EP1605998A1 - Verfahren und anordnung zur titration physiologischer messsignale im zusammenhang mit der observation eines patienten hinsichtlich schlafbezogener atmungsstörungen - Google Patents
Verfahren und anordnung zur titration physiologischer messsignale im zusammenhang mit der observation eines patienten hinsichtlich schlafbezogener atmungsstörungenInfo
- Publication number
- EP1605998A1 EP1605998A1 EP04721162A EP04721162A EP1605998A1 EP 1605998 A1 EP1605998 A1 EP 1605998A1 EP 04721162 A EP04721162 A EP 04721162A EP 04721162 A EP04721162 A EP 04721162A EP 1605998 A1 EP1605998 A1 EP 1605998A1
- Authority
- EP
- European Patent Office
- Prior art keywords
- evaluation
- titration
- pressure
- generated
- breathing
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
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Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/08—Detecting, measuring or recording devices for evaluating the respiratory organs
- A61B5/087—Measuring breath flow
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0057—Pumps therefor
- A61M16/0066—Blowers or centrifugal pumps
- A61M16/0069—Blowers or centrifugal pumps the speed thereof being controlled by respiratory parameters, e.g. by inhalation
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
- A61M16/022—Control means therefor
- A61M16/024—Control means therefor including calculation means, e.g. using a processor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/72—Signal processing specially adapted for physiological signals or for diagnostic purposes
- A61B5/7232—Signal processing specially adapted for physiological signals or for diagnostic purposes involving compression of the physiological signal, e.g. to extend the signal recording period
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
- A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
- A61M2016/003—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
- A61M2016/0033—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
- A61M2016/0039—Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the inspiratory circuit
Definitions
- the invention relates to a method and an arrangement for titrating physiological measurement signals.
- the invention relates to a method and an arrangement for detecting and evaluating a with regard to the
- Respiratory gas flow of a sleeping person indicative measurement signals in connection with the observation of sleep-related breathing disorders.
- So-called polysomnography devices are known for examining sleep-related respiratory disorders, which usually have a plurality of measurement channels for recording measurement signals for a patient's physiological status variables.
- the signals describing the patient's breathing activity can be generated via so-called thermistors or also via pneumotachographs.
- the recorded signals can be visualized in chronological assignment to one another and evaluated in the context of a specialist examination. Based on the specialist evaluation, it can be determined whether respiratory disorders can be prevented by supplying the breathing gas at an elevated pressure level. Suitable therapy parameters can also be determined as part of the specialist evaluation.
- the object of the invention is to provide solutions which make it possible to record physiological properties relevant to breathing during a sleep phase in a manner which makes it possible to assess the physiological state of the examined person with a high degree of reliability and to apply any necessary therapeutic framework conditions vote.
- this object is achieved according to the invention by a method for providing an evaluation result which is indicative of the physiological state on the basis of measurement signals which are related to the breathing of a person, with the measurement signals mentioned using a plurality of evaluation systems , Evaluation characteristics are generated and at least one evaluation result is generated in the context of a result generation step based thereon, by subjecting the evaluation characteristics to a linked consideration, the measurement signals being recorded in different titration sequences with respect to the respiratory gas pressure level applied to the patient and the generation of at least some of the evaluation characteristics or the evaluation result taking into account the respective titration sequence pressure.
- titration sequence pressure is to be understood as the static pressure of the breathing gas applied to the patient.
- titration sequence is to be understood as a titration section which can be defined, for example, with regard to its duration, a certain number of breaths or also with regard to other criteria. It is advantageously possible to keep the titration sequence pressure essentially constant within a titration sequence.
- the titration sequence pressure within a titration sequence can be conducted according to a pressure control concept which, for example, provides weakly alternating or pressure levels that follow a bi-level concept.
- the setting or control of the pressure within a titration sequence can be carried out adaptively according to selected adaptation criteria.
- the pressure adaptation is preferably carried out in such a way that pressure changes occurring within a titration sequence are only permissible in a bandwidth that is less than the average pressure interval of successive titration sequences.
- the temporal length of the titration sequences is preferably determined by sequence length criteria. These sequence length criteria can contain both minimum lengths and maximum lengths. It is possible to provide several sequence length criteria, the fulfillment of which depends on whether a change to a subsequent titration sequence or also a validation sequence is to take place or not.
- At least a minimum length of time and / or a minimum number of breaths is preferably established in the form of a sequence length criterion. It is also possible to provide waiting times in each, or at least in selected titration sequences, it being possible, at least for certain evaluation operations, within the waiting time neglect the measured signals, process them with a reduced priority or subject them to certain verification procedures. This makes it possible to take better account of any reactions caused by the pressure change.
- the compliance check of the sequence length criteria can also include checks for obstruction indicators.
- the change from one titration sequence to the next titration sequence can also be made dependent on other switching criteria.
- precautions are preferably taken such that a predetermined minimum number of individual titration sequences is processed.
- the pressure control within a titration sequence is specific to the detection
- Indicators matched in such a way that these indicators can be determined with a high degree of meaningfulness. Apnea indicators, hypopnea indicators and flow limitation indicators are preferably evaluated.
- the titration sequences are preferably controlled in accordance with a sequence management concept.
- This sequence control concept preferably provides at least one period of successively increasing pressure levels and one period of successively decreasing pressure levels.
- sequence control concept it provides several titration sequences with different titration sequence pressures, in the course of which these titration sequence pressures are controlled, intermediate phase pressures in which the respiratory gas pressure level is at a level which is higher than the titration sequence pressure one previous titration sequence and a subsequent titration sequence.
- the intermediate phase pressures are in each case preferably at the same pressure level, in particular preferably at an expected suitable therapy pressure level.
- the sequence control concept can be designed such that it extends over a period containing several titration sequences and over a validation period. It is also possible to limit the application of the sequence control concept for the breathing gas pressure rule to a period serving the titration and to connect that validation period to this.
- the duration of that period, which serves the titration can be determined as a function of certain, simultaneously generated evaluation results, or can also be predefined - at least with regard to a minimum and maximum duration.
- the pressure setting in the context of the validation period is advantageously based on the previously obtained evaluation results.
- the pressure control is preferably chosen such that there are no significant pressure fluctuations within the scope of the validation period.
- an adaptation or plausibility check of the evaluation results and a suitability check of a patient-specific pressure control configuration are preferably carried out.
