Neural monitoring methods and systems for treating pharyngeal disorders
Methods and systems for monitoring, preventing and/or treating upper airway disorders such as apnea, dysphagia, reflux and/or snoring are described. The methods and systems monitor the upper airway disorders by processing one or more neural signals obtained from one or more upper airway afferents. Upper airway disorders are prevented and/or treated by delivering one or more stimulations to one or more reflex-related afferents, efferents, muscles, and sensory receptors to manipulate the threshold and/or trigger an upper airway reflex including, but not limited to a swallow reflex and/or a negative-pressure reflex.
1 . A method for treating and/or preventing a disorder in a subject in need thereof, the method comprising:
delivering one or more stimulations to modulate one or more reflexes chosen from all or part of a swallowing reflex, all or part of a negative-pressure reflex, and combinations thereof, wherein:
the disorder comprises one or more of: obstructive apnea, central apnea, mixed apnea, snoring, flow limitation, obesity hypoventilation syndrome, dysphagia, esophageal reflux, laryngeal reflux, pharyngeal reflux presence of unswallowed bolus, acid reflux, Gastro-Esophageal Reflux Disease (GERD), and combinations thereof;
the one or more stimulations are delivered with subthreshold parameters insufficient to independently elicit the one or more reflexes in order to reduce a threshold of the one or more reflexes by providing an additive effect that augments and enhance enhances the subject's detection of sensory signals so as to trigger the one or more reflexes; and
the one or more stimulations are delivered either according to a predetermined schedule, in response to one or more stimulation signals, and or combinations thereof.
2 . The method of claim 1 , wherein the one or more stimulations comprise an electrical stimulation, a mechanical stimulation, or both.
3 . The method of claim 2 , wherein:
the electrical stimulation is delivered to a reflex-related nerve, a reflex-related muscle, a reflex-related sensory receptor, and or combinations thereof; and/or
the mechanical stimulation is delivered to a reflex-related sensory receptor.
4 . The method of claim 3 , wherein:
the reflex-related nerve comprises:
an afferent chosen from: internal branch of the superior laryngeal nerve (iSLN), pharyngeal branch of vagus nerve, pharyngeal branch of glossopharyngeal nerve, tonsular branch of glossopharyngeal nerve, lingual branch of glossopharyngeal nerve, intermediate nerve, palantine nerve, greater petrosal nerve, any branch of facial nerve, and pterygopalatine nerve of trigeminal nerve; or
an efferent chosen from: recurrent laryngeal nerve, external branch of superior laryngeal nerve, brancial motor branch of glossopharyngeal nerve and proximal fibers, mandibular nerve, medial pterygoid nerve, pharyngeal branch of vagus nerve and proximal fibers; branch of facial nerve and proximal fibers, and branch of hypoglossal nerve and proximal fibers; and
the reflex-related sensory receptor is situated in skin or mucosa of the subject, and is chosen from:
a mechanoreceptor sensitive to negative airway pressure, positive airway pressure, stretch, position, shear, slip, vibration, texture, touch, mechanical compression, muscle stretch, muscle drive, air flow, blood pressure or blood osmolarity;
a chemoreceptor sensitive to CO 2 , O 2 , or pH;
a thermoreceptor sensitive to temperature or airflow;
a nociceptor sensitive to polymodal pain; and
combinations thereof.
5 . The method of claim 4 , wherein the one or more stimulations are chosen from:
a subthreshold electrical stimulation delivered to the reflex-related nerve or to the reflex-related sensory receptor to reduce the threshold of the reflex, to maintain muscle tone, and or combinations thereof;
a subthreshold electrical stimulation delivered to the reflex-related muscle to maintain muscle tone; and
a subthreshold mechanical stimulation delivered to the reflex-related sensory receptor to reduce the threshold of the one or more reflexes.
6 . The method of claim 5 , wherein the one or more stimulations are delivered according to a delivery schedule chosen from periodic, random, or continuous.
7 . The method of claim 6 , wherein the one or more stimulation signals are received from a patient monitor device.
