• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    On the one hand there are obstructive nocturnal respiratory disorders (obstructive sleep apnea), on the other hand central respiratory disturbances (Cheyne-Stokes respiration and central sleep apnea), which result from periodic oscillations of the central respiratory drive in the respiratory center of the brainstem. Obstructive sleep apnea is usually treated by continuous positive airway pressure (CPAP applied by device, tube and mask). Previous treatment of central respiratory distress using a form of ventilation, the Anti-Cyclic / Adaptive Servo-Ventilation (ASV), has been challenged by study results suggesting increased mortality in frequent patient populations. The invention seeks to address the problem instead of forced passive ventilation during the reduced respiratory drive phases rather than triggering own active breaths even in the phases of reduced or lacking respiratory drive. This is caused by short pressure pulses or pressure stages which are not sufficient for ventilation, but each trigger a breath via a mechanoreceptor-mediated stimulus.
    公开号:CH714047A2
    申请号:CH01004/17
    申请日:2017-08-01
    公开日:2019-02-15
    发明作者:Christian Nirkko Arto
    申请人:Christian Nirkko Arto；
    IPC主号:
    专利说明:

    Description: The present invention relates to a device with extended process features, which can be used to treat or supplement the treatment of patients with respiratory disorders, which means by triggering / initiating one's own breaths by using pressure pulses, pressure ramps or pressure levels, in short Short-term pressure changes are caused, which should stimulate the mechanoreceptors of the thorax, lungs or airways, according to claims 1 to 8. Due to the device features, a treatment should in particular from mixed obstructive-central and purely central nocturnal breathing disorders in the sense of Cheyne-Stokes breathing up to for central sleep apnea syndrome can be facilitated or enabled. This is particularly important in view of recent study results, which indicate that the previous standard therapy for these respiratory disorders could lead to increased mortality in some patient groups and should therefore be avoided in these patients.
    State of the art:
    Nocturnal respiratory disorders with interruptions in breathing (apneas) and weakening of breath (hypopneas) occur on the one hand due to periodic narrowing A / inference (obstruction) primarily of the upper respiratory tract (obstructive sleep apnea syndrome), and on the other hand also due to periodic swelling and declining of the central respiratory drive in the Brainstem (fluctuations in the context of Cheyne-Stokes breathing) up to its periodic complete pauses (central sleep apnea syndrome). Mixed forms also occur (mixed obstructive-central sleep apnea syndrome). A relevant obstructive sleep apnea syndrome (oSAS) is usually treated by means of continuous positive airway pressure (CPAP) during night sleep, which is carried out using a mask (nose mask to full-face mask, in special situations also tube in the trachea) and a hose is applied from a device. Cheyne-Stokes breathing, central sleep apnea, or the central component of mixed sleep apnea syndrome can be treated with more or less constant pressure, but insufficiently or not at all, and on the contrary, it can even worsen. Up to now, anti-cyclical or adaptive servo ventilation (ASV) has mostly been used to treat these forms of sleep apnea, which effectively performs external ventilation in the phases of lack of respiratory drive, i.e. changes the pressure with each breath by applying the full pressure necessary for inhalation and reducing the pressure when exhaling accordingly. These pressure differences are adjusted in reverse (»countercyclical») in phases with central (from the respiratory center) too much and insufficiently controlled breathing in order to keep the breathing constant over longer periods of time.
    This works reasonably well technically, but recent study results suggest that this ASV is likely to increase mortality in heart failure patients. One tries therefore to switch to other nightly ventilation modalities, but these work worse or just reinforce the central component. In addition, patients with central sleep apnea syndrome often have heart failure because it promotes Cheyne-Stokes breathing and central sleep apnea. What is needed is an alternative that can do without the high and apparently harmful ventilation pressure values.
    Description of the invention and its features:
    The present invention circumvents the problem of high ventilation pressure values in that the device should not, as has been customary up to now, attempt to forcefully ventilate the patient passively, during which his respiratory center has no need for breathing at all, but instead should try to breathe himself to stimulate a reflex mechanism in such a way that the patient actively breathes in response to a stimulus without any relevant additional pressure support. As a result, the blood gases also deteriorate less strongly in this phase with reduced respiratory drive, and the next spontaneous phase with increased respiratory drive does not overshoot so much that the next pause is promoted by feedback as much as that in Cheyne-Stokes breathing otherwise it is the case (ie the oscillatory rocking is dampened when breathing a little more during the breathing pause).
