systems related to sleep detection are further described in commonly owned U.S. Pat. No. 7,189,204 (Ni et al.) and incorporated by reference herein in its entirety.
Another method of detecting 632 disordered breathing involves analyzing the patient's respiratory patterns. According to this method, the patient's respiratory cycle is divided into several periods, including, inspiration, expiration, and non-breathing periods. The inspiration, expiration, and non-breathing respiratory periods are analyzed for patterns consistent with various types of disordered breathing. Methods and systems for detecting disordered breathing based on respiration cycle patterns are more fully described in commonly owned U.S. Pat. No. 7,252,640 (Ni et al.) and incorporated herein by reference.
Methods and systems for predicting disordered breathing are described in commonly owned U.S. Pat. No. 7,396,333 (Stahmann et al.) and incorporated herein by reference. As described in the above-referenced patent application, sleep-disordered breathing may be predicted based on a number of patient conditions that increase the likelihood of disordered breathing. Conditions that predispose the patient to disordered breathing include, for example, air pollution, alcohol use, and pulmonary congestion, among other conditions. In addition to predisposing conditions that make disordered breathing more likely, various precursor conditions may be used to determine that a disordered breathing episode is imminent. For example, blood chemistry, hyperventilation, and the regular periodicity of previous disordered breathing episodes may be used to predict an imminent onset of disordered breathing.
If disordered breathing is detected or predicted 632, an appropriate therapy 634 may be provided to terminate or prevent the disordered breathing. Disordered breathing therapy 634 may include, for example, cardiac pacing, nerve stimulation, or other types of disordered breathing therapy, such as those previously discussed. Methods and systems for providing therapy to mitigate disordered breathing based on the prediction or detection of disordered breathing are described in commonly owned U.S. Pat. No. 7,680,537 (Stahmann et al.) and U.S. Pat. No. 7,720,541 (Stahmann et al.), respectively, both incorporated herein by reference in their respective entireties.
The following commonly owned U.S. Patents and U.S. Patent Application Publications, some of which have been identified above, are hereby incorporated by reference in their respective entireties: U.S. Pat. No. 7,252,640 (Ni et al.), U.S. Pat. No. 7,189,204 (Ni et al.), U.S. Pat. No. 8,002,553 (Hatlestad et al.), U.S. Pat. No. 7,720,541 (Stahmann et al.), U.S. Pat. No. 7,396,333 (Stahmann et al.), and U.S. Pat. No. 7,680,537 (Stahmann et al.).
providing sleep state informed therapy to the patient using the sleep state classification.
2. The method of claim 1, wherein sensing the muscle tone includes sensing the muscle tone using an electromyogram sensor.
3. The method of claim 1, wherein sensing the muscle tone includes sensing the muscle tone using a sensor on a header of the cardiac rhythm management device.
4. The method of claim 1, wherein the sleep state informed therapy comprises a cardiac therapy.
5. The method of claim 1, wherein the sleep state informed therapy comprises a preventative therapy.
6. The method of claim 1, wherein the condition associated with the sleep-wake status of the patient comprises patient activity.
7. The method of claim 1, wherein sensing the condition associated with the sleep-wake status includes detecting patient activity using an accelerometer.
8. The method of claim 1, wherein sensing the condition associated with the sleep-wake status includes detecting body posture.
9. The method of claim 1, wherein the condition associated with the sleep-wake status includes a patient activity signal, and wherein classifying includes determining sleep onset by comparing the patient activity signal to a sleep threshold.
10. The method of claim 9, wherein classifying also includes determining sleep offset by comparing the patient activity signal to the sleep threshold.
11. The method of claim 1, wherein classifying includes determining REM sleep onset by comparing the pectoral muscle tone to an REM sleep threshold.
12. The method of claim 11, wherein classifying also includes determining REM sleep offset by comparing the pectoral muscle tone to the REM sleep threshold.
wherein the sleep state informed therapy includes bradycardia pacing therapy responsive to the detected cardiac signal and adapted to switch to a lower pacing rate based on the sleep state classification.
wherein the sleep state informed therapy includes preventative arrhythmia therapy responsive to the detected cardiac signal and to the sleep state classification.
wherein the sleep state informed therapy is responsive to the beat-to-beat cardiac signal analysis.
declaring a hypopnea event if the tidal volume falls below a hypopnea threshold.
declaring an apnea event if the tidal volume falls below an apnea threshold lower than the hypopnea threshold.
a therapy system coupled to the classification system and configured to provide cardiac therapy to the patient based on the sleep state classification.
19. The device of claim 18, wherein the first sensor is an electromyogram sensor.
wherein the first sensor is mechanically coupled to the housing.
21. The device of claim 20, wherein the classification system is disposed within the housing.
22. The device of claim 20, wherein the first sensor is positioned on the housing.
23. The device of claim 20, further comprising a header mounted on the housing, and the first sensor is positioned on the header.
wherein the first sensor is disposed on the lead.
25. The device of claim 18, wherein the second sensor includes an accelerometer.
26. The device of claim 18, wherein the second sensor includes a body posture detector.
27. The device of claim 18, wherein the second sensor is configured to detect a patient activity signal, and wherein the classification system is configured to determine sleep onset by comparing the patient activity signal to a sleep threshold.
28. The device of claim 27, wherein the classification system is also configured to determine sleep offset by comparing the patient activity signal to the sleep threshold.
29. The device of claim 18, wherein the classification system is configured to determine REM sleep onset by comparing the pectoral muscle tone to an REM sleep threshold.
30. The device of claim 29, wherein the classification system is also configured to determine REM sleep offset by comparing the pectoral muscle tone to the REM sleep threshold.
31. The device of claim 18, wherein the detector system further includes a third sensor configured to detect a cardiac signal, and wherein the therapy system is configured to provide bradycardia pacing therapy responsive to the detected cardiac signal and to the sleep state classification.
32. The device of claim 31, wherein the bradycardia pacing therapy is adapted to switch to a lower pacing rate based on the sleep state classification.
33. The device of claim 18, wherein the detector system further includes a third sensor configured to detect a cardiac signal, and wherein the therapy system is configured to provide preventative arrhythmia therapy responsive to the detected cardiac signal and to the sleep state classification.
wherein the therapy system is configured to provide therapy based on both the sleep state classification and the beat-to-beat cardiac signal analysis.
35. The device of claim 18, wherein the detector system further includes a third detector configured to detect a tidal volume of the patient's respiration, and wherein the therapy system is configured to declare a hypopnea event if the tidal volume falls below a hypopnea threshold.
36. The device of claim 35, wherein the therapy system is also configured to declare an apnea event if the tidal volume falls below an apnea threshold lower than the hypopnea threshold.
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References: Application No. 08006191
 Application No. 08075738
 application No. 2004557545
 application No. 2006
 application No. 03790304
 application No. 03790304
 application No. 03790294
 application No. 03790304