Systems for treating disordered breathing by comparing stimulated and unstimulated breathing
A means for treating breathing disorders by stimulating respiratory muscles or nerves to entrain respiratory systems while leaving respiratory drive intact. Embodiments of the invention employ frequency analysis to determine if appropriate stimulation energy is being applied.
1. A system for providing disordered breathing therapy, the system comprising:
at least one cuff electrode configured to stimulate a phrenic nerve of a patient; and
an implantable pulse generator (IPG) configured to:
couple to the at least one cuff electrode,
provide an electrical stimulation signal to the at least one cuff electrode to stimulate the phrenic nerve at a stimulation frequency, wherein the stimulation frequency is lower than an intrinsic breathing rate of the patient,
determine a measure of therapy effectiveness based on a comparison of signals representative of patient respiration corresponding to unstimulated breathing to signals representative of patient respiration corresponding to stimulated breathing, and
control power adjusting circuitry configured to adjust a power of the electrical stimulation signal based on the measure of therapy effectiveness, wherein the IPG is configured to control the power adjusting circuitry to adjust the power of the electrical stimulation signal until the power is at an intensity sufficient to entrain respiration while leaving intrinsic drive to breathe intact.
2. The system of claim 1 , comprising:
at least one sensor configured to generate signals representative of patient respiration comprising the signals representative of patient respiration corresponding to unstimulated breathing and the signals representative of patient respiration corresponding to stimulated breathing; and
at least one processor configured to:
receive the signals representative of patient respiration, and
determine the measure of therapy effectiveness based on the signals representative of patient respiration.
3. The system of claim 2 , wherein the at least one sensor comprises a transthoracic impedance sensor.
4. The system of claim 2 , wherein the at least one sensor is configured to sense physiologic activity indicative of contraction of a muscle in response to the electrical stimulation signal.
5. The system of claim 2 , wherein the IPG comprises at least one processor embedded in the IPG and configured to receive the signals representative of patient respiration.
6. The system of claim 5 , wherein the at least one processor is configured to:
receive the signals representative of patient respiration over a period of time, and
process the signals representative of patient respiration via a histogram-based method.
7. The system of claim 6 , wherein the histogram-based method comprises:
a construction of a frequency distribution of patient breath lengths over the period of time in a respiratory range of patient breath lengths,
an identification of a selected band of patient breath lengths that is centered on the stimulation frequency,
a calculation of a first sum of occupancies of sensed patient breath lengths in a range of the selected band of patient breath lengths,
a calculation of a second sum of occupancies of all sensed patient breath lengths in the respiratory range of patient breath lengths, and
a calculation of the measure of therapy effectiveness as a ratio of the first sum over the second sum.
8. The system of claim 5 , wherein the at least one processor is configured to:
receive the signals representative of patient respiration over a period of time, and
process the signals representative of patient respiration via a spectrum-based method.
9. The system of claim 8 , wherein the spectrum-based method comprises:
a generation of a spectral frequency distribution for the signals representative of patient respiration over the period of time,
an identification of a stimulation frequency band centered on the stimulation frequency corresponding to stimulated breathing,
an identification of a respiration frequency band over a range of natural respiratory frequencies corresponding to unstimulated breathing, and
a calculation of the measure of therapy effectiveness based on a comparison of the stimulation frequency band and the respiration frequency band.
10. The system of claim 9 , wherein the comparison comprises one or more of: a ratio of spectral power in the stimulation frequency band with spectral power in the respiration frequency band,
a ratio of spectral power density in the stimulation frequency band with spectral power density in the respiration frequency band, or
a ratio of spectral magnitude in the stimulation frequency band with spectral magnitude in the respiration frequency band.
11. The system of claim 1 , wherein the IPG is configured to provide the electrical stimulation signal to the at least one cuff electrode to stimulate the phrenic nerve at a variable stimulation frequency based on the measure of therapy effectiveness.
12. The system of claim 1 , wherein the IPG is configured to:
increase the power of the electrical stimulation signal if the measure of therapy effectiveness is below a threshold, and
decrease the power of the electrical stimulation signal if the measure of therapy effectiveness is above the threshold.
13. The system of claim 1 , wherein the power adjusting circuitry is configured to adjust the power of the electrical stimulation signal by changing one or more of a stimulation current or a stimulation voltage.
14. The system of claim 13 , wherein the power adjusting circuitry is configured to adjust the power of the electrical stimulation signal by increasing or decreasing a current of the electrical stimulation signal by steps within a current range below 10 mA.