- the evaluation features generated during the individual titration sequences are subjected to a linking analysis, the linking time window provided for the linking analysis preferably being greater than the time window in which the measurement signals relevant to the evaluation features were processed for the evaluation features.
- the titration concept according to the invention can provide setting parameters for which
- Positive pressure ventilator in particular a CPAP device.
- a physiological typing of the possibly existing clinical picture of the examined person takes place.
- it is possible to automatically optimize the control behavior of a pressure control device provided for controlling the respiratory gas pressure so that, for example, after a period of use of only one night, the control behavior of the pressure control is already correctly matched to the patient.
- the vote can still be validated during the surveillance night.
- the required electronic components can be integrated in a patient device.
- a configuration data record is generated on the basis of the linking consideration for the configuration of the breathing gas pressure regulation of a therapy device, in particular a CPAP device.
- the configuration data record can be generated via an interface device, or advantageously also by a mobile device
- Data carriers in the form of a memory stick or a PCMCIA card can be transferred to the therapy device CPAP device.
- the configuration data record can be modified by interposing an adaptation procedure in such a way that it takes particular account of certain system properties of a CPAP device not used for titration. It is also possible to carry out the examination according to the invention with a subsequent validation directly with a patient device, wherein the control device provided for processing the pressure control concept according to the invention is preferably connected to an interface device of the patient device is dockable. It is also possible to use the one provided for processing the pressure control and measurement value concept according to the invention
- control device if necessary with the interposition of a power circuit for controlling and supplying power to a delivery blower of the patient device. It is also possible to cause the patient device or the device provided for carrying out the examination to control the desired pressure levels by applying varying pressures to a mask pressure measuring device, for example via a mask pressure measuring tube.
- the evaluation features are generated on the basis of correlation criteria, by means of which, for example, similarities with previous breaths or reference breaths are evaluated.
- the correlation criteria can in particular also be based on the first and / or second derivative of the detected one
- Breathing gas flow can be applied.
- the characteristics characteristic of the respective breath can be generated using statistical methods.
- the interrelated consideration of the properties determined for each breath can also be carried out using statistical methods.
- a feature array can be successively filled, from which entries can be read out in accordance with selected linking criteria.
- the evaluation features are generated in such a way that e.g. Evaluation characteristics are located, the information on the duration of a breath and / or e.g. characteristic of breaths to be considered normal
- a feature contribution contained in the evaluation features is determined within a time window that is smaller than a linking time window provided for the linking consideration. This advantageously makes it possible to use typical properties for a single breath in the context of high-resolution
- the evaluation concept according to the invention can be used to control the pressure of a breathing gas supplied to the patient by means of an overpressure ventilation system. This makes it possible to precisely adjust the breathing gas pressure to the patient's current physiological needs without affecting the course of sleep through a control dynamic that is subjectively perceived as inaccurate.
- the interlinked consideration of the breath properties determined for the individual breaths can extend over a time window that, for example, a predetermined e.g. 30 breaths or adaptively optimized number of breaths.
- a time window that, for example, a predetermined e.g. 30 breaths or adaptively optimized number of breaths.
- raw data and / or intermediate results are selected on the basis of linking operations, which enable particularly reliable generation of characteristic parameters, in particular indices.
- a physiological typing of the possibly existing clinical picture of the examined person takes place on the basis of the interlinking consideration.
- it is possible to regulate the behavior of a device intended to control the breathing gas pressure Optimizing the pressure control device adaptively so that, for example, the control behavior of the pressure control is optimally matched to the patient after an application period of several days.
- a configuration data record is generated for configuring the breathing gas pressure control of a CPAP device.
- the configuration data record can be generated via an interface device, or advantageously also by means of a mobile storage medium, e.g. be transferred to the CPAP device in the form of a PCMCIA card.
- the configuration data record can be modified by interposing an adaptation procedure in such a way that it takes particular account of certain system properties of the CPAP device.
- Evaluation features are generated on the basis of correlation criteria, in particular statistical evaluation systems, by means of which, for example, common features with previous breaths, or preferably adaptively optimized reference criteria, e.g. be evaluated for reference breaths.
- the correlation criteria can in particular also apply to the first and / or second
- Derivation of the detected respiratory gas flow can be used.
- the characteristics characteristic of the respective breath can be generated using statistical methods.
- the interrelated consideration of the properties determined for each breath can also be carried out using statistical methods.
- a feature array can be successively filled up, this feature field describing, at least for selected evaluation features, a time window that is at least as large as the smallest link time window provided for the linking consideration of the evaluation features.
- the evaluation features are generated in such a way that there are, for example, evaluation features that contain information on the duration of a breath and / or, for example, information that is characteristic of breaths that are to be regarded as normal. On the basis of these evaluation characteristics, it is possible to determine the length of time of periods with normal breathing in the context of the interrelated consideration.
- the evaluation features are advantageously also generated in such a way that they contain the occurrence of any flow limitation phenomena in individual breaths, preferably also certain information representative of the flow limitation.
- the evaluation characteristics recorded for such flow-limited breaths it becomes possible to describe the time duration of certain properties of at least partially flow-limited breathing sequences.
- evaluation characteristics can also be generated, on the basis of which the phase length of any apnea sequences and / or characteristics characteristic of this apnea phase can be generated in the context of the interlinked consideration.
- These evaluation features preferably contain information regarding the type of apnea phases, e.g. whether the apnea phase should be classified as central, as an obstructive or as a combination (mixed apnea phase).
- such evaluation features are also generated for snoring phases, for phases with Cheyne-Stokes breathing and hypoventilation phases.
- the evaluation features preferably also contain information from which the body position, the head position and preferably also the degree of neck twisting of the patient can be derived.
- the evaluation characteristics can contain sleep phase indications.
- the generated evaluation characteristics are preferably stored by assigning them to the breath taken or taking their temporal position into account. That The generated evaluation characteristics can be assigned to a defined time window - in the case of normal breathing, they can be assigned to the respective breath.
- an index that classifies the flow limitation hereinafter referred to as the flow limitation index, is generated.
- This flow limitation index can be determined, for example, on the basis of the following evaluation rule:
- FLIp index that specifies the flow limits per drain level
- FLR Proportion of the flow-limited inspiration time per effectively breathed inspiration time t
- F l ussl i m i tat i on inspiration time of the flow-limited breaths t
- I nterv ll total inspiration time of a time interval (in hours); the time interval results, for example, from a pressure level
- flow-limited breathing can be brought into various dependencies and the applied therapeutic pressure can be evaluated.
