(19)
(11)EP 2 337 494 B1

(12)EUROPEAN PATENT SPECIFICATION

(45)Mention of the grant of the patent:
14.02.2018 Bulletin 2018/07

(21)Application number: 09811865.6

(22)Date of filing:  08.09.2009
(51)International Patent Classification (IPC): 
A61B 5/08(2006.01)
A61B 5/091(2006.01)
A61B 5/085(2006.01)
A61B 5/113(2006.01)
(86)International application number:
PCT/US2009/005066
(87)International publication number:
WO 2010/027515 (11.03.2010 Gazette  2010/10)

(54)

NONINVASIVE METHOD AND SYSTEM FOR MEASURING PULMONARY VENTILATION

NICHTINVASIVES VERFAHREN UND SYSTEM ZUR MESSUNG DER LUNGENBEATMUNG

PROCÉDÉ ET SYSTÈME NON INVASIFS DE MESURE DE LA VENTILATION PULMONAIRE


(84)Designated Contracting States:
AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO SE SI SK SM TR

(30)Priority: 05.09.2008 US 231692

(43)Date of publication of application:
29.06.2011 Bulletin 2011/26

(73)Proprietor: adidas AG
91074 Herzogenaurach (DE)

(72)Inventor:
  • McCOOL, Franklin Dennis
    Bristol, RI 02809 (US)

(74)Representative: Wegner, Hans 
Bardehle Pagenberg Partnerschaft mbB Patentanwälte, Rechtsanwälte Prinzregentenplatz 7
81675 München
81675 München (DE)


(56)References cited: : 
US-A- 4 308 872
US-A- 4 960 118
US-B1- 6 413 225
US-A- 4 960 118
US-A1- 2004 122 334
US-B1- 6 413 225
  
  • PAEK D ET AL: "Postural effects on measurements of tidal volume from body surface displacements", JOURNAL OF APPLIED PHYSIOLOGY: RESPIRATORY, ENVIRONMENTAL AND EXERCISE PHYSIOLOGY , vol. 68, no. 6 1 June 1990 (1990-06-01), pages 2482-2487, XP008162272, AMERICAN PHYSIOLOGICAL SOCIETY, US ISSN: 0161-7567 Retrieved from the Internet: URL:http://jap.physiology.org/content/68/6 /2482.abstract [retrieved on 2013-06-04]
  • MCCOOL F DENNIS ET AL: "Tidal volume and respiratory timing derived from a portable ventilation monitor", CHEST, vol. 122, no. 2, August 2002 (2002-08), pages 684-691, XP002697751, ISSN: 0012-3692
  • SMITH ET AL: "Three Degree of Freedom Description of Movement of the Human Chest Wall", JOURNAL OF APPLIED PHYSIOLOGY, vol. 60, 1 January 1986 (1986-01-01), pages 928-934, XP008147967, AMERICAN PHYSIOLOGICAL SOCIETY, BETHESDA, MD, US ISSN: 0021-8987
  • SMITH ET AL.: 'Three Degree of Freedom Description of Movement of the Human Chest Wall' J. APPL. PHYSIOL. vol. 60, 1986, pages 928 - 934, XP008147967
  
Note: Within nine months from the publication of the mention of the grant of the European patent, any person may give notice to the European Patent Office of opposition to the European patent granted. Notice of opposition shall be filed in a written reasoned statement. It shall not be deemed to have been filed until the opposition fee has been paid. (Art. 99(1) European Patent Convention).


Description

FIELD OF THE PRESENT INVENTION



[0001] The present invention relates generally to measuring respiratory air volume in humans. More particularly, the invention relates to a noninvasive method for quantitatively measuring pulmonary ventilation and a ventilation system employing same.

BACKGROUND OF THE INVENTION



[0002] In medical diagnosis and treatment of a subject, it is often necessary to assess one or more physiological characteristics; particularly, respiratory characteristics. A key respiratory characteristic is respiratory air volume (or tidal volume).

[0003] Various conventional methods and systems have been employed to measure (or determine) tidal volume. One method comprises having the patient or subject breathe into a mouthpiece connected to a flow rate measuring device. Flow rate is then integrated to provide air volume change.

[0004] As is well known in the art, there are several drawbacks and disadvantages associated with employing a mouthpiece. A significant drawback associated with a mouthpiece and nose-clip is that the noted items cause changes in the monitored subject's respiratory pattern (i.e. rate and volume). Tidal volume determinations based on a mouthpiece and nose-clip are, thus, often inaccurate.

[0005] A mouthpiece is also difficult to use for long term subject monitoring, especially for ill, sleeping or anesthetized subjects. Further, it is uncomfortable for the subject, tends to restrict breathing, and is generally inconvenient for the physician or technician to use.

[0006] Another conventional means for determining tidal volume comprises respiration monitors. Illustrative are the systems disclosed in U.S. Pat. Nos. 3,831,586 and 4,033,332.

[0007] Although the noted systems eliminate most of the disadvantages associated with a mouthpiece, the systems do not, in general, provide an accurate measurement of tidal volume. Further, the systems are typically only used to signal an attendant when a subject's breathing activity changes sharply or stops.

[0008] A further means for determining tidal volume is to measure the change in size (or displacement) of the rib cage and abdomen, as it is well known that lung volume is a function of these two parameters. A number of systems and devices have been employed to measure the change in size (i.e. Δ circumference) of the rib cage and abdomen, including mercury in rubber strain gauges, pneumobelts, respiratory inductive plethysmograph (RIP) belts and magnetometers. See, D.L. Wade, "Movements of the Thoracic Cage and Diaphragm in Respiration", J. Physiol., pp. 124-193 (1954), Mead, et al, "Pulmonary Ventilation Measured from Body Surface Movements ", Science, pp. 196, 1383-1384 (1967).

[0009] RIP belts are, at present, the primary means employed to measure changes in the cross-sectional areas of the rib cage and abdomen. RIP belts comprise conductive loops of wire that are coiled and sewed into an elastic belt. The output voltage of a RIP belt is generally linearly related to changes in the expanded length of the belt and, thus, changes in the enclosed cross-sectional area.

[0010] In practice, to measure changes in the cross-sectional areas of the rib cage and abdomen, one belt is thus typically secured around the mid-thorax and a second belt is placed around the mid-abdomen.

[0011] Various magnetometer systems have also been recently developed to measure displacements of the rib cage and abdomen. Respiratory magnetometers consist of tuned pairs of electromagnetic coils; one coil being adapted to transmit a specific high frequency AC electromagnetic field and the other coil being adapted to receive the field.

[0012] A typical magnetometer system includes two pairs of electromagnetic coils. To measure changes in (or displacement of) the anteroposterior diameter of the rib cage, a first coil is typically placed over the sternum at the level of the 4th intercostal space and the second coil (of the pair) is placed over the spine at the same level. To measure changes in the anteroposterior diameter of the abdomen, a third coil is typically placed on the abdomen at the level of the umbilicus and a fourth coil (of the pair) is placed over the spine at the same level.

[0013] Over the operational range of distances, the output voltage is linearly related to the distance between a pair of coils; provided, the axes of the coils remain substantially parallel to each other. As rotation of the axes can change the voltage, the coils are typically secured to the subject's skin in a parallel fashion and rotation due to the motion of underlying soft tissue is minimized.

[0014] A potential limitation of the use of such coils or magnetometers is presented in environments that contain large metal structures or electric motors. Such devices produce extraneous electromagnetic fields and consequently affect the magnetometer voltage output.

[0015] Various methods, algorithms and mathematical models have been employed with the aforementioned systems to determine tidal volume and other respiratory characteristics. In practice, "two-degrees-of-freedom" models are typically employed to determine tidal volume from RIP belt derived rib cage and abdominal displacements.

[0016] The "two-degrees-of-freedom" models are premised on the inter-related movements by and between the thoracic cavity and the anterior and lateral walls of the rib cage and the abdomen, i.e. since the first rib and adjacent structures of the neck are relatively immobile, the moveable components of the thoracic cavity are taken to be the anterior and lateral walls of the rib cage and the abdomen. Changes in volume of the thoracic cavity will then be reflected by displacements of the rib cage and abdomen.

[0017] As is well known in the art, displacement (i.e. movement) of the rib cage can be directly assessed with an RIP belt. Diaphragm displacement cannot, however, be measured directly. But, since the abdominal contents are essentially incompressible, caudal motion of the diaphragm relative to the pelvis and the volume it displaces is reflected by outward movement of the anterolateral abdominal wall.

[0018] The "two-degrees-of-freedom" model embraced by most in the field holds that the volume displacement of the respiratory system, i.e. tidal volume (VT), is equal to the sum of the volume displacements of the rib cage and abdomen, i.e.

where:

RC and Ab represent linear displacements of the rib cage and abdomen, respectively; and α and β represent volume-motion coefficients.



[0019] It is well established that the use of the noted "two-degrees-of-freedom" model can provide an estimate of VT that is within 10% accuracy of ventilation measured at the mouth; provided, the subject is confined to one body position.

[0020] Two different approaches primarily used for determining the necessary volume-motion coefficients of the rib cage and abdomen are the isovolume technique and the multiple linear regression technique. In the isovolume technique, the subject first performs an isovolume maneuver, shifting volume back and forth between the rib cage and abdominal compartments while holding the glottis closed, whereby there is no net volume change of the system. Since VT equals zero, Equation 1 can be modified as follows:



[0021] On a graph of rib cage and abdomen signals, the slope of the isovolume line is equal to the ratio -β/α.

[0022] In practice, the gains of the rib cage and abdomen signals are often adjusted, whereby the slope of the isovolume line equals one. The rib cage and abdomen displacements are thus equal for any volume change. The two signals can then be directly summed to provide volume.

[0023] The isovolume method is based on the assumptions that displacements of the surfaces of the rib cage and abdomen are representatively sampled at the measured location, and are similar during isovolume efforts and spontaneous breathing. Since volume-motion coefficients change with posture, the isovolume calibration must be repeated in each body position.

[0024] Computer-assisted regression techniques, such as multiple linear regression, are used to determine volume-motion coefficients by solving a matrix of multiple simultaneous equations of changes in chest wall dimensions and lung volume. An advantage of these techniques is that no special calibration maneuver is required to generate volume-motion coefficients.

[0025] A limitation of any approach that uses chest wall motion to assess ventilation is, however, that the overall volume change of the chest wall being measured includes not only changes in lung volume, but also blood volume shifts into and out of the thoracoabdominal cavity. This can occur when the respiratory system is subjected to large pressure changes, or with changes in posture (e.g. between supine and upright position).

[0026] Another limitation is related to distortion that can occur within the rib cage or abdomen (e.g. between the upper and lower rib cage or between the lower transverse and AP rib cage).

[0027] As is well known in the art, the accuracy of "two-degrees-of-freedom" model and, hence, methods employing same to determine volume-motion coefficients of the rib cage and abdomen, is further limited by virtue of changes in spinal flexion that can accompany changes in posture. Indeed, it has been found that VT can be over or under-estimated by as much as 50% of the vital capacity with spinal flexion and extension, see McCool, et al., "Estimates of Ventilation From Body Surface Measurements in Unrestrained Subjects ", J. Appl. Physiol., vol. 61, pp. 1114-1119 (1986); and Paek, et al., "Postural Effects on Measurements of Tidal Volume From Body Surface Displacements", J. Appl. Physiol., vol. 68, pp. 2482-2487 (1990).

[0028] There are two major causes that contribute to the noted "two-degrees-of-freedom" model error(s) and, hence, limitation. A first contributing cause of the error is due to the substantial displacement of the summed rib cage and abdomen signals that occurs with isovolume spinal flexion and extension or pelvic rotation, which is illustrated in Fig. 1.

[0029] These shifts are a consequence of conservation of volume. As one of the thoracoabdominal boundaries is pushed in, another must be pushed out.

[0030] The second contributing cause of the error is due to posturally-induced changes in volume-motion coefficients. With isovolume spinal flexion, the rib cage comes down with respect to the pelvis and the axial dimension of the anterior abdominal wall becomes smaller. Therefore, less abdominal cavity is bordered by the anterior abdominal wall.

[0031] With a smaller anterior abdominal wall surface to displace, a given volume displacement of the abdominal compartment would be accompanied by a greater outward displacement of the anterior abdominal wall. The abdominal volume-motion coefficient would accordingly be reduced.

[0032] It has, however, been found that the addition of a measure of the axial motion of the chest wall, i.e. changes in the distance between the xiphoid and the pubic symphysis (Xi), provides a third degree of freedom, which, when employed to determine VT can reduce the posture related error associated with the "two-degrees-of-freedom" model to within 15% of that measured by spirometry, see Paek, et al., "Postural Effects on Measurements of Tidal Volume From Body Surface Displacements", J. Appl. Physiol., vol. 68, pp. 2482-2487 (1990); and Smith, et al. "Three Degree of Freedom Description of Movement of the Human Chest Wall", J. Appl. Physiol., Vol. 60, pp. 928-934 (1986).

[0033] Smith, et al. proposed the following "three-degrees-of-freedom" model to determine tidal volume, i.e.

where:

RC and Ab represent linear displacements of the rib cage and abdomen, respectively;

Xi represents the Δ distance between the xiphoid and the pubic symphysis; and α, β and γ represent volume-motion coefficients for RC, Ab and Xi.



[0034] According to McCool et al., ("Tidal Volume and Respiratory Timing Derived From a Portable Ventilation Monitor") anteroposterior displacements of the rib cage and abdomen, as well as the axial displacements of the chest wall, were measured using two pairs of coils secured to the rib cage and abdomen. A 8.97-KHz transmitter coil is placed in a posterior position over the spine at the midsternal level. A 7.0-KHz transmitter coil is placed anteriorly in the midline of the abdominal wall just above the umbilicus. One receiver coil is tuned to 7.0 KHz and placed in a posterior position over the spine at the level of the umbilicus. This coil acts as a receiver for the abdomen anteroposterior dimension. The second receiver coil is tuned to both 7.0 KHz and 9.97 KHz frequencies. The second coil acts as a receiver for both the sternal-umbilical signal and the rib cage anteroposterior signal.

[0035] Referring to Fig. 2, there are shown graphical illustrations of % error of estimated VT determined with one, two and three degrees of freedom models (i.e. x-axis) during various postural movements or maneuvers. It can be seen that the use of a "three-degrees-of-freedom" model incorporating the third independent variable, i.e. the Δ distance between the xiphoid and the pubic symphysis ("Xi"), enhances the accuracy with which volume is estimated from body surface motion in those maneuvers that incorporate changes in spinal attitude.

[0036] There are, however, similarly several drawbacks and disadvantages associated with the 'three-degrees-of-freedom" model. A major drawback is that the 'three-degrees-of-freedom" model reflected in Eq. 3 above is still limited in accuracy to about 15% of actual ventilation in individuals who are doing freely moving postural tasks, such as bending, sitting or standing, due to spinal flexion.

[0037] It would thus be desirable to provide an improved method and associated system for determining tidal volume (or pulmonary ventilation) that substantially reduces or eliminates the drawbacks and disadvantages associated with conventional methods and systems that are employed to determine pulmonary ventilation.

[0038] It is therefore an object of the present invention to provide noninvasive methods and associated systems for determining pulmonary ventilation that substantially reduce or eliminate the drawbacks and disadvantages associated with conventional methods and systems for determining pulmonary ventilation.

