Distinguishing closed and open respiratory airway apneas by complex admittance values
View Patent ↗Methods and apparatus are disclosed for determining the occurrence of a closed or open apnea. Respiratory air flow from a patient is measured to give an air flow signal. The determination of an apnea is performed by applying an oscillatory pressure waveform of known frequency to a patient's airway, calculating a complex quantity representing a patient admittance ( 12 ) and comparing its value with ranges ( 14,16 ) indicative of open or closed apneas. The method distinguishes open from closed apneas even when the model used to calculate admittance is not based on details of the respiratory apparatus. In addition the patient admittance may be compared with admittance during normal breathing to avoid having to characterize the airway.
1. An apparatus for providing a supply of continuous positive airway pressure to an airway of a patient at a desired treatment pressure, the apparatus comprising:
a flow generator adapted to provide a supply of continuous positive airway pressure, the flow generator adapted to couple with an air delivery tube coupled with a patient interface configured to sealingly engaged with a face of the patient;
a means for determining respiratory air flow and pressure in the patient interface;
a means for measuring a patient impedance of the airway during a period of a breathing cycle when an apnea is not occurring; and
a controller to control operation of the flow generator based on the determined respiratory air flow and pressure,
the controller configured in use to detect the occurrence of an apnea and to determine patency of the airway of the patient during the apnea by performing:
controlling application of an oscillatory pressure waveform of known frequency to the patient interface for delivery to the airway of the patient in use;
measuring an apnea impedance of the airway during the apnea; and
comparing the measured apnea impedance with the patient impedance to determine whether the airway is patent.
2. The apparatus according to claim 1 , wherein the means for determining respiratory air flow and pressure includes measuring the air flow and pressure using at least one sensor.
3. The apparatus according to claim 2 , wherein the at least one sensor is a differential pressure sensor.
4. The apparatus according to claim 2 , wherein the patient impedance is determined by the controller controlling application of an oscillatory pressure waveform of known frequency to the patient interface for delivery to the patient's airway during the period of the breathing cycle when an apnea is not occurring.
5. The apparatus according to claim 1 , wherein the period of the breathing cycle is at an end of an expiratory portion of a breath.
6. The apparatus according to claim 1 , wherein the patient impedance is a determined average of measured patient impedance over a predetermined time period.
7. The apparatus according to claim 1 , wherein the controller is configured to perform a plausibility check on the measured patient impedance.
8. The apparatus according to claim 7 , wherein if the measured patient impedance value is determined to be implausible, the controller indicates that a fault has occurred.
9. The apparatus according to claim 1 , wherein the known frequency is between 1 and 16 Hz.
10. The apparatus according to claim 9 , wherein the known frequency is between 2 and 8 Hz.
11. The apparatus according to claim 9 , wherein the known frequency is 4 Hz.
12. The apparatus according to claim 1 , wherein the controller is further configured to increase the treatment pressure in response to the determination of a patent airway.
13. The apparatus according to claim 1 , wherein the controller is further configured to reduce the treatment pressure in response to the determination of a closed airway.
14. A method for operating a respiratory device with a flow generator to determine patency of an airway of a patient, the method comprising:
controlling generation of a first oscillatory pressure waveform of known frequency to a patient interface during a period of a breathing cycle when an apnea is not occurring;
measuring respiratory air flow and pressure at the flow generator;
determining a patient impedance of the airway;
determining that an apnea is occurring based on the measured respiratory air flow;
controlling generation of a second oscillatory pressure waveform of known frequency to the patient interface during the apnea;
determining an apnea impedance of the airway during the apnea; and
determining that the airway is patent by comparing the apnea impedance with the patient impedance.
15. The method according to claim 14 , wherein the period of the breathing cycle is at an end of an expiratory portion of the breath.
16. The method according to claim 14 , wherein the patient impedance is determined as an average of measured patient impedance over a predetermined time period.
17. The method according to claim 14 , further including controlling with the respiratory device a continuous positive air pressure in the patient interface at a desired treatment pressure.
18. The method according to claim 17 , wherein if the apnea is classified as an open apnea determining a reduction of the treatment pressure.
19. The method according to claim 17 , wherein if the apnea is classified as a closed apnea determining an increase of the treatment pressure.