- Time inversions e.g. 5/10/30/60/90 min pressure levels, e.g. A I 5 1617 ... mbar
- Phases of sleep e.g. Awake, REM, NREM 1-4
- Quality of sleep e.g. according to the type of events detected, e.g. Apneas, hypopneas
- Body position e.g. Supine
- lateral position breath characteristics e.g. inspiratory / expiratory tidal volume, max. in- / exsp.- volume flow, respiratory rate, various temporal relationships between inspiration / expiration / and / or
- the signal used to determine snoring sequences can be generated from the breathing gas pressure detection device, from the engine output, and also from the breathing gas flow signal or, in particular, acoustic recording systems. Furthermore, it is possible to generate a mouth breathing / nasal breathing index as part of the interlinked consideration. It is also possible to generate a sleep time index in the context of the interlinked view.
- the evaluation features can preferably be based on what is referred to below as a v-measurement
- Volume flow measurement of the respiratory gas flow can be generated.
- the measurement of the gas flow can take place at ambient pressure or under a defined change in breathing gas pressure.
- the object specified at the outset is also achieved by a device for carrying out the method described above, this device comprising a measurement signal input device and a computer device for providing a plurality of evaluation systems, evaluation features being generated from the measurement signals mentioned by the evaluation systems and in the context of a result generation step based thereon at least one
- the evaluation result is generated by the computer device being configured in such a way that it subjects the evaluation features to a linking analysis and detects the measurement signals in different titration sequences with respect to the respiratory gas pressure level applied to the patient and the generation of at least part of the evaluation characteristics or the evaluation result takes into account the respective titration sequence pressure.
- the beginning and end of the inhalation and expiration phases of the breath can be determined, for example, in connection with an examination of the first and second derivative of the respiratory gas flow signal and also taking into account the possible breath volume.
- the duration of the breath phases, the actual volume of the breath and the breathing pattern can be determined on the basis of these evaluation results.
- Breaths within a titration sequence the current physiological state of the examined person can be further determined.
- a raw data reduction can be achieved on the basis of the extraction of features for each individual breath within the titration sequence. From the statistical evaluation of the properties of several subsequent breaths, a distinction can be made between obstruction-relevant snoring and obstruction-irrelevant snoring. A typing of
- Oscillation properties in connection with snoring events can be done without a microphone device.
- the occurrence of any snoring-related oscillations can be recorded on the basis of the time course of the breathing gas pressure. For example, it is possible to extract breathing gas pressure oscillations caused by snoring from signals generated by corresponding breathing gas pressure sensor devices. In particular on the basis of a frequency and amplitude analysis, eg Fast Fourier analysis, it is possible to classify snoring events with regard to their place of origin (soft palate, larynx ). As part of a statistical evaluation of the subsequent breaths, it is possible to generate a breathing index that is indicative of respiratory stability for each titration sequence. This breathing index is preferably determined according to the following rule:
- At-I index, which specifies a certain type of breathing pattern, eg unstable, stable breathing, mouth breathing, nasal breathing per hour
- Stable breathing is present when the breathing stability index is> 0.9 and unstable breathing is considered to be present when the breathing stability index is ⁇ 0.9.
- OSA obstructive breathing disorders
- a respiratory disorder is classified as an apnea event if a respiratory arrest is detected, the length of which exceeds a predetermined period of time, for example 10 seconds.
- a hypopnea event can be considered to be present if, after three breaths classified as normal, for example, at least two and a maximum of three larger breaths are recognized. As another criterion for this the inspiratory differential volume of the breaths considered can be used.
- a flow limitation can be recognized in the breath examined in each case if the respiratory gas flow has certain plateau zones or several maxima during the inspiration phase.
- Stable breathing can be considered as present if the respiratory flow or respiratory frequency and the amplitude of the respiratory gas flow can be regarded as regular within a predetermined time range.
- Breathing can be regarded as stable in particular if a breathing stability index defined for breathing stability has an amount that is> the value 0.911. Breathing currents (OSA) do not occur during stable breathing.
- OSA Breathing currents
- Unstable breathing can be considered to be present if the aforementioned breathing stability index has a value that is less than 0.911 and the respiratory flow is accordingly irregular.
- Such irregular breathing can be classified as a respiratory disorder, with such phases taking place with increased sensitivity in the case of breathing gas pressure control.
- Any high-frequency oscillations that occur in a pressure signal can be classified in connection with the respiratory flow signal as in-breath or expiratory snore.
- the evaluation characteristics generated with regard to the occurrence of snoring can be included in the interlinked view provided for generating the evaluation results.
- Volume flow can also be classified as system states such as variants of incorrect breathing gas flows (leakage), for example caused by mask application artifacts (mask problems) or expiratory mouth breathing, as well as permanent oral breathing. If there is a leak, the Time course of the nasally communicated respiratory gas volume flow a shift in amount compared to a reference value (eg zero line). In the case of expiratory mouth breathing between the inspiratory volume and the expiratory volume, since at least part of the gas exchange takes place orally. Other key features are the slope of the
- Inspiration / expiration flank the relative temporal position of the extreme values in the respective breathing phase.
- Evaluation features within a titration sequence taking into account the assigned titration sequence pressure, for controlling the respiratory gas pressure, it is possible to coordinate device operating parameters such as the switching behavior of a pressure control between different pressure control modes. For example, on the basis of the evaluation results determined, it can be determined under which criteria a respiratory gas pressure control should take place under a standard dynamic range or a higher “sensitive dynamic range”.
- control behavior of the pressure control device for the normal or standard dynamic mode is preferably matched such that any detected
- the respiratory gas pressure can be successively reduced incrementally, the system being able to be coordinated in such a way that any events occurring at a lower respiratory gas pressure are reacted with a higher control dynamic.
- a change to the sensitive mode can be made dependent on several criteria, especially depending on whether there is stable breathing (breathing stability index> 0.911).
- Operation of the device in accordance with the aforementioned control criteria advantageously takes place after the titration period has ended as part of the validation phase.
- the control behavior of the pressure control device is preferably coordinated in such a way that an increase in pressure occurs when apnea conditions, hypopnea conditions or else Flow limits are recognized.
- an increase in pressure occurs when apnea conditions, hypopnea conditions or else Flow limits are recognized.