[0039] It is another object of the invention to provide noninvasive methods and associated systems for determining pulmonary ventilation that substantially reduce the accuracy errors associated with conventional two-degrees and three-degrees of freedom tidal volume models.

[0040] It is another object of the invention to provide noninvasive methods and associated systems for determining pulmonary ventilation that can be readily employed to measure pulmonary ventilation in different postures when awake and during sleep.

[0041] It is another object of the invention to provide noninvasive methods and associated systems for determining pulmonary ventilation that can be readily employed to accurately detect respiratory abnormalities.

[0042] It is yet another object of the invention to provide noninvasive methods and associated systems for determining pulmonary ventilation that can be readily employed to accurately detect respiratory events, such as apneas and hypopneas, during sleep.

SUMMARY OF THE INVENTION



[0043] The present invention is defined in claims 1 and 10. In accordance with the above objects and those that will be mentioned and will become apparent below, the noninvasive method for measuring pulmonary ventilation, i.e. determining the tidal volume (VT), of a subject, in accordance with one embodiment-of the invention, generally comprises the steps of:
  1. (i) determining a first anatomical characteristic representing a first linear displacement of the subject's rib cage in a first orientation,
  2. (ii) determining a second anatomical characteristic representing a first linear displacement of the subject's abdomen in the first orientation,
  3. (iii) determining a third anatomical characteristic representing a first axial displacement of the subject's chest wall in the first orientation,
  4. (iv) determining a first rib cage volume-motion coefficient representing the first orientation of the subject,
  5. (v) determining a first abdomen volume-motion coefficient representing the first orientation of the subject,
  6. (vi) determining a first chest wall volume-motion coefficient representing the first orientation of the subject,
  7. (vii) providing a first mathematical relationship that is adapted to determine VT of the subject as a function of the first, second and third anatomical characteristics, the first rib cage volume-motion coefficient, first abdomen volume-motion coefficient and first chest wall volume-motion coefficient, and
  8. (viii) determining VT of the subject with the first mathematical relationship and the first, second and third anatomical characteristics, and the first abdomen volume-motion coefficient, first abdomen volume-motion coefficient and first chest wall volume-motion coefficient, whereby the determined VT represents the subject's VT at the first orientation.


[0044] In one embodiment, the first orientation comprises an upright position.

[0045] In one embodiment, the first mathematical relationship comprises the following equation

wherein VT represents tidal volume, ΔRC represents the first anatomical characteristic, ΔAb represents the second anatomical characteristic, ΔXi represents the third anatomical characteristic, Bu represents the value of the abdominal volume-motion coefficient (B) in the upright position, α represents the first rib cage volume-motion coefficient, (Bu + εXi) represents the abdominal volume-motion coefficient, ε represents the linear slope of the relationship of B as a function of Xi, and γ represents the first chest wall volume-motion coefficient.

[0046] In one embodiment, the first mathematical relationship comprises the following equation

wherein VT represents tidal volume, ΔRC represents the first anatomical characteristic, ΔAb represents the second anatomical characteristic, ΔXi represents the third anatomical characteristic, α represents the first rib cage volume-motion coefficient, β represents the first abdominal volume-motion coefficient, and γ represents the first chest wall volume-motion coefficient.

[0047] In accordance with another embodiment of the invention, there is provided a method for monitoring respiration of a subject, comprising the steps of:
  1. (i) determining a plurality of rib cage volume-motion coefficients representing a plurality of orientations and motions of the subject,
  2. (ii) determining a plurality of abdomen volume-motion coefficients representing the plurality of orientations and motions of the subject,
  3. (iii) determining a plurality of chest wall volume-motion coefficients representing the plurality of orientations and motions of the subject,
  4. (iv) compiling a plurality of volume-motion coefficient data sets, the plurality of volume-motion data sets including a first plurality of volume-motion coefficient data sets representing the plurality of orientations of the subject and a second plurality of volume-motion coefficient data sets representing the plurality of motions of the subject, each of the first plurality of volume-motion coefficient data sets comprising a respective one of the rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of the plurality of orientations, each of the second plurality of volume-motion coefficient data sets comprising a respective one of the rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of the plurality of motions,
  5. (v) providing a first mathematical relationship that is adapted to determine the tidal volume (VT) of the subject as a function of a first anatomical characteristic representing a first linear displacement of the subject's rib cage, a second anatomical characteristic representing a first linear displacement of the subject's abdomen, a third anatomical characteristic representing a first axial displacement of the subject's chest wall, and a respective one of the plurality of the volume-motion coefficient data sets,
  6. (vi) substantially continuously determining the first, second and third anatomical characteristics over a first period of time,
  7. (vii) monitoring the orientation of the subject,
  8. (viii) determining when the subject is in a selective one of the plurality of orientations, and
  9. (ix) substantially continuously determining VT of the subject over the first period of time with the first mathematical relationship and employing the first, second and third anatomical characteristics determined when the subject is in the respective one of the orientations, and the volume-motion coefficient data set of the first plurality of volume-motion coefficient data sets that represents the selective one of the orientations.


[0048] In one embodiment, the method includes the steps of monitoring the motion of the subject, determining when the subject is exhibiting a selective one of the plurality of motions, determining VT of the subject with the first mathematical relationship and employing the first, second and third anatomical characteristics determined when the subject is in the respective one of the motions, and the volume-motion coefficient data set of the second plurality of volume-motion coefficient data sets that represents the selective one of the motions.

[0049] In accordance with another embodiment of the invention, there is provided a pulmonary ventilation system for monitoring respiration of a subject, comprising:
  1. (i) means for substantially continuously determining a first anatomical characteristic representing a first linear displacement of the subject's rib cage in a first orientation,
  2. (ii) means for substantially continuously determining a second anatomical characteristic representing a first linear displacement of the subject's abdomen in the first orientation,
  3. (iii) means for substantially continuously determining a third anatomical characteristic representing a first axial displacement of the subject's chest wall,
  4. (iv) storage means adapted to store a first empirical relationship adapted to determine at least one rib cage volume-motion coefficient, abdomen volume-motion coefficient and chest wall volume-motion coefficient, and a second empirical relationship adapted to determine a ventilation characteristic as a function of the first, second and third anatomical characteristics and the rib cage, abdomen and chest wall volume-motion coefficients, and
  5. (v) processing means for determining the ventilation parameter with the second empirical relationship.


[0050] In one embodiment of the invention, the system includes means for acquiring at least one base-line ventilation characteristic, and a third empirical relationship adapted to correlate the acquired base-line ventilation characteristic to a ventilation parameter determined with the second empirical relationship.

[0051] In one embodiment, the first empirical relationship is adapted to determine a plurality of the rib cage, abdomen and chest wall volume-motion coefficients, the plurality of rib cage, abdomen and chest wall volume-motion coefficients representing a plurality of body orientations and motions.

[0052] In one embodiment, the storage means includes a plurality of volume-motion coefficient data sets, the plurality of volume-motion data sets including a first plurality of volume-motion coefficient data sets representing the plurality of orientations and a second plurality of volume-motion coefficient data sets representing the plurality of motions, each of the first plurality of volume-motion coefficient data sets comprising a respective one of the rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of the plurality of orientations, each of the second plurality of volume-motion coefficient data sets comprising a respective one of the rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of the plurality of motions.

[0053] In one embodiment, the system includes means for detecting when the subject is in one of the plurality of orientations or exhibiting one of the motions.

[0054] In one embodiment of the invention, the third empirical relationship is adapted to apply a selective one of the first and second plurality of volume-motion coefficient data sets representing one of the plurality of orientations or motions that corresponds to a detected subject orientation or motion to the first empirical relationship, whereby the processing means determines a first ventilation parameter associated with the detected subject orientation or motion.

BRIEF DESCRIPTION OF THE DRAWINGS



[0055] Further features and advantages will become apparent from the following and more particular description of the preferred embodiments of the invention, as illustrated in the accompanying drawings, and in which like referenced characters generally refer to the same parts or elements throughout the views, and in which:

FIGURE 1 is a graphic illustration of isovolume lines over a range of spinal flexion and extension or pelvic rotation;

FIGURE 2 are comparisons of spirometric volume and volume estimates for five subjects that were estimated using one, two and three degrees of freedom models;

FIGURE 3 is a schematic illustration of one embodiment of a pulmonary ventilation system of the invention;

FIGURE 4 is a schematic illustration of one embodiment of the pulmonary ventilation system data acquisition circuitry, according to the invention;

FIGURE 5A is a side view of a subject, showing the positioning of the data acquisition circuitry shown in FIGURE 4, according to one embodiment of the invention;

FIGURE 5B is a schematic illustration of the geometric configurations defined by the points of attachment of transmission and receive coils, according to one embodiment of the invention;

FIGURE 6 is a further schematic illustration of the data acquisition circuitry shown in FIGURE 4, according to the invention;

FIGURE 7 is a schematic illustration of another embodiment of a pulmonary ventilation system, according to the invention;

FIGURE 8A is a graphical illustration of magnetometer derived volume vs. spirometer derived volume for non-obese subjects in three different sleep positions, i.e. supine, right and left lateral decubitus positions, according to the invention;

FIGURE 8B is a graphical illustration of magnetometer derived inspiratory time vs. spirometer derived inspiratory time for non-obese subjects in supine, right and left lateral decubitus positions, according to the invention;

FIGURE 8C is a graphical illustration of magnetometer derived expiratory time vs. spirometer derived expiratory time for non-obese subjects in supine, right and left lateral decubitus positions, according to the invention;

FIGURE 9A is a graphical illustration of magnetometer derived volume vs. spirometer derived volume for awake obese subjects in supine, right and left lateral decubitus positions, according to the invention;

FIGURE 9B is a graphical illustration of magnetometer derived inspiratory time vs. spirometer derived inspiratory time for awake obese subjects in supine, right and left lateral decubitus positions, according to the invention;

FIGURE 9C is a graphical illustration of magnetometer derived expiratory time vs. spirometer derived expiratory time for awake obese subjects in supine, right and left lateral decubitus positions, according to the invention;

FIGURE 10A is a graphical illustration of magnetometer derived volume vs. pneumotachograph derived volume for obese subjects in supine, right and left lateral decubitus positions during a day-time nap, according to the invention;

FIGURE 10B is a graphical illustration of magnetometer derived inspiratory time vs. pneumotachograph derived inspiratory time for obese subjects in supine, right and left lateral decubitus positions during a day-time nap, according to the invention;

FIGURE 10C is a graphical illustration of magnetometer derived expiratory time vs. pneumotachograph derived expiratory time for obese subjects in supine, right and left lateral decubitus positions during a day-time nap, according to the invention;

FIGURE 11A is a graphical illustration of magnetometer and spirometer derived volumes vs. mean magnetometer and spirometer derived volumes for awake non-obese subjects, according to the invention;

FIGURE 11B is a graphical illustration of magnetometer and spirometer derived volumes vs. mean magnetometer and spirometer derived volumes for awake obese subjects, according to the invention;

FIGURE 12 is a graphical illustration of magnetometer and spirometer derived volumes vs. mean magnetometer and spirometer derived volumes for obese subjects during day-time sleep, according to the invention;

FIGURES 13 -16 are exemplar recordings of magnetometer signals and associated derived tidal volumes for a subject;

FIGURE 17 is a graphical illustration of apnea and hypopnea indices for a plurality of monitored subjects, according to the invention;

FIGURE 18 is a graphical illustration of apnea indices for a plurality of monitored subjects, according to the invention; and

FIGURE 19 is a graphical illustration of hypopnea indices for a plurality of monitored subjects, according to the invention.


DETAILED DESCRIPTION OF THE INVENTION



[0056] Before describing the present invention in detail, it is to be understood that this invention is not limited to particularly exemplified methods, systems or circuits, as such may, of course, vary. Thus, although a number of methods and systems similar or equivalent to those described herein can be used in the practice of the present invention, the preferred materials and methods are described herein.

[0057] It is also to be understood that the terminology used herein is for the purpose of describing particular embodiments of the invention only and is not intended to be limiting.

[0058] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one having ordinary skill in the art to which the invention pertains.

[0059] Finally, as used in this specification and the appended claims, the singular forms "a, "an" and "the" include plural referents unless the content clearly dictates otherwise. Thus, for example, reference to "an apnea event" includes two or more such events; reference to "a ventilation signal" includes two or more such signals and the like.

Definitions



[0060] The terms "ventilation parameter" and "ventilation characteristic", as used herein, mean and include, a characteristic associated with the respiratory system and functioning thereof, including, without limitation, total pulmonary ventilation, inspiration volume (VI), expiration volume (VE), breathing frequency, inspiratory breathing time and expiratory breathing time.

[0061] The term "apnea", as used herein, means and includes the temporary cessation of respiration or a reduction in the respiration rate.

[0062] The term "hypopnea", as used herein, means and includes abnormally shallow breathing or a slow respiratory rate.

[0063] The terms "respiratory system disorder", "respiratory disorder" and "adverse respiratory event", as used herein, mean and include any dysfunction of the respiratory system that impedes the normal respiration or ventilation process, including, without limitation, an apnea and/or hypopnea.

[0064] The terms "patient" and "subject", as used herein, mean and include humans and animals.

[0065] As will be appreciated by one having ordinary skill in the art, the present invention is directed to noninvasive methods and associated systems for determining pulmonary ventilation that substantially reduce or eliminate the drawbacks and disadvantages associated with conventional methods and systems for determining pulmonary ventilation. As discussed in detail herein, one major advantage of the present invention is that the noninvasive methods and associated systems for determining pulmonary ventilation substantially reduce the accuracy errors associated with conventional two-degrees and three-degrees of freedom tidal volume models.

[0066] A further major advantage of the present invention is that the noninvasive methods and associated systems for determining pulmonary ventilation can be readily employed to monitor breathing in different positions while awake and during sleep, and accurately detect respiratory events, such sleep apnea and hypopnea, during sleep.

[0067] As is known in the art, sleep apnea is generally defined as a temporary cessation of respiration during sleep. Obstructive sleep apnea is the recurrent occlusion of the upper airways of the respiratory system during sleep. Central sleep apnea occurs when the brain fails to send the appropriate signals to the breathing muscles to initiate respirations during sleep. Those afflicted with sleep apnea experience sleep fragmentation and complete cessation of respiration (or ventilation) during sleep with potentially severe degrees of oxyhemoglobin desaturation.

[0068] Sleep hypopnea is generally defined as abnormally shallow breathing or a slow respiratory rate. Hypopnea differs from apnea in that there remains some air flow.

[0069] Monitoring breathing during sleep is the cornerstone to the diagnosis and management of various sleep disorders. The respiratory inductive plythysmograph (RIP) is the most widely used technology in the diagnosis of sleep disorders. As indicated, RIP uses a "two-degrees-of-freedom" model to derive tidal volume (VT) from changes in the circumference (i.e. cross-sectional area) of the rib cage and abdomen.

[0070] There is, however, a poor correlation between VT measured by a pneumotachograph and that measured by RIP during sleep. The inaccuracies in the RIP derived VT have been attributed to slippage of the rip belts; a factor that would alter RIP calibration, and to changes in posture during sleep. See, e.g., Whyte, et al., "Accuracy of Respiratory Inductive Plythysmograph in Measuring Tidal Volume During Sleep ", J. Appl. Physiol., vol. 71, pp. 1866-1871 (1991).

