U.S. patent application number 12/828981 was filed with the patent office on 2010-10-28 for detecting sleep.
This patent application is currently assigned to Medtronic, Inc.. Invention is credited to Kenneth T. Heruth, Keith A. Miesel.
Application Number | 20100274106 12/828981 |
Document ID | / |
Family ID | 34963539 |
Filed Date | 2010-10-28 |
United States Patent
Application |
20100274106 |
Kind Code |
A1 |
Heruth; Kenneth T. ; et
al. |
October 28, 2010 |
DETECTING SLEEP
Abstract
A system includes one or more sensors and a processor. Each of
the sensors generates a signal as a function of at least one
physiological parameter of a patient that may discernibly change
when the patient is asleep. The processor monitors the
physiological parameters, and determines whether the patient is
asleep based on the parameters. In some embodiments, the processor
determines plurality of sleep metric values, each of which
indicates a probability of the patient being asleep, based on each
of a plurality of physiological parameters. The processor may
average or otherwise combine the plurality of sleep metric values
to provide an overall sleep metric value that is compared to a
threshold value in order to determine whether the patient is
asleep.
Inventors: |
Heruth; Kenneth T.; (Edina,
MN) ; Miesel; Keith A.; (St. Paul, MN) |
Correspondence
Address: |
SHUMAKER & SIEFFERT, P. A.
1625 RADIO DRIVE, SUITE 300
WOODBURY
MN
55125
US
|
Assignee: |
Medtronic, Inc.
|
Family ID: |
34963539 |
Appl. No.: |
12/828981 |
Filed: |
July 1, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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11081786 |
Mar 16, 2005 |
7775993 |
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12828981 |
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10825964 |
Apr 15, 2004 |
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11081786 |
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60553771 |
Mar 16, 2004 |
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Current U.S.
Class: |
600/301 |
Current CPC
Class: |
A61N 1/36135 20130101;
G16H 40/63 20180101; A61M 2230/10 20130101; A61M 2005/1726
20130101; A61M 2230/63 20130101; A61B 5/0205 20130101; A61M 2230/62
20130101; G16H 20/30 20180101; A61N 1/36078 20130101; A61M 5/14276
20130101; A61M 2230/40 20130101; A61B 5/4809 20130101 |
Class at
Publication: |
600/301 |
International
Class: |
A61B 5/00 20060101
A61B005/00 |
Claims
1. A method comprising: monitoring a plurality of physiological
parameters of a patient; for each of the plurality of physiological
parameters, determining within an implantable medical device a
respective one of a plurality of sleep metric values, each of the
sleep metric values indicating a probability of the patient being
asleep based on the respective physiological parameter, and
mathematically combining the plurality of sleep metric values that
each indicates the probability of the patient being asleep based on
the respective one of the plurality physiological parameters to
determine an overall sleep metric value that indicates an overall
probability of the patient being asleep.
2. The method of claim 1, wherein mathematically combining the
plurality of sleep metric values to determine an overall sleep
metric value that indicates an overall probability of the patient
being asleep comprises applying a weighting factor to a value of at
least one of the plurality of sleep metrics.
3. The method of claim 1, further comprising: comparing the value
of the overall sleep metric to a threshold value; and determining
whether the patient is asleep based on the comparison.
4. The method of claim 3, wherein the threshold value is selected
by a user.
5. The method of claim 3, further comprising controlling delivery
of a therapy to the patient based on the determination of whether
the patient is asleep.
6. The method of claim 3, further comprising storing information
indicating when the patient is asleep for retrieval by a user.
7. The method of claim 6, further comprising evaluating the
effectiveness of a therapy delivered to the patient based on the
information indicating whether the patient is asleep.
8. The method of claim 7, wherein the therapy comprises at least
one of a neurostimulation and a drug therapy.
9. The method of claim 7, wherein the therapy is a pain
therapy.
10. The method of claim 3, further comprising: comparing the value
of the sleep metric to a plurality of threshold values; and
determining a sleep state of the patient based on the
comparison.
11. The method of claim 10, wherein determining a sleep state of
the patient comprises determining whether the patient is in one of
a rapid eye movement sleep state or a nonrapid eye movement sleep
state.
12. The method of claim 1, wherein the physiological parameters
comprise at least one of electrocardiogram morphology, core
temperature, subcutaneous temperature, muscular tone, brain
electrical activity, or eye motion.
13. The method of claim 1, wherein the physiological parameters
comprise at least one of activity level or posture.
14. The method of claim 1, wherein the physiological parameters
comprise at least one of heart rate, respiration rate, respiratory
volume, or core temperature.
15. The method of claim 1, wherein the physiological parameters
comprise at least one of blood pressure, blood oxygen saturation,
partial pressure of oxygen within blood, partial pressure of oxygen
within cerebrospinal fluid, muscular activity, core temperature,
arterial blood flow, and galvanic skin response.
16. The method of claim 1, further comprising determining a
variability of at least one of the plurality of physiological
parameters, wherein determining the value of the sleep metric for
the at least one of the plurality of physiological parameters
comprises determining the value of the sleep metric based on the
variability.
17. The method of claim 1, further comprising determining at least
one of a mean value and a median value for at least one of the
plurality of physiological parameters, wherein determining the
value of the sleep metric for the at least one of the plurality of
physiological parameters comprises determining the sleep metric
based on the at least one of the mean value and the median
value.
18. The method of claim 1, wherein mathematically combining the
plurality of sleep metric values to determine an overall sleep
metric value that indicates an overall probability of the patient
being asleep comprises averaging the values of the plurality of
sleep metrics.
Description
[0001] This application is a divisional of U.S. application Ser.
No. 11/081,786, filed Mar. 16, 2005, which is a
continuation-in-part of U.S. application Ser. No. 10/825,964, filed
Apr. 15, 2004, which claims the benefit of U.S. provisional
application No. 60/553,771, filed Mar. 16, 2004. The entire content
of each of these applications is incorporated herein by
reference.