- An increase in the breathing gas pressure can also take place if the breathing has stopped for a predetermined period of time, for example
- the respiratory gas pressure can be increased continuously or in steps, the pressure increase gradient preferably not exceeding a maximum value of 4 mbar per minute. It is possible to provide a minimum pressure limit in the range from 4 to 10 hPa and a maximum pressure limit in the range from 8 to 18 hPa. For one
- a pressure in the range of 4 to 8 hPa is preferably provided.
- a pressure increase is preferably carried out in comparatively small pressure levels of, for example, 1 mbar, the number of pressure increase levels preferably being limited.
- a respiratory stability index of> 0.911 can cause a pressure increase of pressure levels of 1 mbar each.
- the pressure can be reduced if stable breathing is detected within a predetermined time window of, for example, 9 minutes and the breathing stability index has a value of> 0.911.
- a pressure drop of, for example, 2 mbar can be permitted.
- the execution of a pressure change can be prevented, for example, if there is a certain combination of criteria for which, among other things, breathing is classified as unstable and the breathing stability index is ⁇ 0.91 1.
- Operating the respiratory gas pressure control in the sensitive mode leads to an increase in pressure when apnea conditions occur in accordance with a predetermined time behavior. For example, it is possible to increase the pressure by 2 mbar if either a respiratory arrest with a duration of more than two minutes is detected or two large (min. 25 sea.) Or three smaller apnea conditions (max. 25 sea.) And the breathing gas pressure is below 14 mbar. A pressure increase by a value of 1 mbar can be initiated if hypopneas sequences occur over a period of at least 3 minutes.
- a decrease in pressure is preferably initiated in sensitive mode when there is stable breathing and the time for this stable breathing is at least three minutes and at the same time the breathing stability index is> 0.911. In this case, a pressure drop of initially 2 mbar can be initiated.
- sensitive mode it is also preferably possible not to allow pressure changes in phases or to limit the pressure change to a comparatively narrow pressure change corridor. In particular, pressure changes are preferably not permitted if breathing is classified as unstable and obstruction states are recognized.
- a hypopnea phase can be considered as present if at least two but at most three larger breaths follow after three normal breaths. There must be an inspiratory differential volume ⁇ V that exceeds a specified limit (e.g. 50% of the average tidal volume).
- Breathing gas flow indicative signals it is possible to recognize breathing disorders that at least initially require no change in the breathing gas pressure.
- breathing disorders can be, for example: swallowing, coughing, mouth breathing, expiratory mouth breathing, arousals and speaking.
- the detection and evaluation according to the invention of the signals indicative of the respiratory gas flow can provide information for the description and
- the signal acquisition and evaluation according to the invention can be used to configure ventilation devices.
- the signal detection and evaluation according to the invention can also be used
- a breathing gas supply device in particular a positive pressure breathing device with self-adjusting pressure control can be used.
- the breathing gas pressure is set during an examination night in such a way that a titration phase and then a validation phase are processed.
- the pressure is guided according to a pressure control concept that is designed to record the most meaningful and applicable breathing gas flow signals.
- the pressure control during the titration phase is carried out in a repeatable manner according to a standard defined by titration procedure criteria.
- the titration procedure criteria are designed for the acquisition of measurement signals that enable an assessment or classification of the physiological condition of the patient with high statistical certainty.
- breath-specific features are determined in accordance with defined analysis procedures.
- the analysis procedures take particular account of the inspiration process, the expiration process, the transition between the mentioned processes, curve properties of the respiratory gas flow within each breath cycle, combination considerations of features of the respiratory gas flow within one breath.
- evaluation results are generated which describe a physiological state or physiological properties in a standardized parametric manner.
- the pressure control during the titration phase is self-regulating in such a way that the physiological condition of the patient is determined with a high degree of informative value.
- the pressure control during the titration phase takes place in such a self-regulating manner that the physiological condition of the patient is determined with the shortest possible time.
- the pressure control or pressure setting during the validation phase takes place in such a self-regulating manner that the plausibility of a determined breathing gas pressure control concept, in particular the plausibility or correctness of a determined CPAP therapy pressure, is checked with high statistical certainty.
- the aforementioned standard is coordinated such that it converts the intermediate evaluation results into other preferably standardized parametric patient characteristics such as, for example, airway elasticity, airway occlusion pressure,
- Fig.la a time diagram to explain a titration period comprising several titration sequences, the duration of each
- Titration sequences are dynamically coordinated
- 1b is a time diagram to explain a second variant of the titration mode according to the invention with titration sequences which have been predetermined in terms of their duration,
- Fig. 1c is a timing diagram for explaining a portion of a
- Titration pressure is gradually reduced starting from a high pressure level, the length of time of the individual stages decreasing
- 1d shows a section of a titration period divided into several titration sequences
- Fig. 1e is a timing diagram for explaining a portion of a
- Titration pressure is gradually increased starting from a low initial pressure level, with a temporary pressure reduction taking place between each pressure increase to a pressure level which lies between the outlet pressure level of the previous pressure stage and the target pressure of the previous pressure stage;
- Fig. 1f is a timing diagram for explaining a portion of a
- Titration period with several titration sequences, the titration pressure being raised gradually from a low initial pressure level, with a temporary decrease in pressure to a pressure level taking place between each pressure increase lies between the output pressure level of the previous pressure stage and the target pressure of the previous pressure stage; the pressure change taking place over a period of time which is longer than the pressure control concept according to FIG. 1e.
- FIG. 2 shows an overview for explaining the pressure control in a calibration mode, in the titration mode and in the validation mode.