[0071] Further, as a subject bends forward, the abdomen contents displace the diaphragm cephalad and this, in turn, expands the rib cage. It has been found that the overestimation of volume due to this "displacement error' can be as great as 40-50% of the vital capacity. See Paek, et al., "Postural Effects on Measurements of Tidal Volume From Body Surface Displacements", J. Appl. Physiol., vol. 68, pp. 2482-2487 (1990). Similar inaccuracies with RIP have been noted during sleep in asthmatic subjects with nocturnal bronchospasm and paradoxical chest wall motion. See Ballard, et al., "Estimates of Ventilation from Inductive Plythysmography in Sleeping Asthmatic Patients", Chest, vol. 89, pp. 840-845 (1986).

[0072] As discussed in detail above, the accuracy of "two-degrees-of-freedom" model is also limited by virtue of changes in spinal flexion that can accompany changes in posture. Indeed, it has been found that VT can be over or under-estimated by as much as 50% of the vital capacity with spinal flexion and extension.

[0073] It has, however, been found that the addition of a measure of the axial motion of the chest wall, e.g., Δ distance between the xiphoid and the pubic symphysis (Xi), provides a third degree of freedom, which, when employed to determine VT can reduce the error associated with the "two-degrees-of-freedom" model.

[0074] Although a "three-degrees-of-freedom" model can reduce the error associated with the "two-degrees-of-freedom" model, the "three-degrees-of-freedom" model is still limited in accuracy to about 15% of actual ventilation in individuals who are doing freely moving postural tasks, such as bending, lifting, sitting or standing, due to spinal flexion.

[0075] As indicated above, the most pronounced effect of spinal flexion is on the abdominal volume-motion coefficient (β). With bending, β decreases as the xiphi-umbilical distance decreases.

[0076] Eq. 3 has accordingly been modified as follows to incorporate the noted dependency:

where:

ΔRC represents the linear displacement of the rib cage;

ΔAb represents the linear displacement of the abdomen;

ΔXi represents the change in the xiphi-umbilical distance from an upright position;

α represents a rib cage volume-motion coefficient;

β represents an abdominal volume-motion coefficient;

βu represents the value of the abdominal volume-motion coefficient (β) in the upright position;

ε represents the linear slope of the relationship of β as a function of the xiphi-umbilical distance Xi;

(Bu + εXi) represents the corrected abdominal volume-motion coefficient; and γ represents a xiphi-umbilical volume-motion coefficient.



[0077] Equation 4 represents a "three-degrees-of-freedom" model, which now reflects the dependence of β on the xiphi-umbilical distance.

[0078] According to the invention, tidal volume (VT) can also be determined as a function of changes in the anteroposterior dimensions of the rib cage and abdomen, as well as the axial displacement of the chest wall, i.e.

where:

ΔRC represents the linear displacement of the rib cage;

ΔAb represents the linear displacement of the abdomen;

ΔXi represents axial displacement of the chest wall;

α represents a rib cage volume-motion coefficient;

β represents an abdominal volume-motion coefficient; and

γ represents a chest wall volume-motion coefficient.



[0079] According to the invention, the axial displacement of the chest wall can be determined from various reference points. This is facilitated by the unique multi-functionality of selective coils of the invention and placement thereof (discuss in detail below).

[0080] Thus, in one embodiment of the invention, the xiphi-umbilical distance is measured to determine ΔXi. γ would thus represent a xiphi-umbilical volume motion coefficient.

[0081] In a preferred embodiment of the invention, the sternal-umbilical distance is measured to determine ΔXi. y would thus represent a sternal-umbilical volume motion coefficient.

[0082] In one embodiment of the invention, the values of volume-motion coefficients α, β and γ are determined for three positions or orientations, i.e. supine, right and left lateral decubitus positions, by multiple linear regressions, as set forth in Stagg, et al., "Computer-aided Measurement of Breath Volume and Time Components Using Magnetometers", J. Appl. Physiol., vol. 44, pp. 623-633 (1978); VT is then calculated after applying the noted volume-motion coefficients to the signals obtained in the same body position.

[0083] In one embodiment of the invention, the values of coefficients α, β and γ are determined during a plurality of motions or activities by multiple linear regressions.

[0084] The term "volume-motion coefficient", as used herein, thus means both coefficients representing body positions or orientations and motions of a subject.

[0085] As will readily be appreciated by one having ordinary skill in the art, the "three-degrees-of-freedom" models of the invention substantially reduce VT measurement errors associated with conventional two-degrees and three-degrees of freedom models resulting from changes in posture. Indeed, as set forth below, VT, inspiration volume (VI) and expiration volume (VE) can be accurately measured in various postures while awake and during sleep using the "three-degrees-of-freedom" models of the invention.

[0086] As discussed in detail below, the "three-degrees-of-freedom" models of the invention can also be readily employed to detect adverse respiration or ventilation events, such as apneas or hypopneas.

[0087] Several embodiments of pulmonary ventilation systems of the invention will now be described in detail. It is, however, understood that the invention is not limited to the system embodiments described herein. Indeed, as will be appreciated by one having ordinary skill in the art, systems and associated circuits similar or equivalent to the described systems can also be employed within the scope of the present invention.

[0088] In general, the ventilation systems of the invention include means for storing an empirical relationship that is designed and adapted to determine at least one ventilation parameter as a function of a plurality of anatomical measurements and volume-motion coefficients, means for acquiring the anatomical measurements, means for determining the plurality of motion coefficients, and processing means for determining the ventilation parameter based on the acquired anatomical measurements and determined plurality of volume-motion coefficients. In a preferred embodiment, the ventilation system further includes means for acquiring base-line ventilation characteristics and means for correlating the base-line ventilation characteristics to the ventilation parameter determined with the empirical relationship.

[0089] The ventilation systems of the invention are also preferably implemented in a compact, light-weight configuration that can be easily attached to or carried by, e.g. carrier vest, an individual being monitored.

[0090] Referring now to Fig. 3, there is shown one embodiment of a pulmonary ventilation system 20A of the invention. As illustrated in Fig. 3, the system 20A preferably includes data acquisition circuitry 21and data processing circuitry 22.

[0091] The system 20A also includes a power source 50, such as a battery. In one embodiment of the invention, the system 20A is operable on 100 mA current from a +/- 8.0V to +/- 12.-V power source 50.

[0092] According to the invention, the data acquisition circuitry 21 includes data acquisition means, i.e. means for measuring (or sensing) changes in the anteroposterior diameters of the rib cage and abdomen, and axial displacement of the chest wall. In one embodiment of the invention, which is illustrated in Fig. 4 and discussed in detail below, the data acquisition means comprises paired electromagnetic coils (or magnetometers) 60-63.

[0093] It is, however, understood that the invention is not limited to the use of electromagnetic coils to measure changes in the anteroposterior diameters of the rib cage and abdomen, and axial displacement of the chest wall. Indeed, various additional means and devices that can be readily adapted to measure the noted anatomical parameters can be employed within the scope of the invention. Such means and devices include, without limitation, Hall effect sensors and electronic compass sensors.

[0094] Referring back to Fig. 3, in the illustrated embodiment, the data processing circuitry 22 includes data input interface circuitry 24, which is adapted to receive data from the data acquisition circuitry 21. According to the invention, the data input interface circuitry 24 facilitates data communication by and between the data acquisition circuitry 21 and the data processing circuitry 22.

[0095] In the illustrated embodiment, the data input circuitry 24 is in communication with (i.e. operatively connected to) system buses 23, 26, and transmits (or directs) signals thereto. The central processing unit (CPU) 28 is also preferably operatively connected to buses 23, 26.

[0096] As further illustrated in Fig. 3, bus 26 is in communication with memory means (or medium) 30, which includes at least one, more preferably, a plurality of executable programs. In one embodiment of the invention, the programs include a calibration program (or routine) 32, a signal processing or element analysis program 36, a ventilation parameter program 38, and an output program 40.

[0097] According to the invention, the central processing unit 28 executes selective programs stored in the memory means 30. The data provided by the programs, e.g. accumulated pulmonary ventilation data 42, and derived volume-motion coefficients are also preferably stored in the memory means 40.

[0098] In some embodiments of the invention, the calibration program 32 comprises a routine for determining volume-motion coefficients in selective body positions and/or motions and calibrating the data acquisition circuitry 21. In a preferred embodiment, calibration of the data acquisition circuitry 21 is performed in a single step.

[0099] In some embodiments of the invention, the calibration program 32 is also adapted to "automatically" select derived volume-motion coefficients, i.e. a volume-motion coefficient data set, reflecting a specific body position (or posture) or activity to calibrate the data acquisition circuitry 21 when a subject or patient is in the noted body position or performing the activity.

[0100] The element analysis program 36 is designed and adapted to perform element analyses on acquired signals (representing acquired data) to reduce any extraneous noise in the signals. In one embodiment of the invention, the element analyses include at least one Fourier analysis. The Fourier analysis, when combined with band pass filtering in the software, facilitates use of the system 20A in ambulatory activities.

[0101] In a preferred embodiment, the ventilation parameter program 38 employs at least one of the "three-degrees-of-freedom" models of the invention to determine at least one ventilation parameter, e.g., total pulmonary ventilation.

[0102] The output program 40 is designed and adapted to facilitate the visual display of acquired data, which can be displayed on an output device 46, e.g. a liquid crystal display, or, as discussed below, an external output device. As illustrated in Fig. 3, in the noted embodiment, the output device 46 is in communication and, hence, interacts with the CPU 28 through data output interface circuitry 44.

[0103] According to the invention, the data output interface circuitry 44 can be adapted to interact with external output devices, such as a personal computer, a printer, a monitor and the like. Communication by and between the data output interface circuitry 44 and external device(s) can be achieved via wired connections therebetween and/or wireless transmission.

[0104] As illustrated in Fig. 3, the memory means 30 preferably includes at least one, preferably, a plurality of digital band pass filters 34. According to the invention, the digital band pass filters 34 are designed and employed to eliminate extraneous noise or artifacts resulting from soft tissue motion.

[0105] Referring now to Fig. 4, there is shown one embodiment of the data acquisition circuitry 21 of the invention. As illustrated in Fig. 4, the data acquisition circuitry 21 preferably includes a first transmission coil 60, a second transmission coil 62, a first receive coil 61 and a second receive coil 63.

[0106] In a preferred embodiment of the invention, at least one of the two receive coils 61, 63 is adapted to receive transmissions (or electromagnetic fields) from each of the transmission coils 60, 62, i.e. a dual function coil.

[0107] Accordingly, in one embodiment of the invention, the first transmission coil 60 comprises a first frequency (e.g., 8.97 kHz) transmitter coil, the second transmission coil 62 comprises a second frequency (e.g., 7 kHz) transmitter coil, the first receive coil 61 comprises a first frequency receive coil, and the second receive coil 63 comprises a first/second frequency (7/8.97 kHz based on the noted first and second frequency examples) receive coil.

[0108] As will be appreciated by one having ordinary skill in the art, the dual functionality of the second receive coil 63 reduces the number of receive coils, thereby reducing the number of attachments to a patient simplifying system design, and reducing power requirements.

[0109] In some embodiments of the invention, each receive coil 61, 63 is adapted to receive transmissions from each of the transmission coils 60, 62. As discussed in detail below, the dual function of both receive coils 61, 63 enhances the accuracy of anatomical measurements determined from transmissions by and between the coils 60-63.

[0110] Referring now to Fig. 5A, there is shown the positioning of the coils 60-63 and data processing circuitry 22 on a subject or patient 51, in accordance with one embodiment of the invention. As illustrated in Fig. 5A, the first transmission coil 60 is positioned on the front of the subject 51 proximate the umbilicus of the subject 51 and the first receive coil 61 is preferably positioned at the same axial position, but on the back of the subject 51. The second receive coil 63 is positioned on the front of the subject 51 proximate the base of the sternum of the subject 51 and the second transmission coil 62 is located at the same axial position, but on the back of the subject 51.

[0111] In the illustrated embodiment, the data processing circuitry 22 is attached to the subject 51 via a belt 52.

[0112] According to the invention, the positions of the transmission coils 60, 62 and receive coils 61, 63 can be reversed, i.e. transmission coil 60 and receive coil 63 placed on the back of the subject 51 and transmission coil 62 and receive coil 61 placed on the front of the subject.

[0113] As discussed in detail below, both transmission coils 60, 62 can also be placed on the front or back of the subject and the receive coils 61, 63 can be placed on the opposite side.

[0114] As stated, in one embodiment of the invention, the second receive coil 63 is adapted to receive the electromagnetic fields transmitted from both the first and second transmission coils 60, 62, reducing the number of coils required to determine VT (using a "three-degrees-of-freedom" model of the invention) from six to four. This simplifies the instrumentation attached to a subject, and reduces the power requirements of the system 20A.

[0115] According to the invention, the coils 60-63 can be attached to the subject by various suitable means. In one embodiment of the invention, the coils 60-63 are attached to the subject 51 via medical tape.

[0116] Referring back to Fig. 5A, arrow 64 represents the Xi or, in this instance, the xiphi-umbilical distance. Arrow 65 represents the rib cage-anteroposterior (RC-AP) distance, while arrow 66 represents the abdomen-anteroposterior (Ab-AP) distance.

[0117] Fig. 5 thus illustrates the three degrees of freedom or motion (RC-AP, Ab-AP, and Xi) that are measured in accordance with the invention. According to the invention, as the subject or patient breathes, the change in distance between each pair of coils 60, 61 and 62, 63 (denoted by arrows "65" and "66") is determined from measured changes in voltage representing changes in the electromagnetic fields between the paired coils 60, 61 and 62, 63.

[0118] The axial displacement of the chest wall (denoted by arrow "64"), e.g., xiphi-umbilical distance (Xi), is also measured as the subject breathes. In one embodiment of the invention, wherein coil 63 comprises a dual function coil, the axial displacement of the chest wall is directly determined from measured changes in voltage representing changes in the electromagnetic field between transmission coil 60 and receive coil 63.

[0119] In one embodiment of the invention, wherein receive coils 61 and 63 comprise dual function coils, the axial displacement of the chest wall is similarly determined from measured changes in voltage representing changes in the electromagnetic field between transmission coil 60 and receive coil 63. However, in this instance, the measured changes in voltage representing changes in the electromagnetic field between transmission coil 62 and receive coil 61 and, hence, the distance between the points of attachment of coils 62 and 61 (denoted length "67"), can be correlated with the measured changes in voltage representing changes in the electromagnetic field between transmission coil 60 and receive coil 63.

[0120] In one embodiment of the invention, receive coils 61 and 63 similarly comprise dual function coils. However, in this embodiment, both receive coils 61, 63 are placed on the same side of the subject's body and the transmission coils 60, 62 are placed on the opposite side of the subject's body.

[0121] By virtue of the placement of coils 60-63 and the dual function of receive coils 61, 63, various known empirical (e.g., trigonometric) relationships can be employed to determine the axial displacement of the chest wall based on the geometrical configurations defined by the points of attachment of the coils 60-63, and measured lengths therebetween (see Fig. 5B). By way of example, if the triangle defined by coils 60, 61 and 63, i.e. attachment points thereof, is deemed a right triangle, and the distances of lengths "66" and "69" equal x and y, respectively, the change in distance of length "64", i.e. chest wall displacement (ΔXi) can be determined as follows:

where:

Xi represents the original axial chest wall distance, as measured between two selective positions, e.g., xiphi-umbilical distance;

L69 represents the length denoted "69"; and

L66 represents the length denoted "66".