8 . The method of claim 6 , further comprising assessing one or more conditions of the subject chosen from a respiratory condition, a deglutition condition, a vibration condition, a reflux condition, and combinations thereof to predict the occurrence of the disorder in the subject, wherein:
the respiratory condition comprises apnea, tachypnea, hyperpnea, hypopnea, polypnea, dyspnea, bradypnea, cough, Cheyne-Stokes respiration, Biot's respiration, ataxic respiration, Kussmaul respiration, wheezing, irregular respiration, respiratory arrest, restrictive respiration, shallow breathing, hypoventilation and or combinations thereof;
the deglutition condition comprises presence of unswallowed bolus, occurrence of swallow, occurrence of dysphagic swallow, presence of acid reflux, and or combinations thereof;
the vibration condition comprises snoring, stridor, wheezing, vocalization, and or combinations thereof; and
the reflux condition comprises esophageal reflux, pharyngeal reflux, laryngeal reflux, and or combinations thereof.
9 . The method of claim 8 , further comprising:
obtaining one or more neural signals from one or more upper airway afferents of the subject;
processing each of the one or more neural signals to obtain two or more neural activity profiles, each neural activity profile characterized by one or more: a neural signal timing, a neural signal amplitude, a neural signal phase, a neural signal position, a neural signal conduction velocity, and combinations thereof;
comparing each of the neural activity profiles to one or more activity criteria to associate each neural activity profile with an associated activity type chosen from a respiratory activity type, a deglutition activity type, a vibration activity type, a reflux activity type, and combinations thereof, wherein at least one neural activity profile includes a first activity type and at least another neural activity profile includes a second activity type, the first activity type being different than the second activity type;
processing each of the neural activity profiles to determine an activity state characterizing the associated activity type, the activity state comprising:
i. a respiratory state comprising respiratory timing, respiratory amplitude, respiratory phase, respiratory location, and or combinations thereof;
ii. a deglutition state comprising solid contact, fluid contact, contact velocity, contact timing, contact amplitude, contact pressure, contact texture, contact temperature, a presence of a an unswallowed bolus, and or combinations thereof;
iii. a vibration state comprising vibration timing, vibration amplitude, vibration phase, vibration location, vibration pattern, and or combinations thereof;
iv. a reflux state comprising reflux timing, reflux pH, reflux location, and or combinations thereof; and or
v. combinations thereof; and
processing the activity state of the subject to obtain the one or more conditions of the subject.
10 . The method of claim 9 , further comprising:
generating the one or more stimulation signals when:
the disorder is predicted to time the delivery of the one or more stimulations to coincide with an occurrence of the disorder;
the respiratory phase is an exhalation phase to time the delivery of the one or more stimulations to coincide with an exhalation of the subject; and
combinations thereof.
11 . A system for treating and/or preventing a disorder in a subject in need thereof, the system comprising:
at least one processor; and
a disorder treatment application comprising a plurality of modules executable on the at least one processor, the plurality of modules comprising:
a reflex stimulation module configured to provide instructions to the at least one processor in order to cause deliver of one or more stimulations to modulate one or more reflexes chosen from a swallowing reflex, a negative-pressure reflex, and combinations thereof, wherein:
the disorder is chosen from obstructive apnea, central apnea, mixed apnea, snoring, flow limitation, obesity hypoventilation syndrome, dysphagia, esophageal reflux, laryngeal reflux, pharyngeal reflux, presence of unswallowed bolus, acid reflux, Gastro-Esophageal Reflux Disease (GERD), and combinations thereof;
the one or more stimulations are delivered with parameters chosen from subthreshold parameters insufficient to independently elicit the one or more reflexes in order to reduce a threshold of the one or more reflexes and enhance the subject's detection of sensory signals so as to trigger the one or more reflexes; and
the one or more stimulations are delivered in response to one or more stimulation signals.
12 . The system of claim 11 , wherein:
the one or more stimulations comprise an electrical stimulation, a mechanical stimulation, or both;
the electrical stimulation is a delivered to a reflex-related nerve, a reflex-related muscle, and combinations thereof; and/or
the mechanical stimulation is delivered to a reflex-related sensory receptor.
13 . The system of claim 12 , wherein the one or more stimulations are chosen from:
a subthreshold electrical stimulation delivered to the reflex-related nerve or to the reflex-related sensory receptor to reduce the threshold of the reflex, to maintain muscle tone, and combination thereof;
a subthreshold electrical stimulation delivered to the reflex-related muscle to maintain muscle tone; and
a subthreshold mechanical stimulation delivered to the reflex-related sensory receptor to reduce the threshold of the one or more reflexes.
