Surgery – Diagnostic testing – Measuring or detecting nonradioactive constituent of body...
Patent
1997-12-22
2000-07-18
Winakur, Eric F.
Surgery
Diagnostic testing
Measuring or detecting nonradioactive constituent of body...
600484, 600547, A61B 500
Patent
active
060919736
DESCRIPTION:
BRIEF SUMMARY
FIELD OF THE INVENTION
This invention relates to methods and apparatus for the determination or monitoring of arousals that are indicative of an apneic or hypopneic episode. An "A/H episode", as used hereafter, is to be understood as including both obstructive apneas (lack of breathing) or hypopneas (reduction in breathing) occurring during sleep.
BACKGROUND OF THE INVENTION
People suffering from Obstructive Sleep Apnea (OSA) and related conditions experience many A/H episodes during sleep. The conventional treatment for OSA is the well known Continuous Positive Airway Pressure (CPAP) treatment. An A/H episode often has an associated arousal, which is a nervous system response to low blood oxygen level and/or high blood carbon dioxide level.
The condition of OSA normally is diagnosed by laboratory based polysomnography (PSG). PSG involves the measurement of sleep and respiratory variables including EEG, EOG, chin EMG, ECG, respiratory activity, nasal airflow, chest and abdominal movements, abdominal effort and oxygen saturation. The data gathered leads to a calculation of the Respiratory Disturbance Index (RDI) which is the average number of arousals per hour due to respiratory disturbance. PSG is uncomfortable for a patient due to the placement of numerous electrodes on the patient's head or face and the wearing of a mask or nasal prongs. PSG is an expensive procedure and has the inconvenience of requiring the patient to attend a sleep clinic for a whole night requiring continuous technician attendance.
In the clinic, cortical arousals can be detected by measuring and interpreting, either automatically or by eye, changes in the patient's EEG and EMG. Arousals are an important indicator of the amount and quality of sleep obtained by a patient and the degree of severity of the patient's apneas.
To obtain a display of the EEG, electrodes must be attached to the patient's head and the signals from these electrodes passed through high gain amplifiers before subsequent display and recording. This is often inconvenient and time consuming; the signals also can become distorted or disappear due to electrode dislodgement or other artefacts such as sweating. To detect an arousal, the EEG, once displayed, requires interpretation either visually by a skilled operator or automatically by a computer-based analysis system. Apart from the difficulties of attaining accurate EEG data, EEG apparatus also is relatively more expensive than much other biomedical apparatus.
EEG data on its own is not an accurate determination of the occurrence of A/H episodes--an arousal can be due to other factors as noted.
Prior art disclosures that form background information to the present invention include (a) R. Ferber, et al, "ASDA Standards of Practice--Portable Recording in the Assessment of Obstructive Sleep Apnea", Sleep, 17(4): 378-392, 1994; (b) L. Ferini-Strambi, et al, "Heart rate variability during sleep in snorers with and without obstructive sleep apnea", Chest, 102(4): 1023-7, October 1992; and (c) C. Guilleminault, et al, "A review of 50 children with obstructive sleep apnea syndrome", Lung, 159:275-287, 1981.
SUMMARY OF THE INVENTION
It is an object of the present invention to overcome or at least ameliorate one or more of the problems with the prior art. In one preferred form the invention seeks to provide a method and apparatus for monitoring the occurrence of arousals due to A/H episodes. The invention in another broad form has as an object the determination of an index of sleep quality that can be used as a diagnostic indicator of a person suffering from conditions such as OSA. Yet further, the invention has as an object the provision of diagnostic apparatus for the recording the occurrence of A/H episodes. A preferred embodiment particularly contemplates detecting sympathetic arousals indicative of A/H episodes by signals derived from a patient which are easier to detect than by EEG, and by use of apparatus that is less costly than that for EEG.
It has been determined that the coincident occurrence of change in t
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Brydon John William Ernest
Colla Gregory Alan
ResMed Limited
Winakur Eric F.
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