- FIG. 3 shows a sketch to explain an arrangement according to the invention for signal titration according to the invention
- 4a is a diagram for explaining the respiratory gas flow for a single breath
- 4b is a diagram describing the time course of the respiratory gas flow for several breaths
- 4c shows a diagram which shows the time course of the respiratory gas pressure with individual pressure oscillations caused by snoring
- 4d shows a diagram which shows the time course of the respiratory gas flow for several breaths interrupted by an apnea period
- FIG. 5 shows a diagram which shows the time course of the respiratory gas flow with a hypopnea event
- FIG. 6 shows a diagram of the temporal course of the respiratory gas flow for several breaths, some of which are flow-limited;
- Fig. 7 is a diagram for explaining the time course of the
- Breathing gas flow in the case of essentially undisturbed, stable breathing shows a diagram to explain the time course of the respiratory gas flow in the case of unstable, disturbed breathing;
- FIG. 9 shows a diagram which shows the time course of the respiratory gas flow and, in the same temporal association, the course of the respiratory gas pressure, in which pressure signal oscillations occur which are caused by snoring;
- Fig. 10 is a diagram showing the course of the respiratory gas flow over time in the event of a system fault, e.g. through mouth breathing or
- FIG. 11 shows a diagram for explaining a respiratory gas pressure change induced in connection with the detection and linked consideration of respiratory patterns
- FIG. 12 shows a diagram to explain the temporal course of the respiratory gas flow and a change in the respiratory gas pressure carried out on the basis thereof;
- FIG. 13 shows a diagram for explaining the temporal course of the respiratory gas flow in connection with a respiratory gas pressure change initiated on the basis of this respiratory gas flow
- Fig. 14 is a diagram for explaining the time course of the
- 15 shows a diagram for explaining the temporal course of the respiratory gas flow with hypopneas sequences recognized therein and a respiratory gas pressure change induced on the basis of the recognition of these hypopneas sequences;
- 16 shows a diagram for explaining the temporal course of the respiratory gas flow with flow-limited breaths occurring therein, and a graph for explaining the respiratory gas pressure set here;
- FIG. 17 shows a diagram to explain the time course of the respiratory gas flow in connection with the prevailing respiratory gas pressure
- Fig. 18 is a diagram for explaining the time course of the
- 21 shows a diagram for explaining the generation of the evaluation result specific with regard to the physiological state of a patient on the basis of measurement signals which are related to the breathing of the person, evaluation characteristics being generated from the measurement signals mentioned using a plurality of evaluation systems and in
- FIG. 1 a shows, in a highly simplified manner, the pressure of the breathing gas applied to a patient via a breathing mask arrangement, which is changed via successive successive titration sequences 1, 2, 3.
- the set respiratory gas pressures are in a range that extends from 3 mbar to 16 mbar.
- the total duration of the titration period P divided here into titration sequences 1, 2, 3 is 5 hours in this exemplary embodiment.
- Breathing gas pressure levels of different titration sequences make it possible to extract evaluation characteristics from the breathing gas flow signals and to generate evaluation results from these evaluation characteristics within the framework of a linking analysis, which, for example, enable an effective CPAP pressure to be determined or which can contribute to the typification of any existing clinical picture.
- each individual titration sequence contains a waiting sequence and only after this has expired
- the duration of the individual titration sequences is determined by boundary values, it being possible for a transition to a subsequent titration sequence to take place within these boundary values even if predefined switching criteria are met.
- Switchover criteria are, in particular, criteria that provide information as to whether the current breathing can be classified as disturbed. If the current respiration can be classified as disturbed, the remaining time period of the current titration sequence and / or the pressure jump into the next one can depend on the detected disturbance characteristics
- Apnea events, hypopnea events and flow limitation events can be used as pressure-increasing breathing disorders.
- the minimum duration of the individual titration sequences, which is preferably determined by the waiting time an impermissibly rapid rise in breathing gas pressure avoided. It is possible to evaluate the patient's breathing gas flow even during the waiting periods contained in the individual titration sequences.
- the evaluation features determined by evaluating the respiratory gas flow within the waiting time can then in particular be the other
- Signal processing can be taken as a basis if breathing meets predetermined criteria after the waiting time.
- Embodiment according to Figure 1 is gradually increased over successive titration sequences 1, 2, 3 ....
- the pressure range in this embodiment also extends from a minimum pressure of approximately 3 mbar to a maximum pressure of 16 mbar.
- the time duration of each individual titration sequence is rigid and is independent of the current respiratory gas flow. That the pressure is increased successively at preferably constant time intervals.
- FIG. 1c likewise shows in the form of a time / pressure diagram the respiratory gas pressure changed according to a further variant of the pressure control concept during a titration period.
- the breathing gas pressure applied to the patient is set to a plausible maximum pressure of, for example, 16 mbar at the beginning of the titration period.
- the breathing gas pressure is successively reduced to a level of 3 mbar until the end of the titration period P.
- FIG. 1d shows the course of the respiratory gas pressure over time according to a fourth variant of a pressure control concept according to the invention for a titration period P.
- the respiratory gas pressure is reduced to a predetermined titration pressure starting from a high respiratory gas pressure level, with the individual titration sequences 1, 2, 3 there is a jump back to the increased output pressure level for a predetermined period of time.
- the length of time here Titration period P shown can be, for example, 3 to 5 hours.
- the time length of the individual titration sequences is preferably approximately 18-32 minutes.
- the change in the respiratory gas pressure between the subsequent titration sequences or the return to an intermediate pressure level can be carried out gradually over several breaths. It is possible that
- FIG. 1e shows a time diagram to explain a section of a
- Titration period with several titration sequences, whereby the titration pressure is gradually increased from a low initial pressure level, with a temporary decrease in pressure to a pressure level between each increase in pressure, which is between the output pressure level of the previous pressure level and the target pressure of the previous pressure level.
- the individual titration sequences t1, t2 ... tn can be defined with regard to their duration, the number of breaths to be examined or other titration sequence length criteria.
- the pressure changes made between the individual pressure levels occur relatively quickly, preferably within the transition from the inspiration to the expiration phase.
- Titration phase TP having pressure levels is followed by a validation phase VL in which a breathing gas pressure is set, which is determined on the basis of evaluation results that were determined during the titration phase and is evaluated for its plausibility by means of further assessment features.
- FIG. 1f shows a time diagram to explain a section of a titration period with a plurality of titration sequences, the titration pressure being raised gradually from a low initial pressure level, with a temporary decrease in pressure to a pressure level occurring between each pressure increase, which is between the initial pressure level of the previous pressure level and the target pressure previous pressure level; wherein the pressure change over a compared to the pressure control concept of Figure 1e stretched period.
- the respective pressure change is preferably carried out over approximately 10 to 15 breaths.
- FIG. 2 shows details of a calibration mode divided into four levels, the titration mode described above in four variants and a therapy mode provided according to the invention below.
- This calibration mode can extend over a period of, for example, 30 minutes and can preferably be ended automatically as soon as, for example, the detection system can be classified as correct using a self-diagnosis procedure.
- the calibration of the measuring arrangements for recording the respiratory gas pressure and the respiratory gas flow is preferably carried out with the respiratory mask arrangement applied to the patient.
- the breathing gas pressure can be changed step by step over successive successive titration sequences, as was explained above by way of example with reference to FIGS. 1a to 1d.