[0122] If L69 and L66, and angle ϕ are known, the law of cosines can be employed to determine the length "64" and changes thereof, i.e. chest wall displacement (ΔXi).

[0123] As will also be readily appreciated by one having ordinary skill in the art, the use of two dual functionality receiver coils, e.g., receive coils 61, 63, and the placement thereof on one side of the subject facilitates simple and accurate determination of axial displacement of the chest wall, regardless of the axial placement of the receive coils 61, 63 (provided, the receive coils 61, 63 remain substantially axially aligned).

[0124] The use of two dual function receiver coils, e.g., receive coils 61, 63, and the placement thereof on one side of the subject also facilitates accurate determination of whether a measured displacement of the rib cage actually reflects true ventilation of a subject.

[0125] According to the invention (and discussed in detail below), the acquired data representing the noted measured distances is employed by the ventilation parameter program 38 of the invention to determine one or more ventilation parameters or characteristics.

[0126] Referring back to Fig 4, in the illustrated embodiment, a first transmission signal pre-processor 70 transmits a signal to the first transmission coil 60. Similarly, a second transmission signal processor 72 transmits a signal to the second transmission coil 62.

[0127] The received signals are then processed by three channels, including a first detection circuitry channel 80, a second detection circuitry channel 82, and a third detection circuitry channel 84. The output of the individual channels is preferably transmitted to the data input interface circuitry 24 for subsequent processing and storage by the CPU 28, in accordance with the executable programs stored in memory 30.

[0128] The data acquisition circuitry 21 also includes a flow meter 86, whose output is preferably processed by a low pass filter 88 before being transmitted to the data input interface circuitry 24. The data provided by the flow meter 86 is employed during the calibration step, as discussed below.

[0129] Referring now to Fig. 6, there is shown a more detailed view of selected' components of the data acquisition circuitry 21, in accordance with one embodiment of the invention. As illustrated in Fig. 6, the data acquisition circuitry 21 includes a first transmission signal pre-processor 70 having a first oscillator 94. In one embodiment, the first oscillator 94 is set to 8.97 kHz.

[0130] According to the invention, the oscillator signal is transmitted to a first transmission channel variable gain circuit 92, which allows an optimal gain value to be set. The gain adjusted signal is then transmitted to a differential signal driver 90, and is then transmitted to the first transmission coil 60.

[0131] As illustrated in Fig. 6, the output from the differential signal driver 90 is also transmitted to the first channel detection circuitry 80 and the second channel detection circuitry 82, as will be discussed further below.

[0132] The second transmission signal-processor 72 operates in a similar manner. According to the invention, the second oscillator 100 oscillates at a pre-determined frequency, e.g., 7 kHz. The oscillator signal is transmitted to a second transmission channel variable gain circuit 98, which is independently set for an optimal gain value. The gain adjusted signal is then transmitted to a differential signal driver 96, and is then transmitted to the second transmission coil 62. The output of the differential signal driver 96 is also transmitted to the third channel detection circuitry 84, as will be discussed further below.

[0133] In one embodiment, the measured voltage (and change thereto) representing changes in the electromagnetic field between the first transmission coil 60 and the first receive coil 61, i.e. first receive coil signal, is transmitted to the first received signal pre-processor 74. As illustrated in Fig. 6, the first signal pre-processor 74 can be implemented with an input stage 102, a first receive channel variable gain 104, and a band pass filter 106.

[0134] According to the invention, the variable gain 104 can be set through the data input interface circuitry 24 to optimize the signal-to-noise ratio. Preferably, the band pass filter 106 is set to reduce noise above and below 8.97 KHz.

[0135] The second received signal pre-processor 76 operates in a similar manner. However, as indicated above, the second receive coil 63 is preferably responsive to changes in two electromagnetic fields and adapted to transmit two coil signal representing same. The second received signal pre-processor 76 accordingly processes two signals.

[0136] As illustrated in Fig. 6, a single input stage 108 processes the two signals and transmits the output to two channels in communication with the input stage 108. Each channel includes a variable gain circuit 110/116 and a band pass filter 112/118.

[0137] According to the invention, the separate gain controls 92, 98, 104, 110, 116 are preferably optimized to increase the signal-to-noise ratio. The gain controls 92, 98 for the transmitted signal can also be optimized to minimize power requirements.

[0138] Since the gain for the transmitted signal can be changed independently of the gain of the receiver channel, the signal-to-noise ratio can be improved, while minimizing the magnetic field exposure at skin surface of the patient.

[0139] According to the invention, the band pass filters 106, 112, 118 are adapted to minimize interference from extraneous magnetic fields and noise sources. As illustrated in Fig. 6, the output from the first received signal preprocessor 74 is transmitted to the first channel detection circuitry 80. The circuitry 80 preferably includes a first detector 120, which is set to the frequency established by the first oscillator 94. The output of the first detector 120 is transmitted to a low pass filter 122 and an absolute value circuit 124. The signal is then transmitted to the data input interface circuitry 24 for processing by the CPU 28.

[0140] The second channel detection circuitry 82 operates in a similar manner. The second detector 128 is set to the frequency established by the first oscillator 94 and processes the signal from the second receive channel band pass filter 112. The second channel detection circuitry 82 includes a low pass filter 130 and an absolute value circuit 132 to produce a data signal that is also transmitted to the CPU 28 for processing, in accordance with the executable programs stored in memory 30.

[0141] The third channel detection circuitry 84 is set to the frequency established by the second oscillator 100 and processes the signal from the third receive channel band pass filter 118. The third receive channel detection circuitry 84 also includes a low pass filter 138 and an absolute value circuit 140.

[0142] Processing associated with the executable programs stored in memory 30 will now be described in detail.

[0143] According to the invention, the calibration program or routine 32 determines calibration coefficients, i.e. volume-motion coefficients, throughout a range of body positions and activities. Calibration coefficients are then derived for specific activities or body postures, i.e. sets of calibration coefficients. These different sets of calibration coefficients are then applied to selected regions of the acquired data set.

[0144] The calibration routine 32 thus allows the user to employ volume-motion coefficients from different segments of the data set (e.g., sitting, standing, walking, etc.). These coefficients can then be applied to the data set to construct spirograms of volume over time.

[0145] In some embodiments of the invention, the calibration program 32 is also adapted to "automatically" select derived volume-motion coefficients, i.e. a volume-motion coefficient data set, reflecting a specific body position (or posture) or activity when a subject or patient is in the noted body position or performing the activity. In the noted embodiments, the calibration program 32 would automatically select a volume-motion coefficient data set in response to a transmitted body posture-motion signal.

[0146] As will be appreciated by one having ordinary skill in the art, various sensors can be employed within the scope of the invention to sense and transmit the body posture-motion signal, e.g., 3-axis accelerometer. In one embodiment of the invention, the calibration program 32 is responsive to a signal reflecting the axial displacement of the chest wall, e.g., change in the sternal or xiphi-umbilical distance.

[0147] As discussed in detail in the Examples section, the calibration routine 32 facilitates the accurate determination of the volume of air inhaled and exhaled; the volume, i.e. VT, being determined from the sum of three signals (the changes in the axial dimensions of the anteroposterior diameter of the rib cage (RC) and abdomen (Ab) and the changes in the axial dimensions of the anterior chest wall).

[0148] In accordance with one embodiment of the invention, the calibration maneuver includes having a subject breath through a flow meter, e.g., flow meter 86, for 1-2 minutes at varied tidal volumes and body positions.

[0149] In some embodiments of the invention, the calibration program 32 is also used to adjust the variable gain elements 92, 98, 104, 110, and 116 for optimum signal levels.

[0150] As indicated above, in one embodiment, the element analysis program 36 is adapted to perform element analyses on acquired signals (representing acquired data) to reduce any extraneous noise in the signals. In one embodiment of the invention, the element analyses includes at least one Fourier analysis, which, combined with band pass filtering in the software, facilitates use of the system 20A in ambulatory activities.

[0151] In one embodiment of the invention, the ventilation parameter program 38 correlates the three-degrees-of-freedom" data with the flow meter data. The parameter program 38 then employs the data to create correlation parameters for determining ventilation parameters or characteristics, including end-expiratory, lung volume, breathing frequency, total pulmonary ventilation, inspiratory breathing time, expiratory breathing time, and total breathing time. These parameters can then be displayed on an integral visual output device or transmitted wirelessly to an external receiver and/or display device.

[0152] Referring now to Fig. 7, there is shown another embodiment of the pulmonary ventilation system 20B of the invention. As illustrated in Fig. 7, the system 20B is similar to system 20A. However, in this embodiment the power source 50 is external to the data processing circuitry 22. Further, the pulmonary ventilation system 20B includes a removable memory 160 (e.g., a flash memory card), which is employed to store the accumulated data 42. The accumulated data can then be transferred to a receiving station, such as a personal computer 162.

[0153] In the illustrated embodiment, the personal computer 162 includes a central processing unit 164 and a set of input/output devices 166, which communicate via bus 168. The system 20B also includes memory medium 170, which is in communication with bus 168. As illustrated in Fig. 7, the memory medium 162 includes the element analysis program, ventilation parameter program and digital band pass filters 34.

[0154] As will be readily appreciated by one having ordinary skill in the art, system 20B facilitates processing of the accumulated data 42 with a separate device.

EXAMPLES



[0155] The following examples are given to enable those skilled in the art to more clearly understand and practice the present invention. They should not be considered as limiting the scope of the invention, but merely as being illustrated as representative thereof.

Example 1


Subjects



[0156] Thirty (30) subjects were selected to assess the accuracy of the "three-degrees-of-freedom" model of the invention. As reflected in Table 1, ten (10) healthy subjects with no known history of sleep-disordered breathing and ten (10) obese subjects were studied while awake in the supine, right and left lateral decubitus positions. Ten (10) obese subjects with obstructive sleep apnea (obese sleeping subjects) were studied while unrestrained during a daytime nap.
Table 1
SubjectNon-Obese Awake Subjects (BMI)Obese Awake Subjects (BMI)Obese Subjects Daytime Nap (BMI)
1 20 52 51
2 30 45 61
3 27 61 49
4 28 49 40
5 27 59 34
6 29 40 38
7 23 34 51
8 27 38 39
9 21 50 56
10 25 39 38
Mean±SD 25.7±3.4 46.7±9.1 45.7±1.0
BMI: Body Mass Index


[0157] The non-obese, awake subjects comprised seven (7) males and three (3) females, age 28-49 yr. (mean age 30.2 yr). The obese, awake subjects comprised six (6) males and four (4) females, age 24-64 yr. (mean age 44.4 yr). The obese, napping subjects comprised five (5) males and five (5) females, age 28-60 yr. (mean age 42.2 yr).

Device and Measurements



[0158] The anteroposterior displacements of the rib cage and abdomen, as well as the axial displacements of the chest wall (i.e. Xi) were measured using a light-weight, portable pulmonary ventilation system of the invention (also referred to herein as a magnetometer system or device) using the "three-degrees-of-freedom" model set forth in Eq. 5 above. Signals were sampled at 20 Hz and stored to compact flash memory.

[0159] Calibration was performed with subjects in the supine, right lateral and left lateral decubitus positions, as set forth in Paek, et al., "Postural Effects on Measurements of Tidal Volume From Body Surface Displacements", J. Appl. Physiol., vol. 68, pp. 2482-2487 (1990).

Protocol



[0160] The non-obese and obese awake subjects were studied while in the supine, right lateral and left lateral decubitus positions (hereinafter "test positions"). After calibration, each subject breathed through a mouthpiece connected to a spirometer (PK Morgan Ltd®.). Subjects were instructed to take breaths ranging from 0.5 to 2.5 L. At least 15 breaths (average 25.6 breaths) of varied volumes were obtained from each subject in each position. Data was simultaneously collected using a ventilation or magnetometer system of the invention, such as system 20B described above.

[0161] The daytime nap studies were done using a tight-fitting facemask equipped with a pneumotachograph applied to cover the nose and mouth. Subjects were observed while sleeping in a quiet room. Each subject was monitored continuously and changes in position were recorded. Data was collected simultaneously using the magnetometer system.

Statistical Analysis



[0162] The coefficient of determination (R2) was calculated for VT, TI, and TE derived from the simultaneous spirometer or pneumotachograph and magnetometer signals using a linear correlation model. This analysis was performed for individual subjects in each position and for pooled data from all subjects in all positions. The mean percent differences (% difference) between the spirometer or pneumotachograph and magnetometer derived measurements (VT, TI and TE) were also calculated.

[0163] Both absolute and mathematical differences were calculated and used to assess correlation and agreement (see below). TI and TE correlations were calculated for the daytime nap studies using 65 randomly selected breaths from each study.

[0164] The methods set forth in Bland, et al., "Statistical Methods for Assessing Agreement Between the Two Methods of Clinical Measurement ", Lancet, vol. 1, pp. 307-310 (1986), were used to assess the agreement between measurements obtained from the spirometer and magnetometer or pneumotachograph and magnetometer.

Results



[0165] As discussed in detail below, there were significant correlations between the spirometer and magnetometer measurements of VT, TI, and TE during wakefulness for the non-obese and obese subjects. For the non-obese awake subjects (n=10), the R2 values for VT, TI, and TE for each subject in each of the test positions were determined (see Tables 2 and 3A and 3B below):
Table 2
Non-Obese Awake SubjectsObese Awake Subjects
SubjectMean % Diff' ± SDR2SubjectMean % Diff ± SDR2
1 12.2±12% 0.94 11 8.7±7% 0.96
2 8,1±8% 0.97 12 9.7±7% 0.94
3 7.5±6% 0.97 13 6.6±3% 0.98
4 10.2±9% 0.95 14 13.8±7% 0.84
5 11.8±9% 0.90 15 12.3±9% 0.91
6 7.6±7% 0.98 16 7.0±4% 0.98
7 13.5±9% 0.90 17 8.8±6% 0.92
8 12.1±8% 0.97 18 6.4±4% 0.97
9 13.8±9% 0.87 19 7.3±6% 0.94
10 10.5±6% 0.92 20 10.5±11% 0.92
Mean±SD 10.6±9% 0.94 Mean±SD 9.0±7% 0.95
Absolute differences
Table 3A
Non-Obese Awake Subjects
SubjectTITE
Mean % Diff˙ ± SDR2Mean % Diff˙ ± SDR2
1 11.4±11% 0.86 8.5±9% 0.87
2 9.3+9% 0.72 8.0±7% 0.83
3 8.1±4% 0.89 9.2±4% 0.91
4 10.5±8% 0.61 10.6±8% 0.78
5 5.7±5% 0.96 7.4±6% 0.89
6 9.6±9% 0.84 7.3±6% 0.92
7 12.7±9% 0.89 8.5±5% 0.97
8 15.0±14% 0.83 9.0±7% 0.95
9 6.5±7% 0.87 7.6±7% 0.88
10 10.8±8% 0.88 9.7±8% 0.87
Mean±SD 9.7±9% 0.88 8.6±8% 0.91
Table 3B
Obese Awake Subjects
SubjectTITE
 Mean % Diff˙ ± SDR2Mean % Diff˙ ± SDR2
11 9.5±9% 0.88 6.3±6% 0.93
12 8.5±8% 0.77 7.5±6% 0.90
13 7.2±6% 0.87 7.4±7% 0.90
14 3.5±3% 0.91 3.6±3% 0.96
15 8.4±7% 0.87 7.7±6% 0.83
16 5.4±5% 0.91 5.4±5% 0.95
17 6.4±5% 0.80 5.7±6% 0.89
18 8.3±7% 0.94 5.0±5% 0.97
19 8.1+6% 0.92 7.5+6% 0.97
20 5.9±4% 0.91 4.8±3% 0.95
Mean±SD 7.5±7% 0.96 6.4±6% 0.97
˙Absolute differences


[0166] For pooled data of all subjects in all test positions, a total of 645 breaths were analyzed. The R2 values for VT, TI and TE were 0.94, 0.88, and 0.91, respectively (see Figs. 8A, 8B, and 8C).