TECHNICAL FIELD
[0002] The invention relates to medical devices, and to techniques
for determining whether a patient is asleep.
BACKGROUND
[0003] The ability to determine whether a patient is asleep is
useful in a variety of medical contexts. In some situations, the
ability to determine whether a patient is asleep is used to
diagnose conditions of the patient. For example, the amount of time
that patients sleep, the extent of arousals during sleep, and the
times of day that patients sleep have been used to diagnose sleep
apnea. Such sleep information could also be used to diagnose
psychological disorders, such as depression and mania.
[0004] In other situations, a determination as to whether a patient
is asleep is used to control delivery of therapy to the patient.
For example, neurostimulation or drug therapies can be suspended
when the patient is asleep, or the intensity/dosage of the
therapies can be reduced when a patient is asleep. As another
example, the rate response settings of a cardiac pacemaker may be
adjusted to less aggressive settings when the patient is asleep so
that the patient's heart will not be paced at an inappropriately
high rate during sleep. In these examples, therapy may be suspended
or adjusted when the patient is asleep to avoid patient discomfort,
or to conserve a battery and/or contents of a fluid reservoir of an
implantable medical device when the therapy may be unneeded or
ineffective. However, in other cases, a therapy intended to be
delivered when the patient is asleep, such as therapy intended to
prevent or treat sleep apnea, is delivered based on a determination
that the patient is asleep.
[0005] Existing techniques for determining whether a patient is
asleep include monitoring the electroencephalogram (EEG) of the
patient to identify brain wave activity indicative of sleep.
However, EEG monitoring typically requires that an array of
electrodes be placed on a patient's scalp and coupled to an
external monitoring device, and is most often performed in a clinic
setting. Generally, an implantable medical device may only be used
to monitor a patient's EEG in the rare cases when it is coupled to
electrodes implanted within the brain of the patient. Consequently,
existing EEG monitoring techniques are generally unsuitable for
determining whether a patient is asleep in order to control
therapy, or for long-term monitoring of the patient's sleep/wake
cycle.
[0006] Existing techniques employed by implantable medical devices
to determine whether a patient is asleep include monitoring the
patient's respiration rate, respiration rate variability, and
activity level. Each of these physiological parameters may be an
inaccurate indicator of whether a patient is asleep. For example,
from the perspective of these physiological parameters, it may
appear that a patient is sleeping when, instead, the patient is
merely lying down in a relaxed state. As another example,
respiration rate and respiration rate variability, for example, may
fail to accurately indicate that the patient is asleep when the
patient suffers from a breathing disorder, such as Cheyne-Stokes
syndrome.
SUMMARY
[0007] In general, the invention is directed to techniques for
determining whether a patient is asleep. In some embodiments, the
invention is directed to techniques that involve determination of
values of one or more sleep metrics that indicate a probability of
a patient being asleep based on the current value of one or more
physiological parameters of the patient. Use of a plurality of
sleep metrics, in particular, may allow for a more accurate
determination of whether a patient is asleep.
[0008] A system according to the invention includes one or more
sensors and a processor. Each of the sensors generates a signal as
a function of at least one physiological parameter of a patient
that may discernibly change when the patient is asleep. Exemplary
physiological parameters include activity level, posture, heart
rate, electrocardiogram (ECG) morphology, respiration rate,
respiratory volume, blood pressure, blood oxygen saturation,
partial pressure of oxygen within blood, partial pressure of oxygen
within cerebrospinal fluid, muscular activity and tone, core
temperature, subcutaneous temperature, arterial blood flow, brain
electrical activity, eye motion, and galvanic skin response.
[0009] The processor monitors the physiological parameters based on
the signals generated by the sensors, and determines whether the
patient is asleep based on values for the physiological parameters.
The value for a physiological parameter may be a current, mean or
median value for the parameter. In some embodiments, the processor
may additionally or alternatively determine whether the patient is
asleep based on the variability of one or more of the physiological
parameters.
[0010] In some embodiments, the processor determines a value of a
sleep metric that indicates a probability of the patient being
asleep based on a physiological parameter. In particular, the
processor may apply a function or look-up table to the current
value and/or variability of the physiological parameter to
determine the sleep metric value. The processor may compare the
sleep metric value to a threshold value to determine whether the
patient is asleep. In some embodiments, the processor may compare
the sleep metric value to each of a plurality of thresholds to
determine the current sleep state of the patient, e.g., rapid eye
movement (REM), or one of the nonrapid eye movement (NREM) states
(S1, S2, S3, S4). Because they provide the most "refreshing" type
of sleep, the ability to determine whether the patient is in one of
the S3 and S4 sleep states may be, in some embodiments,
particularly useful.
[0011] Further, in some embodiments the processor may determine a
sleep metric value for each of a plurality of physiological
parameters. In other words, the processor may apply a function or
look-up table for each parameter to the current value for that
parameter in order to determine the sleep metric value for that
parameter. The processor may average or otherwise combine the
plurality of sleep metric values to provide an overall sleep metric
value for comparison to the threshold values. In some embodiments,
a weighting factor may be applied to one or more of the sleep
metric values. One or more of functions, look-up tables, thresholds
and weighting factors may be selected or adjusted by a user in
order to select or adjust the sensitivity and specificity of the
system in determining whether the patient is asleep.
[0012] In some embodiments, the processor is included as part of a
medical device, such as an implantable medical device. The sensors
may also be included within the medical device, coupled to the
medical device by one or more leads, or in wireless communication
with the medical device. The medical device may control delivery of
therapy to the patient based on the determination as to whether the
patient is asleep, or may store information indicating when the
patient is asleep for later retrieval and analysis by user. In some
embodiments, the medical device may instead use the one or more
sleep metric values to control delivery of therapy, or may store
one or more sleep metric values. In some embodiments, information
relating to the patient's sleep patterns may be used to diagnose
sleep or psychological disorder, or may be used to evaluate the
effectiveness of a therapy delivered to the patient.
