Method and apparatus for improved flow limitation detection of obstructive sleep apnea
In a respiratory apparatus for treatment of sleep apnea and other disorders associated with an obstruction of a patient's airway and which uses an airflow signal, an obstruction index is generated which detects the flattening of the inspiratory portion of the airflow. The flattening index serves as an obstruction index used to differentiate normal and obstructed breathing. The obstruction index is based upon comparison of values of airflow in different sectors of the inspiratory peak of the wave function and is particularly suitable for distinguishing M shaped or square shaped respiratory patters patterns indicative of partially obstructed airways.
1. An apparatus for detecting inspiratory and expiratory flow-time curves in an airflow, comprising:
a flow detector configured to generate an airflow signal representing a respiratory airflow curve based on measurements of the airflow over time, and
a processor in communication with the flow detector, the processor configured to:
process the airflow signal by:
provisionally taking a start of inspiration as a time that the airflow exceeds a predetermined threshold,
rejecting the start of inspiration if the airflow then falls below zero before a total volume inspired reaches a first predetermined value,
provisionally taking a start of expiration as a time that the airflow falls below zero, and
rejecting the start of expiration if the airflow then goes above a second predetermined value in an inspiratory direction before a total volume expired reaches a predetermined value; and
based on the processed airflow signal, adjust a treatment pressure provided to a patient.
2. The apparatus of claim 1 wherein the processor is further configured to trim any end-expiratory pause that has been included in the inspiratory flow-time curve.
3. The apparatus of claim 2 , wherein, to trim any end-expiratory pause that has been included in the inspiratory flow-time curve, the processor is configured to find an earliest time at which inspiration could have started,
wherein to find the earliest time, the processor is configured to:
locate a time where flow first reaches a predetermined percentage of peak inspiratory flow,
search backwards to a time where the flow last reached a second predetermined percentage of the peak inspiratory flow, and
extrapolate backwards to find a time where flow should be zero.
4. The apparatus of claim 1 wherein the processor is further configured to reverse an effect of a given low pass filter on an original flow-time curve, wherein to reverse the effect, the processor is configured to:
(a) pass the original flow-time curve through a second low pass filter that is identical to the given low pass filter a second time to obtain a doubly filtered flow-time curve,
(b) subtract the doubly filtered flow-time curve from the original flow-time curve to give a difference representing a first-order approximation of the effect of the given low pass filter, and
(c) add the difference back to the original flow-time wave.
5. The apparatus of claim 1 wherein the processor is further configured to normalize an effect of overshoot on the inspiratory flow-time curve.
6. The apparatus of claim 5 wherein to normalize the effect of overshoot, the processor is configured to:
estimate a peak flow in a middle portion of the inspiratory flow-time wave; and
reset each point of the inspiratory flow-time curve outside the middle portion that exceeds the peak flow.
7. The apparatus of claim 6 wherein the resetting is continued until no point of the inspiratory flow-time curve outside the middle portion exceeds the peak flow.
8. The apparatus of claim 5 wherein to normalize the effect of overshoot, the processor is configured to:
divide the inspiratory flow-time curve into n parts,
calculate mean amplitudes for each part,
determine what sort of wave a pattern of the mean amplitudes indicates, and
if overshoot is indicated, mark flattening as low.
9. The apparatus of claim 5 wherein to normalize the effect of overshoot, the processor is configured to:
calculate an estimate of flattening for every one or more samples in a middle half of the inspiratory flow-time curve; and
mark a flattening index as a value that corresponds to the lowest value obtained for all sample permutations.
10. The apparatus of claim 1 wherein the processor is further configured to calculate a mean deviation of the inspiratory flow-time curve from a reference amplitude (M), for a middle portion of the inspiratory flow-time curve.
11. The apparatus of claim 10 wherein the middle portion is one quarter of the inspiratory flow-time curve and is centered, wherein to calculate the mean deviation, the processor is configured to use the formula:
MeanDeviation
=
∑
t
=
2
4
4
0
(
fs
(
t
)
-
M
)
1
6
wherein fs(t) is a sample of a patient's inspiratory airflow.
12. The apparatus of claim 10 wherein the processor is further configured to determine a flattening Index (FI) as
FI
=
M
e
a
n
D
e
v
i
a
t
i
o
n
M
.
13. The apparatus of claim 1 wherein the processor is further configured to update a multiple breath pointwise moving average flow-time curve.
14. The apparatus of claim 1 wherein the processor is further configured to determine whether an inspiratory flow-time curve has an M shape, wherein, to determine whether an inspiratory flow-time curve has an M shape, the processor is configured to:
normalize a time interval so that inspirations begins at zero and ends at B radians,
decompose the inspiratory flow-time curve into a vector of features and a pair of basis vectors that are orthogonal,
wherein to so decompose the processor is configured to:
find a pseudo-inverse of a basis made up of the pair of basis vectors, and multiply the inspiratory flow-time curve by the pseudo-inverse to find the vector of features.
15. The apparatus of claim 14 wherein the processor is further configured to
map a linear space for many patients and noting clusters into which points representing the individual patients fall, and
determine whether a breath is M shaped by a Euclidean measure of distance of the vector of features from an M cluster center.
16. An apparatus for detecting inspiratory and expiratory flow-time curves in an airflow comprising:
a detecting means to generate an airflow signal representing a respiratory airflow curve based on measurements of the airflow over time, and
a processing means in communication with the detecting means, the processing means for:
processing the airflow signal by:
provisionally taking a start of inspiration as a time that the airflow exceeds a predetermined threshold,
rejecting the start of inspiration if the airflow then falls below zero before a total volume inspired reaches a first predetermined value,
provisionally taking a start of expiration as a time that the airflow falls below zero, and
rejecting the start of expiration if the airflow then goes above a second predetermined value in an inspiratory direction before a total volume expired reaches a predetermined value; and
based on the processed airflow signal, adjusting a treatment pressure provided to a patient.
17. The apparatus of claim 16 wherein the processing means comprises means for trimming any end-expiratory pause that has been included in the inspiratory flow-time curve.
18. The apparatus of claim 17 , wherein the trimming comprises finding an earliest time at which inspiration could have started by
locating a time where flow first reaches a predetermined percentage of peak inspiratory flow,
searching backwards to a time where the flow last reached a second predetermined percentage of the peak inspiratory flow, and
extrapolating backwards to find a time where flow should be zero.
19. The apparatus of claim 16 wherein the processing means further comprises means for reversing an effect of a given low pass filter on an original flow-time curve by:
(a) passing the original flow-time curve through a second low pass filter that is identical to the given low pass filter a second time to obtain a doubly filtered flow-time curve,
(b) subtracting the doubly filtered flow-time curve from the original flow-time curve to give a difference representing a first-order approximation of the effect of the given low pass filter, and
(c) adding the difference back to the original flow-time wave.
20. The apparatus of claim 16 wherein the processing means further comprises means for normalizing an effect of overshoot on the inspiratory flow-time curve.