- the current course of the respiratory gas flow is specified using
- evaluation features can be generated for the individual titration sequences and in particular for the pressure stages controlled here. These evaluation features can be saved in a data field. By summarizing the processing of the determined evaluation characteristics, indicative evaluation results can be generated with regard to any existing clinical picture.
- respiratory disorders are preferably described by analyzing the respiratory gas flow and the respiratory gas pressure, and preferably also in relation to other polysomnographic parameters such as the blood oxygen saturation content, the patient's body position and EEG, EKG and / or EOG signals.
- configuration details are determined, according to which a therapy mode is carried out after the titration mode.
- This therapy mode follows the titration mode explained above.
- the patient's breathing can be further monitored, in particular by evaluating the respiratory gas flow signal and the respiratory gas pressure signal. Based on the
- Monitoring results make it possible to check the plausibility of the settings determined in the titration mode. Furthermore, it becomes possible to describe the therapy quality by evaluating the measurement signals determined in the context of the therapy mode.
- the titration mode can in particular be carried out in such a way that it determines a CPAP pressure which is required for a GPAP therapy and is still validated after the titration mode.
- the therapy mode can be carried out in such a way that by means of a pressure control device the breathing gas pressure applied to the patient is successively increased over several titration sequences according to a certain pressure control concept.
- the pressure increase can take place according to a rigidly predetermined time schedule or also on the basis of continuous analysis of the signal indicative of the patient's breathing.
- the breathing gas pressure applied to the patient from a high pressure level, at which, as expected, no breathing disorders should occur, to successively following titration sequences to a predetermined minimum level. It is also possible to do the preceding to apply the described pressure control concepts in combination. For example, the pressure can be raised successively to a plausible maximum level over a number of titration sequences (FIG. 1a) and then again lowered to the initial pressure level over a number of titration sequences (FIG. 1c). It is also possible that
- the measurement signals recorded in this are preferably evaluated with regard to any signs contained therein for disturbed breathing.
- the type of respiratory disorder and, if appropriate, the degree of the same can be stored as an evaluation feature, preferably in association with the respiratory gas pressure set here, in a map.
- the entries stored in this map can be evaluated simultaneously or as part of a subsequent evaluation procedure. On the basis of the evaluations carried out as a whole, it becomes possible to determine indicative indices with regard to a possibly existing clinical picture and a therapy pressure that may be necessary.
- the titration is carried out according to a standardized pressure control concept.
- Breathing disorders are detected using standardized evaluation criteria and are therefore reproducible. - The detection of respiratory disorders can be set selectively according to various medical standards.
- Breathing disorders are preferably detected from the signals volume flow, pressure, oxygen saturation, body position, EOG and EEG.
- Any effective therapeutic pressure required by the patient is derived from the
- the titration algorithm is preferably embedded in a calibration mode and a therapy or validation mode.
- the examination method is preferably designed such that the titration mode preferably extends over the first half of an examination night and during the patient's remaining sleeping time the breathing gas is already supplied under the therapy conditions determined in the context of the titration mode.
- the change from titration mode to therapy or validation mode can be program-controlled taking into account several switchover criteria.
- the program sequence can be determined manually, semi-automatically and also fully automatically.
- the effective therapy pressure can be checked by reducing the pressure in a defined manner for a certain interval and / or a certain number of breaths.
- the pressure can be reduced by a staircase function or in phases by returning to a reference pressure level.
- FIG. 3 shows an arrangement for examining a patient 30 with sleep-related breathing disorders.
- the patient 30 wears a nasally applied breathing mask 31. Via this breathing mask 31 it is possible to supply the patient 30 with ambient air at a pressure level that is at least in phases above the ambient pressure.
- the breathing gas is supplied via a flexible breathing gas line 32 which is coupled to the patient's own CPAP device 34 via a pneumotachograph 33.
- the CPAP device is equipped with a humidifier 35 and an internal one
- the internal pressure control device has a pressure measurement sensor which can be acted upon in a manner known per se via a pressure measurement hose 36.
- the pressure control device can be configured so that it interprets the pressure applied to the pressure measuring hose as the actual pressure and, depending on a set target pressure, the
- pressure measuring hose 36 is connected to a pressure module 37 via which pressures defined by means of an auxiliary pressure source 38 the pressure measuring hose 36 can be put on.
- the pressure module 33 also makes it possible to switchably couple the pressure measurement tube 36 to a pressure measurement tube section 36a leading to the breathing mask.
- the use of the pressure module 36 and the auxiliary pressure source makes it possible to control the fan speed of the CPAP device 34 without interfering with the inside of the device
- Control control and thus adjust the pressure to the desired titration sequence pressure level.
- the processing and the measurement data collection can be carried out in accordance with those described above
- the measurement data collected can be continuously evaluated using program-implemented evaluation procedures.
- the preferably continuously determined and possibly continuously improved evaluation results, as well as, in particular, suspected suitable operating settings for the CPAP device can possibly be visualized on a display device 41 in connection with particularly relevant breathing patterns.
- an input device 42 for example in the form of a keyboard and / or mouse, it is possible to influence the course of the signal titration and the measurement value acquisition.
- the arrangement shown can be operated under settings which were determined in the context of the titration mode.
- the quality of the breathing gas pressure setting can be described and visualized in particular by means of characteristic values.
- the breath 1 shown in FIG. 4 a with respect to the temporal course of the respiratory gas flow comprises an inspiration phase I and an expiration phase E.
- the determination of the respiratory phase limit G between the inspiration phase and the expiration phase is carried out by superimposed evaluation of several
- Curve discussion criteria in particular also taking into account the currently prevailing breathing pattern and the extreme values of the respiratory gas flow and pattern, the determined tidal volume as well as taking into account the breathing phase periods of previous breaths.
- the course of the respiratory gas flow shown in Fig. 4a describes the
- Breathing gas flow during an undisturbed breath can be based on the temporal conditions, e.g. the time of inspiration and expiration to each other or to other properties e.g. of the total breath length.
- the horizon line 2 entered in this illustration clarifies the statistically seen maximum respiratory gas flow for inspiration phases with the highest probability.
- a statistical analysis of the inspiration, expiration and total breath times can be carried out over several breaths (preferably 10 breaths).
- 4c shows the time course of a signal which is indicative of the respiratory gas pressure, this signal having oscillation sequences 3a, 3b, 3c, 3d and 3e which are caused by snoring.