[0013] In one embodiment, the invention is directed to a method in
which a plurality of physiological parameters of a patient are
monitored and a value of a sleep metric that indicates a
probability of the patient being asleep is determined based on the
physiological parameters. The physiological parameters may comprise
at least one of electrocardiogram morphology, core temperature, or
subcutaneous temperature, muscular tone, brain electrical activity,
or eye motion.
[0014] In another embodiment, the invention is directed to a
medical system that comprises a plurality of sensors and a
processor. Each of the sensors generate a signal as a function of
at least one physiological parameter of a patient. The processor
monitors a plurality of physiological parameters of the patient
based on the signals output by the sensors, and determines a value
of a sleep metric that indicates a probability of the patient being
asleep based on the physiological parameters. The physiological
parameters may comprise at least one of electrocardiogram
morphology, core temperature, or subcutaneous temperature, muscular
tone, brain electrical activity, or eye motion.
[0015] In another embodiment, the invention is directed to a
medical system that comprises means for monitoring a plurality of
physiological parameters of a patient and means for determining a
value of a sleep metric that indicates a probability of the patient
being asleep based on the physiological parameters. The
physiological parameters may comprise at least one of
electrocardiogram morphology, core temperature, or subcutaneous
temperature, muscular tone, brain electrical activity, or eye
motion.
[0016] In another embodiment, the invention is directed to a
computer-readable medium comprising program instructions. The
instructions cause a programmable processor to monitor a plurality
of physiological parameters of a patient, and determine a value of
a sleep metric that indicates a probability of the patient being
asleep based on the physiological parameters. The physiological
parameters may comprise at least one of electrocardiogram
morphology, core temperature, or subcutaneous temperature, muscular
tone, brain electrical activity, or eye motion.
[0017] The invention may be capable of providing one or more
advantages. For example, the invention provides techniques for
determining a sleep state of a patient that may be implemented in
an implantable medical device. Further, the techniques provided by
the invention may include analysis of a variety of physiological
parameters not previously used in determining whether a patient is
asleep. Where it is desired to detect sleep via an implantable
medical device, the ability to determine whether a patient is
sleeping based on these physiological parameters may increase the
number of implantable medical device types in which the invention
may be implemented, i.e., the invention may be implemented in a
variety of types of implantable medical devices which include or
may be easily modified to include sensors capable of generating a
signal based on such physiological parameters.
[0018] Monitoring a plurality of physiological parameters according
to some embodiments, rather than a single parameter, may allow for
a more accurate determination of whether a patient is asleep than
is available via existing implantable medical devices. Use of sleep
metrics that indicate a probability of the patient being asleep for
each of a plurality of physiological parameters may further
increase the reliability with which an implantable medical device
may determine whether a patient is asleep. In particular, rather
than a binary sleep or awake determination for each of a plurality
of parameters, sleep metric values for each of a plurality of
parameters may be combined to yield an overall sleep metric value
that may be compared to a threshold to determine whether the
patient is asleep. In other words, failure of any one physiological
parameter to accurately indicate whether a patient is sleeping may
be less likely to prevent the implantable medical device from
accurately indicating whether the patient is sleeping when
considered in combination with other physiological parameters.
[0019] The details of one or more embodiments of the invention are
set forth in the accompanying drawings and the description below.
Other features, objects, and advantages of the invention will be
apparent from the description and drawings, and from the
claims.
BRIEF DESCRIPTION OF DRAWINGS
[0020] FIG. 1 is a conceptual diagram illustrating an example
system including an implantable medical device that determines
whether a patient is asleep according to the invention.
[0021] FIG. 2 is a block diagram further illustrating the system of
FIG. 1.
[0022] FIG. 3 is a block diagram illustrating a memory within an
implantable medical device of the system of FIG. 1.
[0023] FIG. 4 is a flowchart illustrating an example technique for
determining whether a patient is asleep.
DETAILED DESCRIPTION
[0024] FIG. 1 is a conceptual diagram illustrating an example
system 10 that includes an implantable medical device (IMD) 14 that
determines whether a patient 12 is asleep according to the
invention. In the illustrated example system, IMD 14 takes the form
of an implantable neurostimulator that delivers neurostimulation
therapy in the form of electrical pulses to patient 12. However,
the invention is not limited to implementation via an implantable
neurostimulator, or even to implementation via an IMD.
[0025] For example, in some embodiments of the invention, an
implantable pump or implantable cardiac pacemaker may determine
whether a patient is asleep. In other embodiments, the medical
device that determines when patient 12 are asleep may be an
implantable or external patient monitor. Further, a programming
device or other computing device may determine when patient 12 is
asleep based on information collected by a medical device. In other
words, any implantable or external device may determine whether a
patient is asleep according to the invention.
[0026] In the illustrated example, IMD 14 delivers neurostimulation
therapy to patient 12 via leads 16A and 16B (collectively "leads
16"). Leads 16 may, as shown in FIG. 1, be implanted proximate to
the spinal cord 18 of patient 12, and IMD 14 may deliver spinal
cord stimulation (SCS) therapy to patient 12 in order to, for
example, reduce pain experienced by patient 12. However, the
invention is not limited to the configuration of leads 16 shown in
FIG. 1 or the delivery of SCS therapy. For example, one or more
leads 16 may extend from IMD 14 to the brain (not shown) of patient
12, and IMD 14 may deliver deep brain stimulation (DBS) therapy to
patient 12 to, for example, treat tremor or epilepsy. As further
examples, one or more leads 16 may be implanted proximate to the
pelvic nerves (not shown) or stomach (not shown), and IMD 14 may
deliver neurostimulation therapy to treat incontinence or
gastroparesis.
[0027] IMD 14 delivers therapy according to a set of therapy
parameters that define the delivered therapy. In embodiments where
IMD 14 delivers neurostimulation therapy in the form of electrical
pulses, the parameters for each of the parameter sets may include
voltage or current pulse amplitudes, pulse widths, pulse rates, and
the like. Further, each of leads 16 includes electrodes (not shown
in FIG. 1), and the parameters may include information identifying
which electrodes have been selected for delivery of pulses, and the
polarities of the selected electrodes.