[0167] The absolute mean % differences for VT, TI and TE for each subject in each of the test positions are also shown in Tables 2, 3A and 3B. As reflected in Tables 2, 3A and 3B, the absolute mean % differences for VT, TI and TE from pooled data were 10.6±9%, 9.7±9%, and 8.6±8% (means±SD), respectively.

[0168] For the obese awake subjects (n=10), similar results were obtained. The R2 values for VT, TI and TE were similarly determined and are set forth in Tables 2 and 3.

[0169] For pooled data of all subjects in all positions, a total of 892 breaths were analyzed. The R2 values for VT, TI, and TE were 0.95, 0.96, and 0.97, respectively (see Figs. 9A, 9B, and 9C).

[0170] The absolute mean % differences for VT, TI and TE for each subject in each of the test positions are similarly shown in Tables 2 and 3. As also reflected in Tables 2, 3A and 3B, absolute mean % differences for VT, TI and TE from pooled data were 9.0±7%, 7.5±7%, and 6.4±6% (mean ±SD), respectively.

[0171] There were also significant correlations between the pneumotachograph and the magnetometer measurements during daytime sleep for the obese subjects. The R2 values for VT, TI and TE for each of the obese sleeping subjects were determined and are set forth in Table 4 below.
Table 4
Obese Subjects During Daytime Nap
 VTTITE
SubjectMean % Diff' % SDR2Mean % Diff˙ % SDR2Mean % Diff˙ % SDR2
21 9.1±8% 0.93 13.5±7% 0.88 7.6±4% 0.94
22 6.2±5% 0.92 11.2±14% 0.89 10.3±7% 0.90
23 5.7±5% 0.80 7.1±7% 0.92 5.2±4% 0.84
24 15.8±12% 0.87 7.1±5% 0.95 5.3±4% 0.98
25 8.9±7% 0.91 6.4±5% 0.95 6.5±5% 0.90
26 7.6±6% 0.96 7.2±6% 0.96 5.8±5% 0.97
27 13.9±11% 0.81 9.9±6% 0.94 6.8±5% 0.97
28 5.6±4% 0.89 9.6±7% 0.94 6.4±4% 0.95
29 12.2±9% 0.93 8.9±6% 0.87 7.4±5% 0.95
30 10.8±10% 0.73 8.5±6% 0.89 5.1±4% 0.90
Mean±SD 9.1±8% 0.94 8.9±8% 0.95 6.6±5% 0.95
˙Absolute differences


[0172] For VT, a total of 3861 breaths were analyzed. For TI and TE, 65 randomly selected breaths were analyzed from each subject (n=650 breaths). The R2 values for VT, TI and TE were 0.94, 0.95, and 0.95, respectively (see Figs. 10A, 10B, and 10C).

[0173] The absolute mean % differences for VT, TI, and TE for individual subjects are also shown in Table 4. As reflected in Table 4, the absolute mean % differences for VT, TI and TE from pooled data were 9.1±8%, 8.9±8%, and 6.6±5%, respectively.

[0174] Using the Bland, et al. methods, agreement between the magnetometer and spirometer or pneumotachograph values for VT(VT Mag and VT Spiro or VT Pn), TI(TI Mag and TI Spiro or TI Pn), and TE (TE Mag and TE Spiro or TE Pn) for subjects in the above different groups was assessed. The mathematical mean differences (d) between VT Spiro and VT Mag, and the 95% confidence intervals (reflecting bias) for the awake non-obese and obese subjects are graphically illustrated in Figs. 11A and 11B.

[0175] A similar graphical illustration for the obese sleeping subjects using the VT Mag and VT Pn data is shown in Fig. 12.

[0176] The mathematical mean difference for the non-obese awake subjects in all positions was 26.4 ml with a standard error (SE) of 6.8 ml. The means for VT Spiro and VT Mag for this data set were 1177.3 ml and 1150.9 ml, respectively.

[0177] For the obese awake subjects, the mathematical mean difference was -13.5 ml with a SE of 4.0 ml. The means for VT Spiro and VT Mag for this data set were 868.0 ml and 881.5 ml, respectively.

[0178] The mathematical mean difference between VT Pn and VT Mag for the obese sleeping subjects was -17.7 ml with a SE of 1.0 ml. Mean VT Pn and VT Mag for this group were 460.7 ml and 478.4 ml, respectively.

[0179] The limits of agreement (mean±95% confidence intervals) are shown in Table 5 below.
Table 5
Group Magnetometer MeanMean Diff (d) ±SDLimits of Agreement (d) ±95% CI
Non-Obese Awake Subjects VT (ml) 1150.9 26.4±173.0 -319.6 to +372.4
TI (sec) 1.80 -0.06±0.20 -0.46 to +0.34
TE(sec) 1.93 +0.06±0.20 -0.34 to +0.46
         
Obese Awake Subjects VT (ml) 881.5 -13.5±119.0 -251.5 to +224.5
TI (sec) 1.45 -0.03±0.12 -0.27 to +0.21
TE (sec) 1.76 +0.02±0.13 -0.24 to +0.28
         
Obese Subjects During Daytime Nap VT (ml) 478.4 -17.7±59.5 -136.7 to +101.3
TI (sec) 1.39 +0.001±0.14 -0.28 to +0.28
TE (sec) 1.92 +0.003±0.15 -0.30 to +0.30
(d): Mathematical differences
CI: Confidence Intervals


[0180] The limits of agreement for TI and TE during wakefulness and sleep are also summarized in Table 5. It can be seen that the limits of agreement for VT are clinically acceptable (e.g. ±20-30% of VT). As evidenced by the graphical illustrations shown in Figs. 11A, 11B and 12, most of the data is aggregated around zero with a minor percentage scattered peripherally. This scattering of data over the higher ranges of VT increases the limits of agreement.

[0181] This peripheral scatter is primarily due to three factors. First, the range of VT studied was wide during wakefulness (e.g., for group 1, VT ranged from 250 to 4100 ml), as the subjects were instructed to take occasional deep breaths. The inaccuracies over this range of volume may be due to the lesser range of VT encountered during sleep.

[0182] Second, some of the measurements that were scattered peripherally may represent accidental manual errors in measurements from the spirometer or pneumotachograph. Third, the effect of the facemask on VT may have increased VT in our sleeping subjects.

[0183] Nonetheless, as will be appreciated by one having ordinary skill in the art, the agreements and bias are accurate enough to be clinically relevant.

Example 2


Subjects



[0184] The following study was conducted to assess the accuracy of the "three-degrees-of-freedom" model of the invention and a pulmonary ventilation or magnetometer system employing the subject model to detect apneas and hypopneas during sleep.

[0185] As reflected in Table 6, fifteen (15) subjects (10 males and 5 females) with variable degrees of clinical suspicion for obstructive sleep apnea (OSA) were selected for the study. The mean age for the group was 45.47±12.5 years (mean±SD). The mean body mass index for the group was 35.00±5.7 kg/m2.
Table 6
SubjectAgeBody Mass Index (BMI)
1 50 32
2 71 28
3 34 33
4 39 31
5 30 36
6 48 41
7 40 29
8 49 28
9 74 43
10 34 39
11 44 34
12 38 33
13 39 46
14 46 41
15 46 31
Mean±SD 35.00±5.7 45.47±12.5

Device and Measurements



[0186] The anteroposterior displacements of the rib cage and abdomen, as well as the axial displacements of the chest wall (i.e. Xi) were similarly measured using a light-weight, portable pulmonary ventilation system of the invention (also referred to herein as a magnetometer system or device) using the "three-degrees-of-freedom" model set forth in Eq. 5 above.

[0187] Two pairs of electromagnetic coils, each ∼1/2" in diameter, were employed to measure three degrees of chest wall motion. The coils were attached as shown in Fig. 3.

[0188] Signals were sampled at 20 Hz and stored to compact flash memory. A pneumotachograph was also attached to the magnetometer system for calibration.

[0189] Calibration was performed with subjects in the supine, right lateral and left lateral decubitus positions. Each subject was instructed to breath through the pneumotachograph with breaths of varied depth for greater than 1 min. Free movements of the upper and lower extremities were also encouraged during the calibration process (i.e. flexion and extension of the hip, knee, elbow and shoulder joints).

[0190] Multiple linear regression of the change in each chest wall dimension, with the corresponding tidal volume integrated from the pneumotachograph, was performed to obtain the volume-motion coefficients of Eq. 5.

Protocol



[0191] After calibration in the supine, right lateral and left lateral decubitus positions (hereinafter "test positions"), continuous recording of the magnetometer signals was performed throughout a 12 lead polysomnography (PSG).

[0192] Exemplar recordings of magnetometer signals and associated derived tidal volume are shown in Figs. 13-16; Fig. 13 reflecting quiet breathing of a subject during sleep with no apneas or hypopneas, Fig. 14 reflecting sleep onset of a subject (denoted generally "200") followed by hypopneas (denoted generally "202") and apneas (denoted generally "204"), Fig. 15 reflecting recurrent hypopneas (denoted generally "206"), and Fig. 16 reflecting recurrent apneas (denoted generally "208").

[0193] Scoring of the magnetometer data was conducted in 30 second intervals. No oxygen saturation or EEG arousals were employed in the scoring process.

[0194] Scoring comprised polysomnography (PSG) scores and the magnetometer system signals (or scores). Apnea and hypopnea indices (AHI), apnea indices (AI) and hypopnea indices (HI) were also recorded.

[0195] A respiratory event (i.e. apnea or hypopnea) or occurrence was defined as ≥ 50% reduction in VT with a trend that was sustained for ≥ 10 seconds. Apneas were identified when the volume tracing was almost flat (minor oscillations were ignored). Hypopneas were identified when the volume could be measures (i.e. > 120 cc).

Statistical Analysis



[0196] The mean apnea, hypopnea count and indices were compared using the standard t-test. Means ± standard deviation (mean±SD) was also determined.

Results



[0197] No significant differences were noted between the PSG scores and the MTG scores for the apnea and hypopnea index (AHI), apnea index (AI) and hypopnea index (HI). As reflected in Table 7, the mean±SD AHI for the PSG and MTG data were 38.9±30.5 and 42.5±27.9, respectively.
Table 7
SubjectPSGMTG
 A+H (n)AH] (n/hr)A + H (n)AHI (n/hr)
1 131 22.6 161 27.5
2 315 48.0 36.3 55.3
3 15 2.3 10 1.5
4 138 51.1 178 65.9
5 189 30.9 222 36.4
6 102 21.0 135 27.8
7 48 15.0 59 18.4
8 149 28.7 215 41.3
9 352 73.3 397 82.7
10 384 75.3 418 81.9
11 395 92.4 321 75.1
12 5 1.1 13 2.8
13 25 5.4 82 17.7
14 144 31.4 143 31.2
15 132 85.6 112 72.6
Mean±SD 168.3±133.0 38.9±30.5 188.6±133.2 42.5±27.9
A + H: apnea and hypopnea count


[0198] Referring now to Fig. 17, there is shown a graphical illustration of the apnea and hypopnea indices (AHI) for all fifteen subjects. The dashed lines in Fig. 9 represent the limits of severity of sleep apnea, i.e. AHI 5-15 deemed mild sleep apnea, > 15-30 deemed moderate sleep apnea, and > 30 deemed severe sleep apnea.

[0199] As illustrated in Fig. 17, there was significant agreement in severity between PSG and MTG scores.

[0200] As reflected in Table 8, the mean±SD AI for the PSG and MTG data were 13.6±13.3 and 13.8±10.0, respectively.
Table 8
SubjectPSGMTG
 Apnea (n)AI (n/hr)Apnea (n)AI (n/hr)
1 30 5.2 48 8.2
2 98 14.9 121 18.4
3 3 0.5 3 0.5
4 54 20.0 70 25.9
5 63 10.3 86 14.1
6 14 2.9 35 7.2
7 12 3.7 10 3.1
8 61 11.8 87 16.7
9 50 10.4 92 19.2
10 108 21.2 153 30.0
11 143 33.5 135 31.6
12 0 0 0 0
13 10 2.2 42 9.1
14 91 19.9 38 8.3
15 73 47.4 22 14.3
Mean±SD 54±43.1 13.6±13.3 62.8±48.4 13.8±10.0


[0201] As illustrated in Fig. 18, there was no statistically significant difference in the mean apnea index (AI) between the MTG and PSG scores.

[0202] Referring now to Table 9, the mean±SD HI for the PSG and MTG data were 25.6±20.3 and 28.8±19.5, respectively.
Table 9
SubjectPSGMTG
 Hypopnea (n)HI (n/hr)Hypopnea (n)HI (n/hr)
1 101 17.4 113 19.3
2 217 33.1 242 36.9
3 12 1.8 7 1.0
4 84 31.1 108 40.0
5 126 20.6 136 22.3
6 88 18.1 100 20.6
7 36 11.3 49 15.3
8 88 16.9 128 24.6
9 302 62.9 305 63.5
10 276 54.1 265 51.9
11 252 58.9 186 43.5
12 5 1.1 13 2.8
13 15 3.2 40 8.6
14 53 14.6 105 22.9
15 59 38.3 90 58.4
Mean±SD 114.3±99.5 25.6±20.3 125.8±89.3 28.8±19.5


[0203] As illustrated in Fig. 19, there was similarly no statistically significant difference in the mean hypopnea index (HI) between the MTG and PSG scores.

[0204] There was also significant agreement in the severity of sleep apnea (i.e. AHI 5-15 deemed mild, > 15-30 deemed moderate, and > 30 deemed severe) between the MTG and PSG scores. As reflected in Fig. 13, only two subjects had a change in the AHI from mild (i.e. 5.4/hr.) to moderate (i.e. 17.7/hr.), i.e. subject # 13 (shown in parentheses) and from moderate (i.e. 28.7/hr.) to severe (41.3/hr.), i.e. subject # 6, respectively.

[0205] This study thus demonstrates that the "three-degrees-of-freedom" model of the invention and a magnetometer system employing the subject model can accurately and readily detect apneas and hypopneas during sleep. The system can also readily establish the severity of sleep apnea.

[0206] As will be appreciated by one having ordinary skill in the art, the "three-degrees-of-freedom" models of the invention and ventilation (or magnetometer) systems employing the models can be readily employed to accurately determine ventilation parameters or characteristics, including total pulmonary ventilation, breathing frequency, inspiratory breathing time, expiratory breathing time and total breathing time. The noted ventilation parameters can be employed to identify normal breathing patterns at rest (while awake and during sleep) and during activities, with changes in posture, with exposure to pollutants, or to identify abnormal breathing patterns or respiratory events, such as those presented with respiratory dyskinesia, impending respiratory failure, exacerbations of emphysema, asthma and other forms of lung disease.

[0207] The ventilation parameters can also be readily employed to detect and characterize obstructive and central apneic episodes in adults and infants during sleep, calculate flow volume loops during exercise and sleep, characterize breathing patterns in individuals with undiagnosed causes of dyspnea, and determine the effects of air toxins on pulmonary and cardiovascular health.