- the pressure fluctuations caused by snoring can be brought about by a patient
- Pressure detection device for example, a breathing gas pressure measurement hose can be detected. It is also possible to detect such pressure fluctuations via microphone devices or also on the basis of the power consumption of a breathing gas delivery device.
- 4d shows the course of the respiratory gas flow over time for several breaths 1 interrupted by a respiratory failure period 5.
- the respiratory arrest period 5 recorded on the basis of the respiratory gas flow has a time period exceeding a predetermined limit value of, for example, 10 seconds and is thus classified as an apnea phase.
- Both the breaths recorded in this illustration before the breath stop period 5 and the subsequent breaths show flow limitation features which are recorded in association with each breath.
- hypopnea phase 6 shows the temporal course of the respiratory gas flow with a hypopnea phase 6 contained therein.
- the hypopnea phase 6 is then considered to be present if, after three breaths 1 classified as normal, at least two but at most three breaths follow, their difference volume compared to the three previous breaths having a predetermined limit value exceeds.
- FIG. 7 shows the course of the respiratory gas flow during a breathing period classified as stable.
- the respiratory gas flow, the respiratory frequency, the amplitude and the breathing pattern of the respiratory gas flow are regular within a predetermined range which can be defined as a time range or also by a number of breaths.
- the breathing stability is above a breathing stability limit of 0.86.
- a statistical analysis of the inspiration / expiration time and total breath over several breaths can be made (preferably 10 breaths).
- No breathing disorders (OSA) occur during the phase of stable breathing shown here.
- the breathing stability index is below the limit value of preferably 0.911.
- the respiratory gas pressure signal contains high-frequency oscillations in phases, which in the present example can be assigned to inspiratory snoring.
- FIG. 10 shows the time course of the respiratory gas flow for several breaths, the breathing being irregular in phases and starting from time T1 one, e.g. there is a disorder caused by mask leakage or mouth opening. From time T1, a predetermined limit value is exceeded, which can be interpreted as an indication of a system malfunction due to mouth breathing or mask leaks.
- the generation according to the invention of an evaluation result which is indicative of the physiological state of a patient can be used to control the breathing gas pressure in the context of positive pressure ventilation.
- the breathing gas is supplied to the patient using a nasally applied breathing mask which is connected via a breathing gas hose to a breathing gas source, by means of which breathing gas is made available to an adjustable pressure level.
- This respiratory gas supply arrangement comprises a pressure detection device for generating a signal indicative of the respiratory gas pressure and a respiratory gas flow detection device for detecting a respiratory gas flow indicative signals.
- the signal, which is indicative of the respiratory gas flow is analyzed by an evaluation device which generates evaluation features using predefined evaluation systems. These evaluation features are viewed in a linked manner and lead to changes in the respiratory gas pressure or to information on the classification of the patient if predetermined linking criteria are met.
- a first respiratory disorder classified as an apnea phase lasts for about 15 seconds.
- This apnea phase is followed by a series of breaths, some of which have flow limitation features. Following these breaths, some of which are limited in flow, is followed by a second phase of disturbed breathing, classified as an apnea phase, which also extends over a period of 15 seconds.
- This second apnea phase is followed by a number (here six) of
- Pressure level of 2 mbar initiated.
- the breaths that occur after the breathing gas pressure has increased to a pressure of 11 mbar are further analyzed for the features contained therein and viewed in a linked manner over a larger time window.
- the time course of the respiratory gas flow is shown in FIG. 12, the evaluation of the detected respiratory flow signals recognizing a flow-limited respiration and successively increasing the respiratory gas pressure at predetermined time intervals until respiration to be classified as normal takes place.
- the course of the signal, which is indicative of the respiratory gas flow shown in FIG. 13 leads to a first breath sequence being classified as a sequence of stable breathing, the state of stable breathing lasting over a predetermined period of time causing the respiratory gas pressure to decrease.
- the signals generated at this reduced respiratory gas pressure which are indicative of the respiratory gas pressure, allow conclusions to be drawn about breathing that is sometimes flow-limited.
- the breathing gas pressure is increased again.
- the new breathing gas pressure level is at least temporarily below the pressure level at which stable breathing was previously recognized.
- the course of the signal indicative of the respiratory gas flow shown in FIG. 14 shows several apnea phases in part. with subsequent hypopnea phases.
- the temporal position of the apnea and hypopnea phases leads to an evaluation result that classifies the prevailing respiratory gas pressure as insufficient and causes an increase in the respiratory gas pressure.
- the course of the signal, which is indicative of the respiratory gas flow, shown in FIG. 15 shows three breath sequences that can be classified as hypopnea sequences.
- the temporal position of the hypopnea sequences leads to an evaluation result that the prevailing one
- FIG 16 shows a sequence of the signal which is indicative of the respiratory gas flow and which shows flow limitation features for the individual breaths, at the same time as the occurrence of flow limitation features in the breaths in FIG the respiratory gas pressure signal oscillations occur that can be classified as inspiratory snoring.
- breaths recorded after increasing the respiratory gas pressure are classified as breaths of normal breathing.
- the breathing gas pressure can be reduced by, for example, 2 mbar, as shown in FIG. 17. This reduced breathing gas pressure level is maintained as long as there are no flow limitation features in the individual
- Breaths are recognizable. If breathing is classified as normal at this pressure level over a predetermined period of time, the breathing gas pressure can be reduced further.
- the breathing gas pressure can be reduced further as shown in FIG. 18. If flow limitation features occur with this further reduced breathing gas pressure in the individual breaths recorded, then the breathing gas pressure can be increased again on the basis of a linked consideration of the breathing characteristics determined for the individual breaths.
- Fig. 18 is also the course of the indicative of the respiratory gas flow and the indicative of the respiratory gas flow in the case of a z.
- the system according to the invention is coordinated in such a way that in the event of a fault classified as mask leakage, the delivery rate of the respiratory gas source is coordinated in such a way that the up to Prevalent respiratory gas pressure is largely maintained.
- a system disturbance that has been classified as mask leakage for example by temporarily shifting a breathing mask, can e.g. after changing the patient's head position, be rescinded and continue breathing under the breathing gas pressure that was maintained even during the system malfunction.
- the signal indicative of the respiratory gas flow as can be seen in FIG. 20, it can also be recognized whether mouth breathing is present.
- FIG. 21 shows the time profile of a signal S which is indicative of the respiratory gas flow.