[0028] System 10 also includes a clinician programmer 20. A
clinician (not shown) may use clinician programmer 20 to program
neurostimulation therapy for patient 12. Clinician programmer 20
may, as shown in FIG. 1, be a handheld computing device. Clinician
programmer 20 includes a display 22, such as a LCD or LED display,
to display information to a user. Clinician programmer 20 may also
include a keypad 24, which may be used by a user to interact with
clinician programmer 20. In some embodiments, display 22 may be a
touch screen display, and a user may interact with clinician
programmer 20 via display 22. A user may also interact with
clinician programmer 20 using peripheral pointing devices, such as
a stylus, mouse, or the like. Keypad 24 may take the form of an
alphanumeric keypad or a reduced set of keys associated with
particular functions.
[0029] System 10 also includes a patient programmer 26, which also
may, as shown in FIG. 1, be a handheld computing device. Patient 12
may use patient programmer 26 to control the delivery of
neurostimulation therapy by IMD 14. Patient programmer 26 may also
include a display 28 and a keypad 30, to allow patient 12 to
interact with patient programmer 26. In some embodiments, display
26 may be a touch screen display, and patient 12 may interact with
patient programmer 26 via display 28. Patient 12 may also interact
with patient programmer 26 using peripheral pointing devices, such
as a stylus or mouse.
[0030] IMD 14, clinician programmer 20 and patient programmer 26
may, as shown in FIG. 1, communicate via wireless communication.
Clinician programmer 20 and patient programmer 26 may, for example,
communicate via wireless communication with IMD 14 using RF
telemetry techniques known in the art. Clinician programmer 20 and
patient programmer 26 may communicate with each other using any of
a variety of local wireless communication techniques, such as RF
communication according to the 802.11 or Bluetooth specification
sets, infrared communication according to the IRDA specification
set, or other standard or proprietary telemetry protocols.
[0031] Clinician programmer 20 and patient programmer 26 need not
communicate wirelessly, however. For example, programmers 20 and 26
may communicate via a wired connection, such as via a serial
communication cable, or via exchange of removable media, such as
magnetic or optical disks, or memory cards or sticks. Further,
clinician programmer 20 may communicate with one or both of IMD 14
and patient programmer 26 via remote telemetry techniques known in
the art, communicating via a local area network (LAN), wide area
network (WAN), public switched telephone network (PSTN), or
cellular telephone network, for example.
[0032] As mentioned above, IMD 14 is capable of determining whether
patient 12 is asleep. Specifically, as will be described in greater
detail below, IMD 14 monitors a plurality of physiological
parameters of patient 12 that may discernibly change when patient
12 is asleep, and determines whether patient 12 is asleep based on
values of the physiological parameters. The value for a
physiological parameter may be a current, mean or median value for
the parameter. In some embodiments, IMD 14 may additionally or
alternatively determine whether patient 12 is asleep based on the
variability of one or more of the physiological parameters. IMD 14
includes, is coupled to, or is in wireless communication with one
or more sensors, and monitors the physiological parameters via the
sensors.
[0033] Exemplary physiological parameters that may be monitored by
IMD 14 include activity level, posture, heart rate, ECG morphology,
respiration rate, respiratory volume, blood pressure, blood oxygen
saturation, partial pressure of oxygen within blood, partial
pressure of oxygen within cerebrospinal fluid, muscular activity
and tone, core temperature, subcutaneous temperature, arterial
blood flow, brain electrical activity, and eye motion. In some
external medical device embodiments of the invention, galvanic skin
response may additionally or alternatively be monitored. Some of
the parameters, such as activity level, heart rate, some ECG
morphological features, respiration rate, respiratory volume, blood
pressure, arterial oxygen saturation and partial pressure, partial
pressure of oxygen in the cerebrospinal fluid, muscular activity
and tone, core temperature, subcutaneous temperature, arterial
blood flow, and galvanic skin response may be at low values when
patient 12 is asleep. Further, the variability of at least some of
these parameters, such as heart rate and respiration rate, may be
at a low value when the patient is asleep. Information regarding
the posture of patient 12 will most likely indicate that patient 12
is lying down when patient 12 is asleep.
[0034] In some embodiments, IMD 14 determines a value of one or
more sleep metrics based on a value of one or more physiological
parameters of patient 12. A sleep metric value may be a numeric
value that indicates the probability that patient 12 is asleep. In
some embodiments, the sleep metric value may be a probability
value, e.g., a number within the range from 0 to 1.
[0035] In particular, the IMD 14 may apply a function or look-up
table to the current, mean or median value, and/or the variability
of the physiological parameter to determine a value of the sleep
metric. IMD 14 may compare the sleep metric value to a threshold
value to determine whether the patient is asleep. In some
embodiments, the IMD 14 may compare the sleep metric value to each
of a plurality of thresholds to determine the current sleep state
of the patient, e.g., rapid eye movement (REM), S1, S2, S3, or S4.
Because they provide the most "refreshing" type of sleep, the
ability to determine whether the patient is in one of the S3 and S4
sleep states may be, in some embodiments, particularly useful.
[0036] Further, in some embodiments IMD 14 may determine a sleep
metric value for each of a plurality of physiological parameters.
In other words, IMD 14 may apply a function or look-up table for
each parameter to a value for that parameter in order to determine
the sleep metric value for that parameter. IMD 14 may average or
otherwise combine the plurality of sleep metric values to provide
an overall sleep metric value for comparison to the threshold
values. In some embodiments, IMD 14 may apply a weighting factor to
one or more of the sleep metric values prior to combination. One or
more of functions, look-up tables, thresholds and weighting factors
may be selected or adjusted by a user, such as a clinician via
programmer 20 or patient 12 via programmer 26, in order to select
or adjust the sensitivity and specificity of IMD 14 in determining
whether patient 12 is asleep.