[0208] Without departing from the scope of this invention, one of ordinary skill can make various changes and modifications to the invention to adapt it to various usages and conditions. As such, these changes and modifications are properly, equitably, and intended to be, within the full range of equivalence of the following claims.

[0209] Further examples are mentioned as follows:
  1. 1. A method for determining the tidal volume (VT) of a subject, comprising the steps of:

    determining a first anatomical characteristic representing a first linear displacement of the subject's rib cage in a first orientation;

    determining a second anatomical characteristic representing a first linear displacement of the subject's abdomen in said first orientation;

    determining a third anatomical characteristic representing a first axial displacement of the subject's chest wall in said first orientation;

    determining a first rib cage volume-motion coefficient representing said first orientation of the subject;

    determining a first abdomen volume-motion coefficient representing said first orientation of the subject;

    determining a first chest wall volume-motion coefficient representing said first orientation of the subject;

    providing a first mathematical relationship that is adapted to determine VT of the subject as a function of said first, second and third anatomical characteristics, said first rib cage volume-motion coefficient, said first abdomen volume-motion coefficient and said first chest wall volume-motion coefficient; and

    determining VT of the subject with said first mathematical relationship and said first, second and third anatomical characteristics, and said first abdomen volume-motion coefficient, first abdomen volume-motion coefficient and first chest wall volume-motion coefficient, whereby said determined VT represents the subject's VT at said first orientation.

  2. 2. The method of example 1, wherein said first axial displacement of said subject's chest wall is determined from a xiphi-umbilical distance.
  3. 3. The method of example 1, wherein said first axial displacement of said subject's chest wall is determined from a sternal-umbilical distance.
  4. 4. The method of example 1, wherein said first anatomical characteristic represents a second linear displacement of said rib cage during a first motion of the subject, said second anatomical characteristic represents a second linear displacement of said abdomen during said first motion of the subject, said third anatomical characteristic represents a second axial displacement of said chest wall during said first motion of the subject, said first rib cage volume-motion coefficient represents said first motion of the subject, said first abdomen volume-motion coefficient represents said first motion of the subject, and said first chest wall volume-motion coefficient represents said first motion of the subject, and wherein said determined VT represents the subject's VT during said first motion.
  5. 5. The method of example 1, wherein said first orientation comprises an upright position.
  6. 6. The method of example 5, wherein said first mathematical relationship comprises the following equation

    wherein ΔRC represents the linear displacement of the rib cage, ΔAb represents the linear displacement of the abdomen, ΔXi represents the change in the xiphi-umbilical distance from an upright position, α represents a rib cage volume-motion coefficient;
    β represents an abdominal volume-motion coefficient, βu represents the value of the abdominal volume-motion coefficient (β) in the upright position, ε represents the linear slope of the relationship of β as a function of the xiphi-umbilical distance Xi, (Bu + εXi) represents a corrected abdominal volume-motion coefficient, and γ represents a xiphi-umbilical volume-motion coefficient.
  7. 7. The method of example 1, wherein said first mathematical relationship comprises the following equation

    wherein VT represents tidal volume, ΔRC represents said first anatomical characteristic, ΔAb represents said second anatomical characteristic, ΔXi represents said third anatomical characteristic, α represents said first rib cage volume-motion coefficient,
    β represents said first abdominal volume-motion coefficient, and γ represents said first chest wall volume-motion coefficient.
  8. 8. The method of example 7, wherein said volume-motion coefficients are determined by multiple linear regressions.
  9. 9. A method for determining the tidal volume (VT) of a subject, comprising the steps of:

    providing a first sensor system adapted to measure linear displacement of the subject's abdomen, said first sensor system including a first transmission coil adapted to transmit a first electromagnetic field and a second receive coil adapted to receive said first electromagnetic field, said first receive coil being responsive to changes in said first electromagnetic field and further adapted to transmit a first signal representing a first change in said first electromagnetic field;

    providing a second sensor system adapted to measure linear displacement of the subject's rib cage, said second sensor system including a second transmission coil adapted to transmit a second electromagnetic field and a second receive coil adapted to receive said second electromagnetic field, said second receive coil being responsive to changes in said first and second electromagnetic fields and further adapted to transmit a second signal representing a first change in said second electromagnetic field and a third signal representing a second change in said first electromagnetic field;

    determining a first linear displacement of the subject's abdomen in a first orientation as a function of said first signal;

    determining a first linear displacement of the subject's rib cage in said first orientation as a function of said second signal;

    determining a first axial displacement of the chest wall as a function of said third signal;

    determining a first rib cage volume-motion coefficient representing said first orientation of the subject;

    determining a first abdomen volume-motion coefficient representing said first orientation of the subject;

    determining a first chest wall volume-motion coefficient representing said first orientation of the subject;

    providing a first mathematical relationship that is adapted to determine VT of the subject as a function of said first linear displacement of the subject's rib cage, said first linear displacement of the subject's abdomen, said first axial displacement of the chest wall, said first rib cage volume-motion coefficient, said first abdomen volume-motion coefficient and said first chest wall volume-motion coefficient; and

    determining VT of the subject with said first mathematical relationship and said first linear displacement of the subject's rib cage, said first linear displacement of the subject's abdomen, said first axial displacement of the chest wall, said first abdomen volume-motion coefficient, first abdomen volume-motion coefficient and first chest wall volume-motion coefficient, whereby said determined VT represents the subject's VT in said first orientation.

  10. 10. The method of example 9, including the steps of determining a second linear displacement of said rib cage with said first sensor system during a first motion of the subject with said first sensor system, determining a second linear displacement of said subject's abdomen with said second sensor system during said first motion of the subject, determining a second axial displacement of the chest wall during said first motion, determining a second rib cage volume-motion coefficient representing said first motion of the subject, determining a second abdomen volume-motion coefficient representing said first motion of the subject, determining a second chest wall volume-motion coefficient representing said first motion of the subject, and determining VT of the subject with said first mathematical relationship and said second linear displacement of the subject's rib cage, said second linear displacement of the subject's abdomen, said second axial displacement of the chest wall, said second abdomen volume-motion coefficient, said second abdomen volume-motion coefficient and said second chest wall volume-motion coefficient, whereby said determined VT represents the subject's VT during said first motion.
  11. 11. The method of example 9, wherein said first transmission coil is placed at a first position on a first side of the subject's body, said first receive coil is placed at a second position on a second, opposite side of the subject's body, said second transmission coil is placed at a third position on said first side of the subject's body, and said second receive coil is placed at a fourth position on said second side of the subject's body, said first, second, third and fourth coil positions defining a plurality of geometrical configurations.
  12. 12. The method of example 11, wherein each of said first and second receive coils is adapted to receive said first and second electromagnetic fields.
  13. 13. The method of example 12, wherein said first axial displacement of said subject's chest wall is determined as a function of a least one of said first and second signals and one of said plurality of geometrical configurations.
  14. 14. The method of example 9, wherein said first mathematical relationship comprises the following equation

    wherein VT represents tidal volume, ΔRC represents said first linear displacement of said subject's rib cage, ΔAb represents said first linear displacement of said subject's abdomen, ΔXi represents said first axial displacement of said subject's chest wall, α represents said first rib cage volume-motion coefficient, β represents said abdominal volume-motion coefficient, and γ represents said first chest wall volume-motion coefficient.
  15. 15. A method for monitoring respiration of a subject, comprising the steps of:

    determining a plurality of rib cage volume-motion coefficients representing a plurality of orientations and motions of the subject;

    determining a plurality of abdomen volume-motion coefficients representing said plurality of orientations and motions of the subject;

    determining a plurality of chest wall volume-motion coefficients representing said plurality of orientations and motions of the subject;

    compiling a plurality of volume-motion coefficient data sets, said plurality of volume-motion data sets including a first plurality of volume-motion coefficient data sets representing said plurality of orientations of the subject and a second plurality of volume-motion coefficient data sets representing said plurality of motions of the subject, each of said first plurality of volume-motion coefficient data sets comprising a respective one of said rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of said plurality of orientations, each of said second plurality of volume-motion coefficient data sets comprising a respective one of said rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of said plurality of motions;

    providing a first mathematical relationship that is adapted to determine the tidal volume (VT) of the subject as a function of a first anatomical characteristic representing a first linear displacement of the subject's rib cage, a second anatomical characteristic representing a first linear displacement of the subject's abdomen, a third anatomical characteristic representing a first axial displacement of the subject's chest wall, and a respective one of said plurality of said volume-motion coefficient data sets;

    substantially continuously determining said first, second and third anatomical characteristics;

    monitoring the orientation of the subject;

    determining when the subject is in a selective one of said plurality of orientations; and

    substantially continuously determining VT of the subject over a first period of time with said first mathematical relationship and employing said first, second and third anatomical characteristics determined when said subject is in said respective one of said orientations, and said volume-motion coefficient data set of said first plurality of volume-motion coefficient data sets that represents said selective one of said orientations.

  16. 16. The method of example 15, including the steps of monitoring the motion of the subject, determining when the subject is exhibiting a selective one of said plurality of motions, determining VT of the subject with said first mathematical relationship and employing said first, second and third anatomical characteristics determined when said subject is in said respective one of said motions, and said volume-motion coefficient data set of said second plurality of volume-motion coefficient data sets that represents said selective one of said motions.
  17. 17. The method of example 13, wherein said first mathematical relationship comprises the following equation

    wherein VT represents tidal volume, ΔRC represents said first anatomical characteristic, ΔAb represents said second anatomical characteristic, ΔXi represents said third anatomical characteristic, α represents said first rib cage volume-motion coefficient,
    β represents said first abdominal volume-motion coefficient, and γ represents said first chest wall volume-motion coefficient.
  18. 18. A ventilation system for monitoring respiration of a subject, comprising:

    means for substantially continuously determining a first anatomical characteristic representing a first linear displacement of the subject's rib cage in a first orientation;

    means for substantially continuously determining a second anatomical characteristic representing a first linear displacement of the subject's abdomen in said first orientation;

    means for substantially continuously determining a third anatomical characteristic representing a first axial displacement of the subject's chest wall;

    storage means adapted to store a first empirical relationship adapted to determine at least one rib cage volume-motion coefficient, abdomen volume-motion coefficient and chest wall volume-motion coefficient, and a second empirical relationship adapted to determine a ventilation characteristic as a function of said first, second and third anatomical characteristics and said rib cage, abdomen and chest wall volume-motion coefficients; and

    processing means for determining said ventilation parameter with said second empirical relationship.

  19. 19. The system of example 18, wherein said system includes means for acquiring at least one base-line ventilation characteristic, and a third empirical relationship adapted to correlate said acquired base-line ventilation characteristic to a ventilation parameter determined with said second empirical relationship.
  20. 20. The system of example 19, wherein said third empirical relationship is stored in said storage means.
  21. 21. The system of example 19, wherein said first empirical relationship is adapted to determine a plurality of said rib cage, abdomen and chest wall volume-motion coefficients, said plurality of rib cage, abdomen and chest wall volume-motion coefficients representing a plurality of body orientations and motions.
  22. 22. The system of example 21, wherein said storage means includes a plurality of volume-motion coefficient data sets, said plurality of volume-motion data sets including a first plurality of volume-motion coefficient data sets representing said plurality of orientations and a second plurality of volume-motion coefficient data sets representing said plurality of motions, each of said first plurality of volume-motion coefficient data sets comprising a respective one of said rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of said plurality of orientations, each of said second plurality of volume-motion coefficient data sets comprising a respective one of said rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of said plurality of motions.
  23. 23. The system of example 22, wherein said system includes means for detecting when the subject is in one of said plurality of orientations or exhibiting one of said motions.
  24. 24. The system of example 23, wherein said third empirical relationship is adapted to apply a selective one of said first and second plurality of volume-motion coefficient data sets representing one of said plurality of orientations or motions that corresponds to a detected subject orientation or motion to said first empirical relationship, whereby said processing means determines a first ventilation parameter associated with said detected subject orientation or motion.



Claims

1. A method for determining the tidal volume (VT) of a subject, comprising the steps of:

- providing a first sensor system adapted to measure linear displacement of the subject's abdomen, said first sensor system including a first transmission coil (60) adapted to transmit a first electromagnetic field and a first receive coil (61) adapted to receive said first electromagnetic field, said first receive coil (61) being responsive to changes in said first electromagnetic field and further adapted to transmit a first signal representing a first change in said first electromagnetic field;

- providing a second sensor system adapted to measure linear displacement of the subject's rib cage, said second sensor system including a second transmission coil (62) adapted to transmit a second electromagnetic field and a second receive coil (63) adapted to receive said second electromagnetic field, said second receive coil (63) being responsive to changes in said first and second electromagnetic fields and further adapted to transmit a second signal representing a first change in said second electromagnetic field and a third signal representing a second change in said first electromagnetic field;

- determining a first linear displacement of the subject's abdomen in a first orientation as a function of said first signal; determining a first linear displacement of the subject's rib cage in said first orientation as a function of said second signal;

- determining a first axial displacement of the chest wall as a function of said third signal; determining a first rib cage volume-motion coefficient representing said first orientation of the subject;

- determining a first abdomen volume-motion coefficient representing said first orientation of the subject;

- determining a first chest wall volume-motion coefficient representing said first orientation of the subject;

- providing a first mathematical relationship that is adapted to determine VT of the subject as a function of said first linear displacement of the subject's rib cage, said first linear displacement of the subject's abdomen, said first axial displacement of the chest wall, said first rib cage volume-motion coefficient, said first abdomen volume-motion coefficient and said first chest wall volume-motion coefficient; and determining VT of the subject with said first mathematical relationship and said first linear displacement of the subject's rib cage, said first linear displacement of the subject's abdomen, said first axial displacement of the chest wall, said first abdomen volume-motion coefficient, first abdomen volume-motion coefficient and first chest wall volume-motion coefficient, whereby said determined VT represents the subject's VT in said first orientation;

- wherein said first transmission coil (60) is placed at a first position on a first side of the subject's body, said first receive (61) coil is placed at a second position on a second, opposite side of the subject's body,

characterized in that
said second transmission coil (62) is placed at a third position on said first side of the subject's body, and said second receive coil (63) is placed at a fourth position on said second side of the subject's body, said first, second, third and fourth coil positions defining a plurality of geometrical configurations; and

- wherein each of said first (61) and second (63) receive coils is adapted to receive each of said first and second electromagnetic fields.


 
2. The method of Claim 1, including the steps of determining a second linear displacement of said rib cage with said first sensor system during a first motion of the subject with said first sensor system, determining a second linear displacement of said subject's abdomen with said second sensor system during said first motion of the subject, determining a second axial displacement of the chest wall during said first motion, determining a second rib cage volume-motion coefficient representing said first motion of the subject, determining a second abdomen volume-motion coefficient representing said first motion of the subject, determining a second chest wall volume-motion coefficient representing said first motion of the subject, and determining VT of the subject with said first mathematical relationship and said second linear displacement of the subject's rib cage, said second linear displacement of the subject's abdomen, said second axial displacement of the chest wall, said second abdomen volume-motion coefficient, said second abdomen volume-motion coefficient and said second chest wall volume-motion coefficient, whereby said determined VT represents the subject's VT during said first motion.
 
3. The method of Claim 1, wherein said first axial displacement of said subject's chest wall is determined as a function of a least one of said first and second signals and one of said plurality of geometrical configurations.
 
