Photoplethysmography in combination with medical devices
The disclosure provides systems and methods for detecting, monitoring, and/or treating obstructive sleep apnea, as well as other conditions, using vital sign and/or biometric data collected and/or imputed from one or more photoplethysmography sensors in conjunction with vital sign and/or biometric data from one or more additional sensors such as activity, body position, ECG, HR, or SpO 2 levels, e.g., as feedback to control therapy and/or to titrate therapy on a periodic basis.
1. A system for delivering therapy to treat a medical condition of a human subject, comprising:
a photoplethysmography (“PPG”) sensor configured to detect, measure, and/or monitor a first biomarker parameter of the subject, wherein the first biomarker parameter comprises data indicative of one or more of an oxygen saturation level, a heart rate, a respiration rate, a stroke volume, a cardiac output, a pulse pressure, a systemic vascular resistance, an arterial pressure, or a cardiac index, of the human subject;
at least one additional sensor configured to detect, measure, and/or monitor one or more secondary biomarker parameters of the subject, wherein the secondary biomarker parameters comprise data indicative of a body temperature, an activity and/or body position, a presence or level of sweat on skin, or a single-electrode or low electrode count electrocardiogram (“ECG”), of the human subject; and
a treatment device comprising a stimulator configured to administer electrical stimulation to at least one nerve of the human subject associated with upper airway patency, and a controller configured to control the stimulator;
wherein the controller is further configured to
determine an apnea-hypopnea index (“AHI”), body position, and sleep stage of the human subject based on the first biomarker parameter and the secondary biomarker parameters,
determine whether the human subject is experiencing an onset or worsening of sleep-disordered breathing (“SDB”) based on the determined AHI, body position, and sleep stage of the human subject, or a change in the determined AHI, body position, and/or sleep stage of the human subject compared to historical data, and
cause the stimulator to switch to a higher-intensity treatment mode in response to determining that the subject is experiencing an onset or worsening of SDB.
2. The system of claim 1 , wherein the first biomarker parameter comprises one or more of: an oxygen saturation level, a heart rate, a respiration rate, a cardiac output, a pulse pressure, a systemic vascular resistance, an arterial pressure, and/or a cardiac index, of the human subject.
3. The system of claim 1 , wherein the secondary biomarker parameters comprise data indicative of a body temperature, a body position, and a presence or level of sweat on the skin, of the human subject.
4. The system of claim 1 , wherein controller of the treatment device is further configured to
determine an AHI, body position, and sleep stage of the human subject based on the first biomarker parameter and the secondary biomarker parameters, at a predetermined time point or after a predetermined time period has elapsed, after causing the stimulator to switch to a higher-intensity treatment mode;
determine whether the subject is experiencing SDB at the predetermined time point or after the predetermined time period has elapsed; and
cause the stimulator to switch to a lower-intensity treatment mode in response to determining that the human subject's SDB has ceased or is at a reduced level compared to a preceding determination.
5. The system of claim 4 , wherein the switch to the lower-intensity treatment mode comprises a gradual titration of an amplitude, frequency, pulse width, duty cycle, and/or bursting parameters of the electrical stimulation.
6. The system of claim 1 , wherein the treatment device is a medical device implanted in the subject.
7. The system of claim 1 , wherein the switch to the higher-intensity treatment mode comprises a gradual titration of an amplitude, frequency, pulse width, duty cycle, and/or bursting parameters of the electrical stimulation.
8. The system of claim 1 , wherein the treatment device is an external stimulation device.
9. The system of claim 7 , wherein the treatment device is further configured to stimulate the human subject's heart.
10. The system of claim 7 , wherein the treatment device is configured to stimulate:
a) at least one nerve of the human subject, optionally one or more of a vagus, phrenic, sacral, tibial, hypoglossal, pharyngeal, glossopharyngeal, occipital, spinal, cranial, cavernous, facial, radial, ulnar, auditory, esophageal, laryngeal, femoral, frontal, cardiac, cervical, hypogastric, plantar, mandibular, perineal, pelvic, saphenous, splanchnic, splenic, tympanic, renal, thoracic, vestibular or trigeminal nerve of the human subject, or any of their branches; and/or
b) at least one tissue or organ of the human subject, optionally one or more of the heart, carotid sinus, vocal cords, tongue, or muscles, of the human subject.
11. The system of claim 1 , wherein the treatment device is configured to stimulate the hypoglossal nerve and/or the phrenic nerve of the human subject.
12. The system of claim 1 , wherein the controller is further configured to determine whether the human subject is experiencing an onset or worsening of SDB based on determining that the human subject's AHI is above a preset threshold, or increasing at a rate above a preset threshold.
13. The system of claim 1 , wherein the controller of the treatment device is further configured to cause the PPG sensor, and/or the at least one additional sensor, to increase a sampling rate after determining that the human subject is experiencing an onset or worsening of SDB.
14. The system of claim 12 , wherein the treatment device is configured to:
a) provide electrical stimulation; and
b) adjust one or more parameters of the electrical stimulation based on the first biomarker parameter, wherein adjustment comprises modulation of the amplitude, frequency, pulse width, duty cycle, or bursting parameters of the electrical stimulation.
15. The system of claim 12 , wherein the treatment device is configured to
a) provide electrical stimulation to at least one nerve associated with upper airway patency; and
b) adjust one or more parameters of the electrical stimulation based on the first biomarker parameter and/or the second biomarker parameter, wherein adjustment comprises modulation of the amplitude, frequency, pulse width, duty cycle, or bursting parameters of the electrical stimulation.
16. The system of claim 1 , wherein the system further comprises a positive air pressure (“PAP”) device and the controller is further configured to cause the PAP device to increase a pressure level of air administered to the subject in response to determining that the subject is experiencing an onset or worsening of SDB.
17. The system of claim 1 , wherein the system further comprises a negative air pressure device and the controller is further configured to cause the negative air device to increase a negative pressure level, and/or a duration of the application of negative pressure administered to the subject, in response to determining that the subject is experiencing an onset or worsening of SDB.
18. A method for treating a medical condition of a human subject, comprising:
detecting and/or monitoring, by a photoplethysmography (“PPG”) sensor, a first biomarker parameter of the subject, wherein the first biomarker parameter comprises one or more of an oxygen saturation level, a heart rate, a respiration rate, a stroke volume, a cardiac output, a pulse pressure, a systemic vascular resistance, an arterial pressure, or a cardiac index, of the human subject;
detecting and/or monitoring, by at least one additional sensor, one or more secondary biomarker parameters of the human subject;
determining an apnea-hypopnea index (“AHI”), body position, and sleep stage of the human subject based on the first biomarker parameter and the secondary biomarker parameters;
determining whether the human subject is experiencing an onset or worsening of sleep-disordered breathing (“SDB”) based on the determined AHI, body position, and sleep stage of the human subject, or a change in the determined AHI, body position, and/or sleep stage of the human subject compared to historical data;
causing a treatment device to administer a higher-intensity treatment of electrical stimulation to at least one nerve associated with upper airway patency of the human subject after determining that the subject is experiencing an onset or worsening of SDB.
19. The method of claim 18 , wherein the medical condition comprises: sleep apnea, hypertension, or an abnormal heart rhythm/rate.
20. The method of claim 18 , wherein the treatment device comprises:
a) an implantable pulse generator connected to one or more electrodes, or
b) an external stimulator.