14 . The system of claim 11 , wherein the plurality of modules further comprises a stimulation timing module configured to provide instructions to the at least one processor in order to time the delivery of each of the one or more stimulations according to a predetermined schedule, in response to at least one stimulation signal, and combinations thereof.
15 . The system of claim 14 , wherein the one or more stimulation signals are received from a patient monitor system.
16 . The system of claim 14 , wherein the plurality of modules further comprises a disorder prediction module configured to provide instructions to the at least one processor in order to assess one or more conditions of the subject chosen from a respiratory condition, a deglutition condition, a vibration condition, a reflux condition, and combinations thereof to predict the occurrence of the disorder in the subject, wherein:
the respiratory condition comprises apnea, tachypnea, hyperpnea, hypopnea, polypnea, dyspnea, bradypnea, cough, Cheyne-Stokes respiration, Biot's respiration, ataxic respiration, Kussmaul respiration, wheezing, irregular respiration, respiratory arrest, restrictive respiration, shallow breathing, hypoventilation and combinations thereof;
the deglutition condition comprises presence of unswallowed bolus, occurrence of swallow, occurrence of dysphagic swallow, presence of acid reflux, and combinations thereof;
the vibration condition comprises snoring, stridor, wheezing vocalization, and combinations thereof; and
the reflux condition comprises esophageal reflux, pharyngeal reflux, laryngeal reflux, and combinations thereof.
17 . The system of claim 16 , wherein the plurality of modules further comprises:
a neural signal acquisition module configured to provide instructions to the at least one processor in order to obtain one or more neural signals from one or more upper airway afferents of the subject;
a neural activity profile module configured to provide instructions to the at least one processor in order to process each of the one or more neural signals to obtain two or more neural activity profiles, each neural activity profile characterized by one or more: a neural signal timing, a neural signal amplitude, a neural signal phase, a neural signal position, a neural signal conduction velocity, and combinations thereof; and
an activity type module configured to provide instructions to the at least one processor in order to compare each of the neural activity profiles to one or more activity criteria to associate each neural activity profile with an associated activity type chosen from a respiratory activity type, a deglutition activity type, a vibration activity type, a reflux activity type, and combinations thereof, wherein at least one neural activity profile includes a first activity type and at least another neural activity profile includes a second activity type, the first activity type being different than the second activity type.
18 . The system of claim 17 , wherein the plurality of modules further comprises an activity state module configured to provide instructions to the at least one processor in order to process each of the at least one neural activity profiles to determine an activity state characterizing the associated activity type, the activity state comprising a respiratory state comprising respiratory timing, respiratory amplitude, respiratory phase, respiratory location, and any combination thereof, and wherein the stimulation timing module provides the instructions to the at least one processor in order to generate the one or more stimulation signals when:
the disorder prediction module predicts the disorder, to time the delivery of the one or more stimulations to coincide with an occurrence of the disorder;
the activity state module is configured to determine that the respiratory phase is an exhalation phase, to time the delivery of the one or more stimulations to coincide with an exhalation of the subject; and
combinations thereof.
19 . The system of claim 11 , further comprising:
a graphical user interface (GUI) module configured to provide instructions to the at least one processor in order to generate one or more forms used to receive inputs to the system and configured to deliver outputs from the system.
20. The method of claim 1 , further comprising:
delivering, in addition to the one or more stimulations delivered with subthreshold parameters, one or more stimulations with suprathreshold parameters sufficient to independently elicit all or part of the swallowing reflex, all or part of the negative-pressure reflex, or combinations thereof.
21. The method of claim 20 , wherein the one or more stimulations with suprathreshold parameters is chosen from:
a suprathreshold electrical stimulation delivered to the reflex-related nerve, the reflex-related sensory receptor, the reflex-related muscle, or combinations thereof to maintain muscle tone, position and/or posture of one or more respiratory and/or deglutition structures of the subject;
a suprathreshold mechanical stimulation delivered to the reflex-related sensory receptor to maintain muscle tone, position and/or posture of one or more respiratory and/or deglutition structures of the subject;
a suprathreshold electrical stimulation delivered to the reflex-related nerve, the reflex-related sensory receptor, the reflex-related muscle, or combinations thereof to treat the disorder; and/or
a suprathreshold mechanical stimulation delivered to the reflex-related sensory receptor to treat the disorder.