- This signal is recorded, for example, as a so-called raw data signal by a pressure sensor connected to a dynamic pressure measuring point with a sampling frequency of ⁇ .B 10 to 500 Hz.
- Raw data signal S can be transmitted via an approximation system 20 using approximation procedures implemented therein, e.g. Series developments in the form of a Fast Fourier analysis, (e.g.) MP3 compression, Laplace series development, binomial series development, correlation series development etc. are recorded in compressed form.
- Approximation procedures e.g. Series developments in the form of a Fast Fourier analysis, (e.g.) MP3 compression, Laplace series development, binomial series development, correlation series development etc. are recorded in compressed form.
- the possibly compressed raw data of the signal S can be recorded within a data sequence D.
- Evaluation systems 21 Evaluation features M are generated which e.g. describe certain characteristics of breaths or periods of time.
- At least one evaluation result is generated in the context of a result generation step in that the evaluation features M are subjected to a linking consideration.
- one of the evaluation results can be a signal which, for example, specifies the current breathing gas pressure as suitable, too low or too high.
- an amount of change in the respiratory gas pressure that may be required can be determined.
- Control parameters for the setting and synchronization of the breathing gas pressure in a bi-level pressure control can also be determined as evaluation results.
- Evaluation feature groups ai, a 2 , bi, c 2 are generated.
- Evaluation results can be the result of a large number of OR-linked operating systems.
- raw data sets or evaluation characteristic sets can be selected that are used to generate the desired statements, such as the amount of pressure change, and typing indices (FLI, snoring index, ).
- the approximation system 20, the evaluation systems 21 and the systems for interlinked consideration of the evaluation characteristics M and the preparatory generation of Boolean variables are preferably provided by a computer device configured by means of a program data set.
- the evaluation results can be generated as part of a data postprocessing, or used in real time - or in a timely manner - when setting a breathing gas pressure or configuring a pressure control system.
- the evaluation results can be made available to a pressure control algorithm which is preferably designed such that it in the case of a breathing gas pressure control, there are at least two pressure control modes which differ in their reaction behavior. It is thus possible to operate a breathing gas pressure control system in a basic mode in which certain events or a sum of events cause an increase in the breathing gas pressure.
- This sensitive mode can be set in particular if the breathing gas pressure e.g. after a phase more stable
- the basic mode it is preferably provided to initiate an increase in pressure when two large or three small apneas occur and the respiratory gas pressure is less than 14 mbar or a respiratory arrest is detected which corresponds to a predetermined period of e.g. Exceeds 2 minutes.
- a pressure increase of two mbar can be initiated.
- a pressure increase of 1 mbar can preferably be initiated when three hypopnese sequences in a given one
- Pressure increases of a pressure level of 1 mbar are preferably brought about if, with a breathing stability index> 0.911, flow restrictions occur with A of B or also C of D breaths.
- the basic mode is furthermore preferably coordinated in such a way that it causes a pressure reduction if there is stable breathing with a breathing stability index AS> 0.911 over a period of at least 9 minutes.
- a pressure reduction of preferably 2 mbar is initiated.
- a change in pressure is suppressed in particular if the breathing stability index is ⁇ 0.911 and the limit symptoms recorded in the individual breaths do not exceed a predetermined severity criterion.
- an increase in the breathing gas pressure by, for example, 2 mbar is initiated when there are two large or three small apneas and the breathing gas pressure ⁇ 14 mbar. If three hypopnese sequences occur, the breathing gas pressure is increased by 1 mbar.
- an increase in the breathing gas pressure by 1 mbar is initiated if four of B breaths have flow limitation features and the breathability index is> 0.87.
- a pressure increase of 1 mbar is also initiated if C of D breaths have flow limitation features and the breath stability index ⁇ 0.911. If D of B breaths show flow limitation characteristics and the breath stability index is below a value of 0.911, the breathing gas pressure is also increased by 1 mbar in the sensitive mode.
- the breathing gas pressure is already lowered in the sensitive mode if there is stable breathing over a period of 3 minutes and the breathing stability index> 0.911.
- the breathing gas pressure can be reduced, for example, by 2 mbar
- the linking consideration can lead to pressure changes, for example. It can also lead to the calculation of patient-specific indices by using these relevant measurement data are selected that are relevant for the respective index and that were determined in a patient stage that ensures a high level of informative value.
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Abstract
Description
Claims
Applications Claiming Priority (5)
Application Number | Priority Date | Filing Date | Title |
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DE10311704A DE10311704A1 (de) | 2003-03-17 | 2003-03-17 | Verfahren und Anordnung zur Titration physiologischer Messsignale im Zusammenhang mit der Observation schlafbezogener Atmungsstörungen |
DE10311704 | 2003-03-17 | ||
DE10326817 | 2003-06-13 | ||
DE2003126817 DE10326817A1 (de) | 2003-06-13 | 2003-06-13 | Verfahren und Anordnung zur Titration physiologischer Messsignale im Zusammenhang mit der Observation eines Patienten hinsichtlich schlafbezogener Atmungsstörungen |
PCT/EP2004/002781 WO2004082751A1 (de) | 2003-03-17 | 2004-03-17 | Verfahren und anordnung zur titration physiologischer messsignale im zusammenhang mit der observation eines patienten hinsichtlich schlafbezogener atmungsstörungen |
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EP1605998A1 true EP1605998A1 (de) | 2005-12-21 |
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EP04721162A Withdrawn EP1605998A1 (de) | 2003-03-17 | 2004-03-17 | Verfahren und anordnung zur titration physiologischer messsignale im zusammenhang mit der observation eines patienten hinsichtlich schlafbezogener atmungsstörungen |
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US (1) | US20060249149A1 (de) |
EP (1) | EP1605998A1 (de) |
JP (1) | JP2006520227A (de) |
WO (1) | WO2004082751A1 (de) |
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2004
- 2004-03-17 JP JP2006504713A patent/JP2006520227A/ja active Pending
- 2004-03-17 EP EP04721162A patent/EP1605998A1/de not_active Withdrawn
- 2004-03-17 US US10/549,650 patent/US20060249149A1/en not_active Abandoned
- 2004-03-17 WO PCT/EP2004/002781 patent/WO2004082751A1/de active Application Filing
Non-Patent Citations (1)
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Also Published As
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WO2004082751A1 (de) | 2004-09-30 |
JP2006520227A (ja) | 2006-09-07 |
US20060249149A1 (en) | 2006-11-09 |
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