4. The method of Claim 1, wherein said first mathematical relationship comprises the following equation

wherein Vj represents tidal volume, ΔRC represents said first linear displacement of said subject's rib cage, ΔAb represents said first linear displacement of said subject's abdomen, ΔXi represents said first axial displacement of said subject's chest wall, α represents said first rib cage volume-motion coefficient, β represents said abdominal volume-motion coefficient, and γ represents said first chest wall volume-motion coefficient.
 
5. The method of Claim 1, wherein said first axial displacement of said subject's chest wall is determined from a xiphi-umbilical distance.
 
6. The method of Claim 1, wherein said first axial displacement of said subject's chest wall is determined from a sternal-umbilical distance.
 
7. The method of Claim 1, wherein said first orientation comprises an upright position.
 
8. The method of Claim 7, wherein said first mathematical relationship comprises the following equation
VT = α(ΔRC) + (βu + εXi) x (ΔAb) + γ(ΔXi) wherein ΔRC represents the linear displacement of the rib cage, ΔAb represents the linear displacement of the abdomen, εXi represents the change in the xiphi-umbilical distance from an upright position, α represents a rib cage volume-motion coefficient; β represents an abdominal volume-motion coefficient, βu represents the value of the abdominal volume-motion coefficient (β) in the upright position, ε represents the linear slope of the relationship of β as a function of the xiphi-umbilical distance Xi, (βu + εXi) represents a corrected abdominal volume-motion coefficient, and γ represents a xiphi-umbilical volume-motion coefficient.
 
9. The method of Claim 1, wherein said first mathematical relationship comprises the following equation
VT = α(ΔRC) + β(ΔAb) + γ(ΔXi) wherein VT represents tidal volume, ΔRC represents said first anatomical characteristic, ΔAb represents said second anatomical characteristic, ΔXi represents said third anatomical characteristic, α represents said first rib cage volume-motion coefficient, β represents said first abdominal volume-motion coefficient, and γ represents said first chest wall volume-motion coefficient.
 
10. A ventilation system for monitoring respiration of a subject, comprising:

- means for substantially continuously determining a first anatomical characteristic representing a first linear displacement of the subject's rib cage in a first orientation;

- means for substantially continuously determining a second anatomical characteristic representing a first linear displacement of the subject's abdomen in said first orientation;

- a first sensor system adapted to measure the first linear displacement of the subject's abdomen, said first sensor system including a first transmission coil (60) adapted to transmit a first electromagnetic field and a first receive coil (61) adapted to receive said first electromagnetic field, said first receive coil (61) being responsive to changes in said first electromagnetic field and further adapted to transmit a first signal representing a first change in said first electromagnetic field;

- a second sensor system adapted to measure the linear displacement of the subject's rib cage, said second sensor system including a second transmission coil (62) adapted to transmit a second electromagnetic field and a second receive coil (63) adapted to receive said second electromagnetic field, said second receive coil (63) being responsive to changes in said first and second electromagnetic fields and further adapted to transmit a second signal representing a first change in said second electromagnetic field and a third signal representing a second change in said first electromagnetic field,

- means for substantially continuously determining a third anatomical characteristic representing a first axial displacement of the subject's chest wall;

- storage means adapted to store a first empirical relationship adapted to determine at least one rib cage volume-motion coefficient, abdomen volume-motion coefficient and chest wall volume-motion coefficient, and a second empirical relationship adapted to determine a ventilation characteristic as a function of said first, second and third anatomical characteristics and said rib cage, abdomen and chest wall volume-motion coefficients; and

- processing means for determining said ventilation parameter with said second empirical relationship;

characterized in that
each of said first (61) and second (63) receive coils is adapted to receive said first and second electromagnetic fields.
 
11. The system of Claim 10, wherein said system includes means for acquiring at least one base-line ventilation characteristic, and a third empirical relationship adapted to correlate said acquired base-line ventilation characteristic to a ventilation parameter determined with said second empirical relationship.
 
12. The system of Claim 11, wherein said third empirical relationship is stored in said storage means.
 
13. The system of Claim 11, wherein said first empirical relationship is adapted to determine a plurality of said rib cage, abdomen and chest wall volume-motion coefficients, said plurality of rib cage, abdomen and chest wall volume-motion coefficients representing a plurality of body orientations and motions.
 
14. The system of Claim 13, wherein said storage means includes a plurality of volume-motion coefficient data sets, said plurality of volume-motion data sets including a first plurality of volume-motion coefficient data sets representing said plurality of orientations and a second plurality of volume-motion coefficient data sets representing said plurality of motions, each of said first plurality of volume-motion coefficient data sets comprising a respective one of said rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of said plurality of orientations, each of said second plurality of volume-motion coefficient data sets comprising a respective one of said rib cage, abdomen and chest wall volume-motion coefficients that represent a respective one of said plurality of motions.
 
15. The system of Claim 14, wherein said system includes means for detecting when the subject is in one of said plurality of orientations or exhibiting one of said motions.
 


Ansprüche

1. Verfahren zum Ermitteln eines Atemvolumens (VT) eines Patienten, aufweisend die Schritte:

- Bereitstellen eines ersten Sensorsystems, welches angepasst ist, lineare Verschiebung des Abdomens des Patienten zu messen, wobei das erste Sensorsystem eine erste Sendespule (60) aufweist, welche angepasst ist, ein erstes elektromagnetisches Feld zu senden und eine erste Empfangsspule (61), welche angepasst ist, das erste elektromagnetische Feld zu empfangen, wobei die erste Empfangsspule (61) auf Veränderungen in dem ersten elektromagnetischen Feld reagiert und weiter angepasst ist, ein erstes Signal zu senden, welches eine erste Veränderung in dem ersten elektromagnetischen Feld repräsentiert;

- Bereitstellen eines zweiten Sensorsystems, welches angepasst ist, lineare Verschiebung des Brustkorbs des Patienten zu messen, wobei das zweite Sensorsystem eine zweite Sendespule (62) aufweist, welche angepasst ist, ein zweites elektromagnetisches Feld zu senden und eine zweite Empfangsspule (63), welche angepasst ist, das zweite elektromagnetische Feld zu empfangen, wobei die zweite Empfangsspule (63) auf Veränderungen in dem ersten und zweiten elektromagnetischen Feld reagiert und weiter angepasst ist, ein zweites Signal zu senden, welches eine erste Veränderung in dem zweiten elektromagnetischen Feld repräsentiert und ein drittes Signal, welches eine zweite Veränderung in dem ersten elektromagnetischen Feld repräsentiert;

- Ermitteln einer ersten linearen Verschiebung des Abdomens des Patienten in einer ersten Ausrichtung als eine Funktion des ersten Signals; Ermitteln einer ersten linearen Verschiebung des Brustkorbs des Patienten in der ersten Ausrichtung als eine Funktion des zweiten Signals;

- Ermitteln einer ersten axialen Verschiebung der Brustwand als eine Funktion des dritten Signals; Ermitteln eines ersten Brustkorbvolumen-Bewegungskoeffizienten, welcher die erste Ausrichtung des Patienten repräsentiert;

- Ermitteln eines ersten Abdomenvolumen-Bewegungskoeffizienten, welcher die erste Ausrichtung des Patienten repräsentiert;

- Ermitteln eines ersten Brustwandvolumen-Bewegungskoeffizienten, welcher die erste Ausrichtung des Patienten repräsentiert;

- Bereitstellen einer ersten mathematischen Beziehung, welche angepasst ist, um VT des Patienten als eine Funktion der ersten linearen Verschiebung des Brustkorbs des Patienten, der ersten linearen Verschiebung des Abdomens des Patienten, der ersten axialen Verschiebung der Brustwand, des ersten Brustkorbvolumen-Bewegungskoeffizienten, des ersten Abdomenvolumen-Bewegungskoeffizienten und des ersten Brustwandvolumen-Bewegungskoeffizienten zu ermitteln; und Ermitteln von VT des Patienten mit der ersten mathematischen Beziehung und der ersten linearen Verschiebung des Brustkorbs des Patienten, der ersten linearen Verschiebung des Abdomens des Patienten, der ersten axialen Verschiebung der Brustwand, des ersten Abdomenvolumen-Bewegungskoeffizienten, des ersten Abdomenvolumen-Bewegungskoeffizienten, und des ersten Brustwandvolumen-Bewegungskoeffizienten, wobei das ermittelte VT das VT des Patienten in der ersten Ausrichtung repräsentiert;

- wobei die erste Übertragungsspule (60) bei einer ersten Position auf einer ersten Seite des Körpers des Patienten platziert wird, die erste Empfangsspule (61) bei einer zweiten Position auf einer zweiten, gegenüberliegenden Seite des Körpers des Patienten platziert wird, dadurch gekennzeichnet, dass
die zweite Sendespule (62) bei einer dritten Position auf der ersten Seite des Körpers des Patienten platziert wird und die zweite Empfangsspule (63) bei einer vierten Position auf der zweiten Seite des Körpers des Patienten platziert wird, wobei die erste, zweite, dritte und vierte Spulenpositionen eine Vielzahl von geometrischen Konfigurationen definieren; und

- wobei jede der ersten (61) und zweiten (63) Empfangsspulen angepasst ist, jedes von dem ersten und zweiten elektromagnetischen Feld zu empfangen.


 
2. Verfahren nach Anspruch 1, aufweisend die Schritte des Ermittelns einer zweiten linearen Verschiebung des Brustkorbs mit dem ersten Sensorsystem während einer ersten Bewegung des Patienten mit dem ersten Sensorsystem, ermitteln einer zweiten linearen Verschiebung des Abdomens des Patienten mit dem zweiten Sensorsystem während der ersten Bewegung des Patienten, Ermitteln einer zweiten axialen Verschiebung der Brustwand während der ersten Bewegung, Ermitteln eines zweiten Brustkorbvolumen-Bewegungskoeffizienten, welcher die erste Bewegung des Patienten repräsentiert, Ermitteln eines zweiten Abdomenvolumen-Bewegungskoeffizienten, welcher die erste Bewegung des Patienten repräsentiert, Ermitteln eines zweiten Brustwandvolumen-Bewegungskoeffizienten, welcher die erste Bewegung des Patienten repräsentiert, und Ermitteln von VT des Patienten mit der ersten mathematischen Beziehung und der zweiten linearen Verschiebung des Brustkorbs des Patienten, der zweiten linearen Verschiebung des Abdomen des Patienten, der zweiten axialen Verschiebung der Brustwand, des zweiten Abdomenvolumen-Bewegungskoeffizienten, des zweiten Abdomenvolumen-Bewegungskoeffizienten und des zweiten Brustwandvolumen-Bewegungskoeffizienten, wobei das ermittelte VT das VT des Patienten während der ersten Bewegung repräsentiert.
 
3. Verfahren nach Anspruch 1, wobei die erste axiale Verschiebung der Brustwand des Patienten ermittelt wird als eine Funktion zumindest eines von dem ersten und zweiten Signal und einer der Vielzahl von geometrischen Konfigurationen.
 
4. Verfahren nach Anspruch 1, wobei die erste mathematische Beziehung die folgende Gleichung aufweist

wobei Vj das Atemvolumen repräsentiert, ΔRC die erste lineare Verschiebung des Brustkorbs des Patienten repräsentiert, ΔAb die erste lineare Verschiebung des Abdomen des Patienten repräsentiert, ΔXi die erste axiale Verschiebung der Brustwand des Patienten repräsentiert, α den ersten Brustkorbvolumen-Bewegungskoeffizienten repräsentiert, β den Abdominalvolumen-Bewegungskoeffizienten repräsentiert, und γ den ersten Brustwandvolumen-Bewegungskoeffizienten repräsentiert.
 
5. Verfahren nach Anspruch 1, wobei die erste axiale Verschiebung der Brustwand des Patienten aus einem Schwert-Nabel-Abstand ermittelt wird.
 
6. Verfahren nach Anspruch 1, wobei die erste axiale Verschiebung der Brustwand des Patienten aus einem Brustbein-Nabel-Abstand ermittelt wird.
 
7. Verfahren nach Anspruch 1, wobei die erste Ausrichtung eine aufrechte Position aufweist.
 
8. Verfahren nach Anspruch 7, wobei die erste mathematische Beziehung die folgende Gleichung aufweist
VT = α(ΔRC) + (βu + εXi) x (ΔAb) + γ(ΔXi) wobei ΔRC die lineare Verschiebung des Brustkorbs repräsentiert, ΔAb die lineare Verschiebung des Abdomens repräsentiert, εXi die Veränderung im Schwert-Nabel-Abstand aus einer aufrechten Position repräsentiert, α einen Brustkorbvolumen-Bewegungskoeffizienten repräsentiert, β einen Abdominalvolumen-Bewegungskoeffizienten repräsentiert, βu den Wert des Abdominalvolumen-Bewegungskoeffizienten (β) in einer aufrechten Position repräsentiert, ε die lineare Steigung der Beziehung von β als seine Funktion des Schwert-Nabel-Abstands Xi repräsentiert, (βu + εXi) einen korrigierten Abdominalvolumen-Bewegungskoeffizienten repräsentiert, und γ einen Schwert-Nabel-Volumen-Bewegungskoeffizienten repräsentiert.
 
9. Verfahren nach Anspruch 1, wobei die erste mathematische Beziehung die folgende Gleichung aufweist
VT = α(ΔRC) + β(ΔAb) + γ(ΔXi) wobei VT das Atemvolumen repräsentiert, ΔRC die erste anatomische Charakteristik repräsentiert, ΔAb die zweite anatomische Charakteristik repräsentiert, ΔXi die dritte anatomische Charakteristik repräsentiert, α den ersten Brustkorbvolumen-Bewegungskoeffizienten repräsentiert, β den ersten Abdominalvolumen-Bewegungskoeffizienten repräsentiert, und γ den ersten Brustwandvolumen-Bewegungskoeffizienten repräsentiert.
 
