Adherent device for sleep disordered breathing

1. A method of monitoring a sleep apnea and/or hypopnea of a patient, the method comprising:

adhering an adhesive patch to a skin of the patient to couple at least one electrode to the skin of the patient, wherein the adhesive patch supports the at least one electrode, impedance circuitry, a processor, and wireless communication circuitry;

measuring an impedance signal of the patient with the impedance circuitry coupled to the at least one electrode;

processing the impedance signal with the processor to determine a respiration rate;

processing the impedance signal with the processor to determine extracellular fluid of the patient, sufficient to monitor hydration status, wherein the extracellular fluid is determined using impedance measurements with a frequency from about 0.5 kHz to about 20 kHz;

communicating via the wireless communication circuitry the respiration rate and the hydration status to a remote monitoring center;

detecting at the remote monitoring center the sleep apnea and/or hypopnea of the patient in response to the communicated respiration rate;

determining a decompensation risk at the remote monitoring center based on the detected sleep apnea and/or hypopnea and the hydration status.

2. The method of claim 1 , further comprising determining an apnea hypopnea index of the patient in response to the detected sleep apnea and/or hypopnea of the patient, and providing the apnea hypopnea index to the decompensation prediction algorithm in addition to the hydration status.

3. The method of claim 2 , wherein the index is determined at the remote monitoring center.

4. The method of claim 2 , wherein the index is determined at an intermediate device.

5. The method of claim 1 , further comprising:

generating an accelerometer signal with an accelerometer; and

processing the accelerometer signal with the processor to detect sleep status of the patient.

6. The method of claim 5 , wherein the accelerometer comprises a three axis accelerometer.

7. The method of claim 1 , further comprising:

measuring an electrocardiogram signal of the patient with electrocardiogram circuitry coupled to the at least one electrode; and

measuring a signal from an accelerometer in response to at least one of an activity and a position of the patient.

8. The method of claim 7 wherein the adhesive patch further supports the electrocardiogram circuitry and the accelerometer when the adhesive patch is adhered to the skin of the patient.

9. The method of claim 7 , further comprising determining a heart rate based on the electrocardiogram signal.

10. The method of claim 1 , further comprising

generating an accelerometer signal with an accelerometer; and

processing the accelerometer signal with the processor to detect at least one of a patient activity and a patient orientation.

11. The method of claim 1 , further comprising transmitting data collection commands from the remote monitoring center to the processor supported with the adhesive patch.

12. The method of claim 1 , further comprising alerting a health care provider in response to at least one of the monitored hydration status, detected sleep apnea and/or hypopnea, and combinations thereof.

13. The method of claim 1 , wherein extracellular fluid is determined using impedance measurements with a frequency from about 1.0 kHz to about 10 kHz.

14. A method of monitoring a sleep apnea and/or hypopnea of a patient, the method comprising:

adhering an adhesive patch to a skin of the patient to couple at least four electrodes to the skin of the patient, wherein the adhesive patch supports the at least four electrodes, impedance circuitry, electrocardiogram circuitry, a processor, and wireless communication circuitry;

measuring an impedance signal of the patient with the impedance circuitry coupled to the at least four electrodes;

processing the impedance signal to detect sleep apnea and/or hypopnea of the patient in response to the impedance signal;

processing the impedance signal with the processor to determine extracellular fluid of the patient, sufficient to monitor hydration status, wherein the extracellular fluid is determined using impedance measurements with a frequency from about 0.5 kHz to about 20 kHz;

measuring an electrocardiogram signal of the patient with the electrocardiogram circuitry coupled to at least two of the at least four electrodes, to provide at least heart rate data; and

communicating using the wireless communication circuitry information about the heart rate data, hydration status, and the detected sleep apnea and/or hypopnea to a decompensation prediction algorithm located on a remote monitoring center.

15. The method of claim 14 , further comprising:

generating an accelerometer signal with an accelerometer; and

processing the accelerometer signal with the processor to determine at least one of a patient activity and a patient orientation.

16. The method of claim 15 , further comprising determining if the patient is asleep by analysis of at least one of the patient activity, the patient orientation and the heart rate data.

17. The method of claim 14 , further comprising determining an apnea hypopnea index of the patient in response to the detected sleep apnea and/or hypopnea of the patient, wherein the apnea hypopnea index is determined at the remote monitoring center.

18. The method of claim 14 , further comprising determining an apnea hypopnea index of the patient in response to the detected sleep apnea and/or hypopnea of the patient, wherein the apnea hypopnea index is determined at an intermediate device.

19. The method of claim 14 , wherein the extracellular fluid is determined using impedance measurements with a frequency from about 1.0 kHz to about 10 kHz.