[0037] Monitoring a plurality of physiological parameters according
to some embodiments, rather than a single parameter, may allow IMD
14 to determine whether patient 12 is asleep with more accuracy
than existing implantable medical devices. Use of sleep metric
values that indicate a probability of the patient being asleep for
each of a plurality of physiological parameters may further
increase the accuracy with which IMD 14 may determine whether
patient 12 is asleep. In particular, rather than a binary sleep or
awake determination for each of a plurality of parameters, sleep
metric values for each of a plurality of parameters may be combined
to yield an overall sleep metric value that may be compared to a
threshold to determine whether patient 12 is asleep. In other
words, failure of any one physiological parameter to accurately
indicate whether a patient is sleeping may be less likely to
prevent IMD 14 from accurately indicating whether patient 12 is
sleeping when considered in combination with other physiological
parameters.
[0038] IMD 14 may control delivery of therapy to patient 12 based
on the determination as to whether patient 12 is asleep. For
example, IMD 14 may suspend delivery of neurostimulation or reduce
the intensity of delivered neurostimulation when patient 14 is
determined to be asleep. In other embodiments, IMD 14 may suspend
or reduce intensity of drug delivery, or may reduce the
aggressiveness of rate response for cardiac pacing when patient 12
is determined to be asleep. In still other embodiments, IMD 14 may
initiate delivery of a therapy, such as a therapy to treat or
prevent sleep apnea, when patient 12 is determined to be
asleep.
[0039] In some embodiments, IMD 14 stores information indicating
when patient 12 is asleep, which may be retrieved for analysis by a
clinician via programmer 20, for example. The clinician may use the
sleep information to diagnose conditions of patient 12, such as
sleep apnea or psychological disorders. Information relating to the
sleep patterns of patient 12 may in other situations indicate the
effectiveness of a delivered therapy and/or the need for increased
therapy. Some ailments of patient 12, such as chronic pain, tremor,
gastrointestinal disorders, incontinence, congestive heart failure,
and sleep apnea may disturb or hinder the sleep or patient 12, or,
in some cases, inadequate or disturbed sleep may increase the
symptoms of these ailments.
[0040] IMD 14 may collect information relating to the sleep
patterns of patient 12, which may be retrieved by a clinician via
programmer 20 and used to evaluate the effectiveness of a therapy
delivered to patient 12 for such an ailment, or to indicate the
need for an additional therapy to improve the sleep pattern of
patient 12. In some cases, IMD 14 may evaluate such collected sleep
information and automatically adjust a therapy for such a condition
based on the evaluation. Further information regarding evaluation
of a therapy based on sleep information collected by an IMD may be
found in a commonly-assigned and copending U.S. patent application
Ser. No. 11/081,811 by Ken Heruth and Keith Miesel, entitled
"COLLECTING SLEEP QUALITY INFORMATION VIA A MEDICAL DEVICE," which
is filed on Mar. 16, 2005 and assigned attorney docket number
1023-350US02. Further information regarding automatic control of a
therapy based on sleep information collected by an IMD may be found
in a commonly-assigned and copending U.S. patent application Ser.
No. 11/081,155 by Ken Heruth and Keith Miesel, entitled
"CONTROLLING THERAPY BASED ON SLEEP QUALITY," which is filed on
Mar. 16, 2005 and assigned attorney docket number 1023-363US02. The
entire content of both of these applications is incorporated herein
by reference.
[0041] FIG. 2 is a block diagram further illustrating system 10. In
particular, FIG. 2 illustrates an example configuration of IMD 14
and leads 16A and 16B. FIG. 2 also illustrates sensors 40A and 40B
(collectively "sensors 40") that generate signals as a function of
one or more physiological parameters of patient 12. IMD 14 monitors
the signals to determine whether patient 12 is asleep.
[0042] IMD 14 may deliver neurostimulation therapy via electrodes
42A-D of lead 16A and electrodes 42E-H of lead 16B (collectively
"electrodes 42"). Electrodes 42 may be ring electrodes. The
configuration, type and number of electrodes 42 illustrated in FIG.
2 are merely exemplary. For example, leads 16A and 16B may each
include eight electrodes 42, and the electrodes 42 need not be
arranged linearly on each of leads 16A and 16B.
[0043] Electrodes 42 are electrically coupled to a therapy delivery
module 44 via leads 16A and 16B. Therapy delivery module 44 may,
for example, include a pulse generator coupled to a power source
such as a battery. Therapy delivery module 44 may deliver
electrical pulses to patient 12 via at least some of electrodes 42
under the control of a processor 46, which controls therapy
delivery module 44 to deliver neurostimulation therapy according to
a set of therapy parameters, which may be one of a plurality of
therapy parameter sets stored in memory 48. However, the invention
is not limited to implantable neurostimulator embodiments or even
to IMDs that deliver electrical stimulation. For example, in some
embodiments a therapy delivery module 44 of an IMD may include a
pump, circuitry to control the pump, and a reservoir to store a
therapeutic agent for delivery via the pump.
[0044] Processor 46 may include a microprocessor, a controller, a
digital signal processor (DSP), an application specific integrated
circuit (ASIC), a field-programmable gate array (FPGA), discrete
logic circuitry, or the like. Memory 48 may include any volatile,
non-volatile, magnetic, optical, or electrical media, such as a
random access memory (RAM), read-only memory (ROM), non-volatile
RAM (NVRAM), electrically-erasable programmable ROM (EEPROM), flash
memory, and the like. In some embodiments, memory 48 stores program
instructions that, when executed by processor 46, cause IMD 14 and
processor 46 to perform the functions attributed to them
herein.