10. Ein Lüftungssystem zum Beobachten der Atmung eines Patienten, aufweisend:

- Mittel zum im Wesentlichen kontinuierlichen Ermitteln einer ersten anatomischen Charakteristik, welche eine erste lineare Verschiebung des Brustkorbs des Patienten in einer ersten Ausrichtung repräsentiert;

- Mittel zum im Wesentlichen kontinuierlichen Ermitteln einer zweiten anatomischen Charakteristik, welche eine erste lineare Verschiebung des Abdomens des Patienten in der ersten Ausrichtung repräsentiert;

- ein erstes Sensorsystem, welches angepasst ist, die erste lineare Verschiebung des Abdomens des Patienten zu messen, wobei das erste Sensorsystem eine erste Sendespule (60) aufweist, welche angepasst ist, ein erstes elektromagnetisches Feld zu senden und eine erste Empfangsspule (61), welche angepasst ist, das erste elektromagnetische Feld zu empfangen, wobei die erste Empfangsspule (61) auf Veränderungen in dem ersten elektromagnetischen Feld reagiert und weiter angepasst ist, ein erstes Signal zu senden, welches eine erste Veränderung in dem ersten elektromagnetischen Feld repräsentiert;

- ein zweites Sensorsystem, welches angepasst ist, die lineare Verschiebung des Brustkorbs des Patienten zu messen, wobei das zweite Sensorsystem eine zweite Sendespule (62) aufweist, welche angepasst ist, ein zweites elektromagnetisches Feld zu senden und eine zweite Empfangsspule (63), welche angepasst ist, das zweite elektromagnetische Feld zu empfangen, wobei die zweite Empfangsspule (63) auf Veränderungen in dem ersten und zweiten elektromagnetischen Feld reagiert und weiter angepasst ist, ein zweites Signal zu senden, welches eine erste Veränderung in dem zweiten elektromagnetischen Feld repräsentiert und ein drittes Signal, welches eine zweite Veränderung in dem ersten elektromagnetischen Feld repräsentiert;

- Mittel zum im Wesentlichen kontinuierlichen Ermitteln einer dritten anatomischen Charakteristik, welche eine erste axiale Verschiebung der Brustwand des Patienten repräsentiert;

- Speichermittel, welches angepasst ist, eine erste mathematische Beziehung zu speichern, welche angepasst ist, um zumindest eines von einem Brustkorbvolumen-Bewegungskoeffizienten, Abdomenvolumen-Bewegungskoeffizienten und Brustwandvolumen-Bewegungskoeffizienten zu ermitteln, und eine zweite mathematische Beziehung, welche angepasst ist, eine Atmungscharacteristik als eine Funktion, der ersten, zweiten und dritten anatomischen Charakteristiken und der Brustkorb-, Abdomen- und Brustwand-Volumen-Bewegungskoeffizienten zu ermitteln; und

- Verarbeitungsmittel zum Ermitteln der Atmungsparameter mit der zweiten empirischen Charakteristik;

dadurch gekennzeichnet, dass
jede der ersten (61) und zweiten (63) Empfangsspulen angepasst ist, die ersten und zweiten elektromagnetischen Felder zu empfangen.
 
11. System nach Anspruch 10, wobei das System Mittel zum Erhalten zumindest einer Grundlinien-Atmungscharakteristik aufweist und eine dritte empirische Beziehung, welche angepasst ist, die erhaltene Grundlinien-Atmungscharakteristik mit einem Atmungsparameter zu korrelieren, welcher mit der zweiten empirischen Beziehung ermittelt wurde.
 
12. System nach Anspruch 11, wobei die dritte empirische Beziehung in dem Speichermittel gespeichert ist.
 
13. System nach Anspruch 11, wobei die erste empirische Beziehung angepasst ist, eine Vielzahl der Brustkorb-, Abdomen- und Brustwand-Volumen-Bewegungskoeffizienten zu ermitteln, wobei die Vielzahl von Brustkorb-, Abdomen- und Brustwand-Volumen-Bewegungskoeffizienten eine Vielzahl von Körperausrichtungen und -bewegungen repräsentieren.
 
14. System nach Anspruch 13, wobei das Speichermittel eine Vielzahl von Volumen-Bewegungskoeffizienten-Datensätzen aufweist, wobei die Vielzahl von Volumen-Bewegungskoeffizienten-Datensätzen eine erste Vielzahl von Volumen-Bewegungskoeffizienten-Datensätzen aufweist, welche die Vielzahl von Ausrichtungen repräsentiert und eine zweite Vielzahl von Volumen-Bewegungskoeffizienten-Datensätzen aufweist, welche die Vielzahl von Bewegungen repräsentiert, wobei jede der ersten Vielzahl von Volumen-Bewegungskoeffizienten-Datensätzen einen Entsprechenden von den Brustkorb-, Abdomen- und Brustwand-Volumen-Bewegungskoeffizienten aufweist, welche eine Entsprechende der Vielzahl von Ausrichtungen repräsentieren, wobei jede der zweiten Vielzahl von Volumen-Bewegungskoeffizienten-Datensätzen einen Entsprechenden von den Brustkorb-, Abdomen- und Brustwand-Volumen-Bewegungskoeffizienten aufweist, welche eine Entsprechende der Vielzahl von Bewegungen repräsentieren.
 
15. System nach Anspruch 14, wobei das System Mittel zum Entdecken aufweist, wenn der Patient in einer der Vielzahl von Ausrichtungen ist oder eine der Bewegungen vollführt.
 


Revendications

1. Un procédé de détermination du volume respiratoire courant (VT) d'un patient, comprenant les étapes suivantes :

- mise en place d'un premier système capteur apte à mesurer un déplacement linéaire de l'abdomen du patient, ledit premier système capteur comprenant une première bobine d'émission (60) apte à émettre un premier champ électromagnétique et une première bobine de réception (61) apte à recevoir ledit premier champ électromagnétique, ladite première bobine de réception (61) répondant aux modifications dudit premier champ électromagnétique et étant en outre apte à émettre un premier signal représentant une première modification dudit premier champ électromagnétique ;

- la mise en place d'un second système capteur apte à mesurer un déplacement linéaire de la cage thoracique du patient, ledit second système capteur comprenant une seconde bobine d'émission (62) apte à émettre un second champ électromagnétique et une seconde bobine de réception (63) apte à recevoir ledit second champ électromagnétique, ladite seconde bobine de réception (63) répondant aux modifications desdits premier et second champs électromagnétiques et étant en outre apte à émettre un second signal représentant une première modification dudit second champ électromagnétique et un troisième signal représentant une seconde modification dudit premier champ électromagnétique ;

- la détermination d'un premier déplacement linéaire de l'abdomen du patient dans une première orientation en fonction dudit premier signal ; la détermination d'un premier déplacement linéaire de la cage thoracique du patient dans ladite première orientation en fonction dudit second signal ;

- la détermination d'un premier déplacement axial de la paroi de la poitrine en fonction dudit troisième signal ; la détermination d'un premier coefficient volume-déplacement de la cage thoracique représentant ladite première orientation du patient ;

- la détermination d'un premier coefficient volume-déplacement de l'abdomen représentant ladite première orientation du patient ;

- la détermination d'un premier coefficient volume-déplacement de la paroi de la poitrine représentant ladite première orientation du patient ;

- l'obtention d'une première relation mathématique qui est apte à déterminer le VT du patient en fonction dudit premier déplacement linéaire de la cage thoracique du patient, dudit premier déplacement linéaire de l'abdomen du patient, dudit premier déplacement axial de la paroi de la poitrine, dudit premier coefficient volume-déplacement de la cage thoracique, dudit premier coefficient volume-déplacement de l'abdomen et dudit premier coefficient volume-déplacement de la paroi de la poitrine ; et la détermination du VT du patient avec ladite première relation mathématique et dudit premier déplacement linéaire de la cage thoracique du patient, dudit premier déplacement linéaire de l'abdomen du patient, dudit premier déplacement axial de la paroi de la poitrine, dudit premier coefficient volume-déplacement de l'abdomen, du premier coefficient volume-déplacement de l'abdomen et du premier coefficient volume-déplacement de la paroi de la poitrine, de telle sorte que ledit VT déterminé représente le VT du patient dans ladite première orientation ;

- dans lequel ladite première bobine d'émission (60) est placée en une première position d'un premier côté du corps du patient, ladite première bobine de réception (61) est placée en une seconde position d'un second côté opposé du corps du patient,

caractérisé en ce que

- ladite seconde bobine d'émission (62) est placée en une troisième position sur ledit premier côté du corps du patient, et ladite seconde bobine de réception (63) est placée en une quatrième position sur ledit second côté du corps du patient, lesdites première, seconde, troisième et quatrième positions des bobines définissant une pluralité de configurations géométriques ; et

- dans lequel chacune desdites première (61) et seconde (63) bobines de réception est apte à recevoir chacun desdits premier et second champs électromagnétiques.


 
2. Le procédé de la revendication 1, comprenant les étapes de détermination d'un second déplacement linéaire de ladite cage thoracique avec ledit premier système capteur durant un premier déplacement du patient avec ledit premier système capteur, la détermination d'un second déplacement linéaire dudit abdomen du patient avec ledit second système capteur durant ledit premier déplacement du patient, la détermination d'un second déplacement axial de la paroi de la poitrine durant ledit premier déplacement, la détermination d'un second coefficient volume-déplacement de la cage thoracique représentant ledit premier déplacement du patient, la détermination d'un second coefficient volume-déplacement de l'abdomen représentant ledit premier déplacement du patient, la détermination d'un second coefficient volume-déplacement de la paroi de la poitrine représentant ledit premier déplacement du patient, et la détermination du VT du patient avec ladite première relation mathématique et ledit second déplacement linéaire de la cage thoracique du patient, ledit second déplacement linéaire de l'abdomen du patient, ledit second déplacement axial de la paroi de la poitrine, ledit second coefficient volume-déplacement de l'abdomen, ledit second coefficient volume-déplacement de l'abdomen et ledit second coefficient volume-déplacement de la paroi de la poitrine, de telle sorte que ledit VT déterminé représente le VT du patient durant ledit premier déplacement.
 
3. Le procédé de la revendication 1, dans lequel ledit premier déplacement axial de ladite paroi de la poitrine du patient est déterminé en fonction d'au moins l'un d'entre lesdits premier et second signaux et l'un de ladite pluralité de configurations géométriques.
 
4. Le procédé de la revendication 1, dans lequel ladite première relation mathématique comprend l'équation suivante :

où VT représente le volume respiratoire courant, ΔRC représente ledit premier déplacement linéaire de ladite cage thoracique du patient, ΔAb représente ledit premier déplacement linéaire dudit abdomen du patient, ΔXi représente ledit premier déplacement axial de ladite paroi de la poitrine du patient, α représente ledit premier coefficient volume-déplacement de la cage thoracique, β représente ledit coefficient volume-déplacement abdominal et γ représente ledit premier coefficient volume-déplacement de la paroi de la poitrine.
 
5. Le procédé de la revendication 1, dans lequel ledit premier déplacement axial de ladite paroi de la poitrine du patient est déterminé à partir d'une distance xipho-ombilicale.
 
6. Le procédé de la revendication 1, dans lequel ledit premier déplacement axial de ladite paroi de la poitrine du patient est déterminé à partir d'une distance sternoombilicale.
 
7. Le procédé de la revendication 1, dans lequel ladite première orientation comprend une position redressée.
 
8. Le procédé de la revendication 7, dans lequel ladite première relation mathématique comprend l'équation suivante :

où ΔRC représente le déplacement linéaire de la cage thoracique, ΔAb représente le déplacement linéaire de l'abdomen, eXi représente la modification de la distance xipho-ombilicale à partir d'une position redressée, α représente un coefficient volume-déplacement de la cage thoracique, β représente un coefficient volume-déplacement abdominal, βu représente la valeur du coefficient volume-déplacement abdominal (β) en position redressée, epsilon représente la pente linéaire de la relation donnant β en fonction de la distance xipho-ombilicale Xi, (βu+εXi) représente un coefficient volume-déplacement abdominal corrigé, et γ représente un coefficient volume-déplacement xipho-ombilical.
 
9. Le procédé de la revendication 1, dans lequel ladite première relation mathématique comprend l'équation suivante :

où VT représente le volume respiratoire courant, ΔRC représente ladite première caractéristique anatomique, ΔAb représente ladite seconde caractéristique anatomique, ΔXi représente ladite troisième caractéristique anatomique, α représente ledit premier coefficient volume-déplacement de la cage thoracique, β représente ledit premier coefficient volume-déplacement abdominal, et γ représente ledit premier coefficient volume-déplacement de la paroi de la poitrine.
 
10. Un système ventilatoire pour la surveillance de la respiration d'un patient, comprenant :

- des moyens de détermination substantiellement continue d'une première caractéristique anatomique représentant un premier déplacement linéaire de la cage thoracique du patient dans une première orientation ;

- des moyens de détermination substantiellement continue d'une seconde caractéristique anatomique représentant un premier déplacement linéaire de l'abdomen du patient dans ladite première orientation ;

- un premier système capteur apte à mesurer un déplacement linéaire de l'abdomen du patient, ledit premier système capteur comprenant une première bobine d'émission (60) apte à émettre un premier champ électromagnétique et une première bobine de réception (61) apte à recevoir ledit premier champ électromagnétique, ladite première bobine de réception (61) répondant aux modifications dudit premier champ électromagnétique et étant en outre apte à émettre un premier signal représentant une première modification dudit premier champ électromagnétique ;

- un second système capteur apte à mesurer un déplacement linéaire de la cage thoracique du patient, ledit second système capteur comprenant une seconde bobine d'émission (62) apte à émettre un second champ électromagnétique et une seconde bobine de réception (63) apte à recevoir ledit second champ électromagnétique, ladite seconde bobine de réception (63) répondant aux modifications desdits premier et second champs électromagnétiques et étant en outre apte à émettre un second signal représentant une première modification dudit second champ électromagnétique et un troisième signal représentant une seconde modification dudit premier champ électromagnétique ;

- des moyens de détermination substantiellement continue d'une troisième caractéristique anatomique représentant un premier déplacement axial de la paroi de la poitrine du patient ;

- des moyens de stockage aptes à stocker une première relation empirique apte à déterminer au moins un coefficient volume-déplacement de la cage thoracique, un coefficient volume-déplacement de l'abdomen et un coefficient volume-déplacement de la paroi de la poitrine, et une seconde relation empirique apte à déterminer une caractéristique de ventilation en fonction desdites première, seconde et troisième caractéristiques anatomiques et desdits coefficients volume-déplacement de la cage thoracique, de l'abdomen et de la paroi de la poitrine ; et

- des moyens de traitement pour la détermination dudit paramètre de ventilation avec ladite seconde relation empirique ;

caractérisé en ce que
chacune desdites première (61) et seconde (63) bobines de réception est apte à recevoir lesdits premier et second champs électromagnétiques.
 
11. Le système de la revendication 10, dans lequel ledit système comprend des moyens d'acquisition d'au moins une caractéristique de ventilation de ligne de base, et une troisième relation empirique apte à corréler ladite caractéristique de ventilation de ligne de base acquise avec un paramètre de ventilation déterminé avec ladite seconde relation empirique.
 
12. Le système de la revendication 11, dans lequel ladite troisième relation empirique est stockée dans lesdits moyens de stockage.
 
13. Le système de la revendication 11, dans lequel ladite première relation empirique est apte à déterminer une pluralité desdits coefficients volume-déplacement de la cage thoracique, de l'abdomen et de la paroi de la poitrine, ladite pluralité de coefficients volume-déplacement de la cage thoracique, de l'abdomen et de la paroi de la poitrine représentant une pluralité d'orientations et de déplacements du corps.
 
14. Le système de la revendication 13, dans lequel lesdits moyens de stockage comprennent une pluralité d'ensembles de données de coefficients volume-déplacement, ladite pluralité d'ensembles de données de coefficients volume-déplacement comprenant une première pluralité d'ensembles de données de coefficients volume-déplacement représentant ladite pluralité d'orientations et une seconde pluralité d'ensembles de données de coefficients volume-déplacement représentant ladite pluralité de déplacements, chacune d'entre ladite première pluralité d'ensembles de données de coefficients volume-déplacement comprenant un coefficient respectif des coefficients volume-déplacement de la cage thoracique, de l'abdomen et de la paroi de la poitrine qui représentent l'une respective d'entre ladite pluralité d'orientations, chaque ensemble de ladite seconde pluralité d'ensembles de données de coefficients volume-déplacement comprenant un coefficient respectif desdits coefficients volume-déplacement de la cage thoracique, de l'abdomen et de la paroi de la poitrine qui représente un déplacement respectif de ladite pluralité de déplacements.
 
15. Le système de la revendication 14, dans lequel ledit système comprend des moyens de détection du moment où le patient est dans l'une desdites pluralités d'orientations ou présente l'un desdits déplacements.
 




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