    In addition to chemoreceptors in the brain stem, which measure the blood gas concentration (especially carbon dioxide / CO 2 and oxygen / O 2 ), mechanoreceptors in the chest, lungs and airways also influence the control of breathing. Within the scope of the invention, these mechanoreceptors are to be excited by short-duration and low-amplitude pressure pulses, and thus trigger one breath each. As with all previous devices, all possible device parameters can be set separately, so the pressure pulses should be adjustable for each patient, and can be in short pressure ramps, pressure levels or pressure pulses both in the positive direction (more pressure) or in the negative direction (less pressure) can be applied depending on the situation and combination with obstructive sleep apnea components and other factors. As an exemplary embodiment, a commercially available CPAP or BiPAP device (bilevel-PAP) is assumed, which is programmed with the additional ability to lower the pressure with a short pulse during 1 sec and then return to the original pressure, and continue to do so even in the absence of spontaneous breaths during a complete pause at a rate of at least 15 bpm. Similar capabilities for the passive support of insufficient own breaths, or for the complete replacement of own breaths during an apnea already exist with today's devices. in the
    CH 714 047 A2
    In contrast to this, the invention is not intended to provide relevant support or replacement of the breath, but (in addition or solely) to trigger or intensify an active breath of one's own through a naturally existing reflex mechanism, with short and sharper pressure changes, but which apply less pressure and take less time. This is not possible with the devices available today, at best as a side effect by setting parameters on the edge of another ventilation mode intended today.
    权利要求:
    Claims (8)
    [1]
    claims
    1. A method for triggering or intensifying one's own breaths in patients with respiratory disorders, characterized in that brief changes in the respiratory pressure in the airways are applied, which effects are said to bring about reflection.
    [2]
    2. The method according to claim 1, characterized in that it is a brief increase in the pressure which is applied.
    [3]
    3. The method according to claim 1, characterized in that it is a short-term decrease in the pressure which is applied.
    [4]
    4. The method according to claim 1 to 3, characterized in that it is a change in a short time (decrease or increase) of the pressure, which is maintained longer and is reset later or in the time until the next breath back to the The initial value subsides (for example the so-called sawtooth time profile).
    [5]
    5. Device for performing one of the methods according to claim 1 to 4, characterized in that the pressure changes are generated in a device and are supplied to the airways via a hose and / or mask.
    [6]
    6. Device for performing one of the methods according to claim 1 to 5, characterized in that a device which also has other abilities for treatment by means of pressure application to the respiratory tract is additionally equipped with the abilities described.
    [7]
    7. Application of methods according to claims 1 to 4 to patients with nighttime breathing disorders.
    [8]
    8. Application of a device according to claim 5 or 6 to patients with nighttime breathing disorders.
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    同族专利:
    公开号 | 公开日
    CH714047B1|2021-09-30|
    EP3437684A1|2019-02-06|
    引用文献:
    公开号 | 申请日 | 公开日 | 申请人 | 专利标题
    US6932084B2|1994-06-03|2005-08-23|Ric Investments, Inc.|Method and apparatus for providing positive airway pressure to a patient|
    SE9502543D0|1995-07-10|1995-07-10|Lachmann Burkhardt|Artificial ventilation system|
    US6988994B2|2003-08-14|2006-01-24|New York University|Positive airway pressure system and method for treatment of sleeping disorder in patient|
    US7810497B2|2006-03-20|2010-10-12|Ric Investments, Llc|Ventilatory control system|
    US8789528B2|2007-02-12|2014-07-29|Ric Investments, Llc|Pressure support method with automatic comfort feature modification|
    NZ713947A|2009-11-16|2017-05-26|Resmed Ltd|Methods and apparatus for adaptable pressure treatment of sleep disordered breathing|
    US10065007B2|2011-03-18|2018-09-04|Maquet Critical Care Ab|Breathing apparatus and method for support ventilation|
    WO2014199264A1|2013-06-11|2014-12-18|Koninklijke Philips N.V.|Synchronous airway pressure release ventilation|
    法律状态:
    优先权:
    申请号 | 申请日 | 专利标题
    CH01004/17A|CH714047B1|2017-08-01|2017-08-01|Device for the treatment of breathing disorders by ventilatory triggering of one's own breaths by means of short pressure impulses, ramps or levels.|CH01004/17A| CH714047B1|2017-08-01|2017-08-01|Device for the treatment of breathing disorders by ventilatory triggering of one's own breaths by means of short pressure impulses, ramps or levels.|
    EP18000634.8A| EP3437684A1|2017-08-01|2018-07-30|Method and device for treating breathing disorders|
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