15. The system of claim 1 ,
wherein the electrical stimulation signal comprises a series of pulse trains delivered at the stimulation frequency, with each pulse train being composed of a series of individual pulses, and
wherein the power adjusting circuitry is configured to adjust the power of the electrical stimulation signal by changing one or more of: a duration of the individual pulses, an amplitude of the individual pulses, or a frequency of the individual pulses.
16. The system of claim 15 , wherein the power adjusting circuitry is configured to change the duration of the individual pulses by increasing or decreasing the duration of the individual pulses in a step-wise manner.
17. A system for providing disordered breathing therapy, the system comprising:
at least one electrode configured to stimulate a phrenic nerve of a patient;
at least one sensor configured to generate signals representative of patient respiration comprising signals representative of patient respiration corresponding to unstimulated breathing and signals representative of patient respiration corresponding to stimulated breathing; and
an implantable pulse generator (IPG) configured to:
couple to the at least one electrode and the at least one sensor, and
provide an electrical stimulation signal to the at least one electrode to stimulate the phrenic nerve at a stimulation frequency,
wherein the IPG comprises:
at least one embedded processor configured to:
receive the signals representative of patient respiration over a period of time, and
determine a measure of therapy effectiveness based on a spectrum-based method of comparison of the signals representative of patient respiration corresponding to unstimulated breathing to the signals representative of patient respiration corresponding to stimulated breathing, and
power adjusting circuitry configured to adjust a power of the electrical stimulation signal based on the measure of therapy effectiveness.
18. The system of claim 17 , wherein the at least one sensor comprises a transthoracic impedance sensor.
19. The system of claim 17 , wherein the at least one sensor is configured to sense physiologic activity indicative of contraction of a muscle in response to the electrical stimulation signal.
20. The system of claim 17 , wherein the spectrum-based method of comparison comprises:
a generation of a spectral frequency distribution for the signals representative of patient respiration over the period of time,
an identification of a stimulation frequency band centered on the stimulation frequency corresponding to stimulated breathing,
an identification of a respiration frequency band over a range of natural respiratory frequencies corresponding to unstimulated breathing, and
a calculation of the measure of therapy effectiveness based on a comparison of the stimulation frequency band and the respiration frequency band.
21. The system of claim 20 , wherein the comparison comprises one or more of: a ratio of spectral power in the stimulation frequency band with spectral power in the respiration frequency band,
a ratio of spectral power density in the stimulation frequency band with spectral power density in the respiration frequency band, or
a ratio of spectral magnitude in the stimulation frequency band with spectral magnitude in the respiration frequency band.
22. The system of claim 17 , wherein the IPG is configured to provide the electrical stimulation signal to the at least one electrode to stimulate the phrenic nerve at a variable stimulation frequency based on the measure of therapy effectiveness.
23. The system of claim 17 , wherein the power adjusting circuitry is configured to:
increase the power of the electrical stimulation signal if the measure of therapy effectiveness is below a threshold, and
decrease the power of the electrical stimulation signal if the measure of therapy effectiveness is above the threshold.
24. The system of claim 17 ,
wherein the stimulation frequency is lower than an intrinsic breathing rate of the patient, and
wherein the IPG is configured to control the power adjusting circuitry to adjust the power of the electrical stimulation signal until the power is at an intensity sufficient to entrain respiration while leaving intrinsic drive to breathe intact.
25. The system of claim 17 , wherein the power adjusting circuitry is configured to adjust the power of the electrical stimulation signal by changing one or more of a stimulation current or a stimulation voltage.
26. The system of claim 25 , wherein the power adjusting circuitry is configured to adjust the power of the electrical stimulation signal by increasing or decreasing a current of the electrical stimulation signal by steps within a current range below 10 mA.
27. The system of claim 17 ,
wherein the electrical stimulation signal comprises a series of pulse trains delivered at the stimulation frequency, with each pulse train being composed of a series of individual pulses, and
wherein the power adjusting circuitry is configured to adjust the power of the electrical stimulation signal by changing one or more of: a duration of the individual pulses, an amplitude of the individual pulses, or a frequency of the individual pulses.
28. The system of claim 27 , wherein the power adjusting circuitry is configured to change the duration of the individual pulses by increasing or decreasing the duration of the individual pulses in a step-wise manner.
29. The system of claim 17 , wherein the at least one electrode is one of a cuff electrode or a transvenous lead electrode.