[0045] Each of sensors 40 generates a signal as a function of one
or more physiological parameters of patient 12. Although shown as
including two sensors 40, system 10 may include any number of
sensors. As illustrated in FIG. 2, sensors 40 may be included as
part of IMD 14, or coupled to IMD 14 via leads 16. Sensors 40 may
be coupled to IMD 14 via therapy leads 16A and 16B, or via other
leads 16, such as lead 16C depicted in FIG. 2. In some embodiments,
a sensor located outside of IMD 14 may be in wireless communication
with processor 46. Wireless communication between sensors 40 and
IMD 14 may, as examples, include RF communication or communication
via electrical signals conducted through the tissue and/or fluid of
patient 12.
[0046] As discussed above, exemplary physiological parameters of
patient 12 that may be monitored by IMD 14 to determine values of
one or more sleep metrics include activity level, posture, heart
rate, ECG morphology, respiration rate, respiratory volume, blood
pressure, blood oxygen saturation, partial pressure of oxygen
within blood, partial pressure of oxygen within cerebrospinal
fluid, muscular activity and tone, core temperature, subcutaneous
temperature, arterial blood flow, brain electrical activity, and
eye motion. Further, as discussed above, in some external medical
device embodiments of the invention galvanic skin response may
additionally or alternatively be monitored. The detected values of
these physiological parameters of patient 12 may discernibly change
when patient 12 falls asleep or wakes up. Some of these
physiological parameters may be at low values when patient 12 is
asleep. Further, the variability of at least some of these
parameters, such as heart rate and respiration rate, may be at a
low value when the patient is asleep. Sensors 40 may be of any type
known in the art capable of generating a signal as a function of
one or more of these parameters.
[0047] For example, sensors 40 may include electrodes located on
leads or integrated as part of the housing of IMD 14 that generate
an electrogram signal as a function of electrical activity of the
heart of patient 12, and processor 46 may monitor the heart rate of
patient 12 based on the electrogram signal. In other embodiments, a
sensor may include an acoustic sensor within IMD 14, a pressure or
flow sensor within the bloodstream or cerebrospinal fluid of
patient 12, or a temperature sensor located within the bloodstream
of patient 12. The signals generated by such sensors may vary as a
function of contraction of the heart of patient 12, and can be used
by IMD 14 to monitor the heart rate of patient 12.
[0048] In some embodiments, processor 46 may detect, and measure
values for one or more ECG morphological features within an
electrogram generated by electrodes as described above. ECG
morphological features may vary in a manner that indicates whether
patient 12 is asleep or awake. For example, the amplitude of the ST
segment of the ECG may decrease when patient 12 is asleep. Further,
the amplitude of QRS complex or T-wave may decrease, and the widths
of the QRS complex and T-wave may increase when patient 12 is
asleep. The QT interval and the latency of an evoked response may
increase when patient 12 is asleep, and the amplitude of the evoked
response may decrease when patient 12 is asleep.
[0049] Sensors 40 may include one or more accelerometers, gyros,
mercury switches, or bonded piezoelectric crystals that generate a
signal as a function of patient activity, e.g., body motion,
footfalls or other impact events, and the like. Additionally or
alternatively, sensors 40 may include one or more electrodes that
generate an electromyogram (EMG) signal as a function of muscle
electrical activity, which may indicate the activity level of a
patient. The electrodes may be, for example, located in the legs,
abdomen, chest, back or buttocks of patient 12 to detect muscle
activity associated with walking, running or the like. The
electrodes may be coupled to IMI 14 wirelessly or by leads 16 or,
if IMD 14 is implanted in these locations, integrated with a
housing of IMD 14.
[0050] However, bonded piezoelectric crystals located in these
areas generate signals as a function of muscle contraction in
addition to body motion, footfalls or other impact events.
Consequently, use of bonded piezoelectric crystals to detect
activity of patient 12 may be preferred in some embodiments in
which it is desired to detect muscle activity in addition to body
motion, footfalls, or other impact events. Bonded piezoelectric
crystals may be coupled to IMD 14 wirelessly or via leads 16, or
piezoelectric crystals may be bonded to the can of IMD 14 when the
IMD is implanted in these areas, e.g., in the back, buttocks,
chest, or abdomen of patient 12.
[0051] Processor 46 may detect spasmodic or pain related muscle
activation via the signals generated by electrodes or a bonded
piezoelectric crystal in addition to the electrical activation and
contractions of muscles associated with gross motor activity of the
patient, e.g., walking, running or the like. Spasmodic or pain
related muscle activation may indicate that patient 12 is not
sleeping, e.g., unable to sleep.
[0052] Sensors 40 may also include a plurality of accelerometers,
gyros, or magnetometers oriented orthogonally that generate signals
that indicate the posture of patient 12. In addition to being
oriented orthogonally with respect to each other, each of sensors
40 used to detect the posture of patient 12 may be generally
aligned with an axis of the body of patient 12. When
accelerometers, for example, are aligned in this manner, the
magnitude and polarity of DC components of the signals generate by
the accelerometers indicate the orientation of the patient relative
to the Earth's gravity, e.g., the posture of patient 12. Further
information regarding use of orthogonally aligned accelerometers to
determine patient posture may be found in a commonly-assigned U.S.
Pat. No. 5,593,431, which issued to Todd J. Sheldon.
[0053] Other sensors 40 that may generate a signal that indicates
the posture of patient 12 include electrodes that generate an
electromyogram (EMG) signal, or bonded piezoelectric crystals that
generate a signal as a function of contraction of muscles. Such
sensors 40 may be implanted in the legs, buttocks, chest, abdomen,
or back of patient 12, as described above. The signals generated by
such sensors when implanted in these locations may vary based on
the posture of patient 12, e.g., may vary based on whether the
patient is standing, sitting, or laying down.
[0054] Further, the posture of patient 12 may affect the thoracic
impedance of the patient. Consequently, sensors 40 may include an
electrode pair, including one electrode integrated with the housing
of IMD 14 and one of electrodes 42, that generates a signal as a
function of the thoracic impedance of patient 12, and processor 46
may detect the posture or posture changes of patient 12 based on
the signal. The electrodes of the pair may be located on opposite
sides of the patient's thorax. For example, the electrode pair may
include one of electrodes 42 located proximate to the spine of a
patient for delivery of SCS therapy, and IMD 14 with an electrode
integrated in its housing may be implanted in the abdomen of
patient 12.
[0055] Additionally, changes of the posture of patient 12 may cause
pressure changes with the cerebrospinal fluid (CSF) of the patient.
Consequently, sensors 40 may include pressure sensors coupled to
one or more intrathecal or intracerebroventricular catheters, or
pressure sensors coupled to IMD 14 wirelessly or via lead 16. CSF
pressure changes associated with posture changes may be
particularly evident within the brain of the patient, e.g., may be
particularly apparent in an intracranial pressure (ICP)
waveform.
[0056] The thoracic impedance of patient 12 may also vary based on
the respiration of patient 12. Consequently, in some embodiments,
an electrode pair that generates a signal as a function of the
thoracic impedance of patient 12 may be used to detect respiration
of patient 12. In other embodiments, sensors 40 may include a
strain gauge, bonded piezoelectric element, or pressure sensor
within the blood or cerebrospinal fluid that generates a signal
that varies based on patient respiration. An electrogram generated
by electrodes as discussed above may also be modulated by patient
respiration, and may be used as an indirect representation of
respiration rate.
[0057] Sensors 40 may include electrodes that generate an
electromyogram (EMG) signal as a function of muscle electrical
activity, as described above, or may include any of a variety of
known temperature sensors to generate a signal as a function of a
core subcutaneous temperature of patient 12. Such electrodes and
temperature sensors may be incorporated within the housing of IMD
14, or coupled to IMD 14 wirelessly or via leads. Sensors 40 may
also include a pressure sensor within, or in contact with, a blood
vessel. The pressure sensor may generate a signal as a function of
the a blood pressure of patient 12, and may, for example, comprise
a Chronicle Hemodynamic Monitor.TM. commercially available from
Medtronic, Inc. of Minneapolis, Minn. Further, certain muscles of
patient 12, such as the muscles of the patient's neck, may
discernibly relax when patient 12 is asleep or within certain sleep
states. Consequently, sensors 40 may include strain gauges or EMG
electrodes implanted in such locations that generate a signal as a
function of muscle tone.
[0058] Sensors 40 may also include optical pulse oximetry sensors
or Clark dissolved oxygen sensors located within, as part of a
housing of, or outside of IMD 14, which generate signals as a
function of blood oxygen saturation and blood oxygen partial
pressure respectively. In some embodiments, system 10 may include a
catheter with a distal portion located within the cerebrospinal
fluid of patient 12, and the distal end may include a Clark sensor
to generate a signal as a function of the partial pressure of
oxygen within the cerebrospinal fluid. Embodiments in which an IMD
comprises an implantable pump, for example, may include a catheter
with a distal portion located in the CSF.
[0059] In some embodiments, sensors 40 may include one or more
intraluminal, extraluminal, or external flow sensors positioned to
generate a signal as a function of arterial blood flow. A flow
sensor may be, for example, an electromagnetic, thermal convection,
ultrasonic-Doppler, or laser-Doppler flow sensor. Further, in some
external medical device embodiments of the invention, sensors 40
may include one or more electrodes positioned on the skin of
patient 12 to generate a signal as a function of galvanic skin
response.
[0060] Additionally, in some embodiments, sensors 40 may include
one or more electrodes positioned within or proximate to the brain
of patient, which detect electrical activity of the brain. For
example, in embodiments in which IMD 14 delivers stimulation or
other therapy to the brain, processor 46 may be coupled to
electrodes implanted on or within the brain via a lead 16. In other
embodiments, processor 46 may be wirelessly coupled to electrodes
that detect brain electrical activity.
[0061] For example, one or more modules may be implanted beneath
the scalp of the patient, each module including a housing, one or
more electrodes, and circuitry to wirelessly transmit the signals
detected by the one or more electrodes to IMD 14. In other
embodiments, the electrodes may be applied to the patient's scalp,
and electrically coupled to a module that includes circuitry for
wirelessly transmitting the signals detected by the electrodes to
IMD 14. The electrodes may be glued to the patient's scalp, or a
head band, hair net, cap, or the like may incorporate the
electrodes and the module, and may be worn by patient 12 to apply
the electrodes to the patient's scalp when, for example, the
patient is attempting to sleep. The signals detected by the
electrodes and transmitted to IMD 14 may be electroencephalogram
(EEG) signals, and processor 46 may identify the amplitude and or
frequency of the EEG signals as physiological parameter values.
[0062] Also, the motion of the eyes of patient 12 may vary
depending on whether the patient is sleeping and which sleep state
the patient is in. Consequently, sensors 40 may include electrodes
place proximate to the eyes of patient 12 to detect electrical
activity associated with motion of the eyes, e.g., to generate an
electro-oculography (EOG) signal. Such electrodes may be coupled to
IMD 14 via one or more leads 16, or may be included within modules
that include circuitry to wirelessly transmit detected signals to
IMD 14. Wirelessly coupled modules incorporating electrodes to
detect eye motion may be worn externally by patient 12, e.g.,
attached to the skin of patient 12 proximate to the eyes by an
adhesive when the patient is attempting to sleep.
[0063] Processor 46 monitors the physiological parameters based on
the signals generated by the one or more sensors 40, and determines
whether patient 12 is asleep based on current values for the
physiological parameters. In some embodiments, processor 46 may
determine mean or median value for the parameter based on values of
the signal over time, and determines whether patient 12 is asleep
based on the mean or median value. In other embodiments, processor
46 may additionally or alternatively determine a variability of one
or more of the parameters based on the values of the parameter over
time, and may determine whether patient 12 is asleep based on the
one or more variability values. IMD 14 may include circuitry (not
shown) that conditions the signals generate by sensors 40 such that
they may be analyzed by processor 46. For example, IMD 14 may
include one or more analog to digital converters to convert analog
signals generate by sensors 40 into digital signals usable by
processor 46, as well as suitable filter and amplifier
circuitry.
[0064] In some embodiments, processor 46 determines a value of a
sleep metric that indicates a probability of the patient being
asleep based on a physiological parameter. In particular, processor
46 may apply a function or look-up table to the current value, mean
or median value, and/or variability of the physiological parameter
to determine the sleep metric value. For example, the values of one
or more physiological parameters serve as indices to the lookup
table to yield a corresponding output value, which serves as the
sleep metric value. Processor 46 may compare the sleep metric value
to a threshold value to determine whether patient 12 is asleep. In
some embodiments, processor 46 may compare the sleep metric value
to each of a plurality of thresholds to determine the current sleep
state of patient 12, e.g., rapid eye movement (REM), S1, S2, S3, or
S4.
[0065] Further, in some embodiments processor 46 determines a sleep
metric value for each of a plurality of monitored physiological
parameters. In other words, processor 46 may apply a function or
look-up table for each parameter to the current value for that
parameter in order to determine the sleep metric value for that
individual parameter. Processor 46 may then average or otherwise
combine the plurality of sleep metric values to provide an overall
sleep metric value, and may determine whether patient 12 is asleep
based on the overall sleep metric value. In some embodiments,
processor 46 may apply a weighting factor to one or more of the
sleep metric values prior to combination.
[0066] As shown in FIG. 3, memory 48 may include parameter
information 60 recorded by processor 46, e.g., parameter values, or
mean or median parameter values. Memory 48 may also store sleep
metric functions 62 or look-up tables (not shown) that processor 46
may retrieve for application to physiological parameter values or
variability values, and threshold values 64 that processor 46 may
use to determine whether patient 12 is asleep and, in some
embodiments, the sleep state of patient 12. Memory 48 may also
store weighting factors 66 used by processor 46 when combining
sleep metric values to determine an overall sleep metric value.
Processor 46 may store sleep information 68 within memory 48, such
as recorded sleep metric values and information indicating when
patient 12 was asleep.
[0067] As shown in FIG. 2, IMD 14 also includes a telemetry circuit
50 that allows processor 46 to communicate with clinician
programmer 20 and patient programmer 26. For example, using
clinician programmer 20, a clinician may direct processor 46 to
retrieve sleep information 68 from memory 48 and transmit the
information via telemetry circuit 50 to programmer 20 for analysis.
Further, the clinician may select or adjust the one or more of
functions 62, look-up tables, thresholds 64 and weighting factors
66 in order to select or adjust the sensitivity and specificity of
processor 46 determining whether the patient is asleep.
[0068] FIG. 4 is a flowchart illustrating an example technique for
determining whether a patient is asleep that may be employed by IMD
14. According to the example technique, IMD 14 monitors a plurality
of physiological parameters of patient 12 (70). More particularly,
processor 46 receives signals from one or more sensors 40, and
monitors the physiological parameters based on the signals.
[0069] Processor 46 applies a respective function 62 to current
values, mean or median values, and/or variability values for each
of physiological parameters to determine a sleep metric value for
each of the parameters (72). Processor 46 then combines the various
sleep metric values to determine a current overall sleep metric
value (74). For example processor 46 may apply weighting factors 66
to one or more of the parameter specific sleep metric values, and
then average the parameter specific sleep metric values in light of
the weighting factors 66.
[0070] Processor 46 compares the current overall sleep metric value
to a threshold value 64 (76), and determines whether patient 12 is
asleep or awake, e.g., whether the sleep state of patient 12 has
changed, based on the comparison (78). For example, processor 46
may determine that patient 12 is asleep if the current overall
sleep metric value exceeds the threshold value 64. If the sleep
state of patient 12 has changed, processor 46 may initiate, suspend
or adjust a therapy delivered to patient 12 by IMD 14, or processor
46 may store an indication of the time and the change within memory
48 (80).
[0071] Various embodiments of the invention have been described.
However, one skilled in the art will appreciated that various
modifications may be made to the described embodiments without
departing from the scope of the invention. For example, although
described herein in the context of an implantable neurostimulator,
the invention may be embodied in any implantable or external
device.
[0072] As another example, although described in the context of
determining whether a patient is asleep, e.g., whether the
patient's current sleep state is asleep or awake, the invention
may, as described above, be used to determine what level of sleep a
patient is currently experiencing, e.g., which of sleep states REM,
S1, S2, S3, and S4 the patient is currently in. A medical device
may record transitions between these states and between sleep and
wakefulness, or may control therapy based on transitions between
these states and between sleep and wakefulness. Further, in some
embodiments, a medical device may, without making a sleep
determination, simply record one or more determined sleep metric
values for later analysis, or may control delivery of therapy based
on the sleep metric values.
[0073] Further, the invention may be embodied in a programming
device, such as programmers 20, 26 described above, or another type
of computing device. In particular, in some embodiments, a
computing device may determine when patient 12 is asleep according
to the invention instead of, or in addition to an implantable or
external medical device. For example, a medical device may record
values for one or more of the physiological parameters discussed
herein, and may provide the physiological parameter values to the
computing device in real time or when interrogated by the computing
device. The computing device may apply the techniques described
herein with reference to IMD 14 to determine when patient 12 is
asleep, and may control delivery of therapy based on the
determination, or present information relating to the patient's
sleep patterns to a user to enable diagnosis or therapy evaluation.
The computing device may be a programming device, such as
programmers 20, 26, or may be any handheld computer, desktop
computer, workstation, or server. A computing device, such as a
server, may receive information from the medical device and present
information to a user via a network, such as a local area network
(LAN), wide area network (WAN), or the Internet.
[0074] The invention may also be embodied as a computer-readable
medium, such as memory 48, that includes instructions to cause a
processor, such as processor 46, to perform any of the methods
described herein. These and other embodiments are within the scope
of the following claims.
* * * * *