A method for the diagnosis and correction of disorders of breathing during sleep
(57) Abstract:The invention relates to the field of medicine. The invention is characterized by the fact that the results of the survey and limnologically registration with the previously installed base symptoms markers of the disease and the boundary values of significance polimorfismo indicators are gradation of symptoms and verical sonographically parameters that determine the severity of respiratory disorders and depending on the latest therapeutic, dental or surgical correction, and with very severe disease - non-invasive ventilation. Assessment of the severity of the disease and extent of surgical and/or dental perform impact speed by changing the amount of exposure according to the level therapeutic level. The method involves identifying criteria for the appropriateness of the assignment and the assessment of the effectiveness of non-invasive ventilation, surgical treatment, dental correction. The proposed method can improve the effectiveness of treatment failure from expensive equipment for non-invasive ventilation in two groups of patients at lower side is astice respiratory disorders during sleep and emergency conditions in pulmonology and their correction.Known methods of diagnosing respiratory disorders during sleep. They are based on an assessment of a number of values received in the course of questioning, the patient, and indicators obtained during polysomnography .Known methods of correction of respiratory disorders, consisting in non-invasive ventilation in the mode of continuous positive airway pressure applying apparatus for supporting intranasal ventilation method positive pressure .The disadvantages of these methods are the lack of an integrated stepwise approach to diagnosis of respiratory disorders and the use of expensive equipment for non-invasive ventilation.The proposed method is free from the above disadvantages. The technical goal of the invention consists in determining the severity of respiratory disorders and volume of therapeutic and surgical treatment.The claimed technical result is achieved that establish the basic symptoms-markers of disease and boundary value relevance of indicators polysomnographically parameters; the results limnologische ankeney; establish the severity of respiratory and insomniacal disorders.Depending on the severity of the disease are dental and surgical correction, and extremely heavy during non - invasive ventilation. Assessment of the severity of the disease perform manual, changing the volume of medical, dental and surgical treatment according to stages of the treatment level. The method is based on the stepped perform basic diagnostic and therapeutic stages. Jagged complete method allows to avoid diagnostic errors, to clearly establish the existing markers of disease, to assess the degree of severity of the disease by providing symptom of breathing disorders during sleep.The method is performed as follows. Breathing pattern during sleep and the state of pathological disorders of breathing during sleep (apnea-hypopnea sleep - SOAGS) is determined by evaluating the range of values obtained in the course of specialized personal tests ('questionnaires) and indicators obtained during polysomnography. To assess the respiratory pattern of the patient during sleep and definition of the basic stamp is ysenia arterial blood oxygen, an indirect indicator of the gas exchange function of the lungs, which reflects the degree of saturation of hemoglobin with oxygen and oxygen transport from the blood into the tissues. OK this value is 95-98%.Tg/AB (LBI) is the degree of correlation excursion characteristics of chest excursions of the abdominal wall, the indicator characterizing the phenomenon of thoracoabdominal paradox breathing, which reflects the degree of efficiency of the respiratory muscles. OK this value is equal to one dimensionless unit.AHI index, apnea-hypopnea sleep, the average frequency of pathologic apnea-related desaturation of arterial blood for 60 minutes sleep, reflecting the severity of respiratory sleep disorders. OK this value does not exceed 15 dimensionless units. This index is one of the main sonographically parameters characterizing the respiratory pattern of the patient.Currently there is no single criterion to assess the degree and severity of respiratory disorders in General. A comprehensive evaluation of all these parameters is especially important in the study of the respiratory pattern in patients with razlichnyye called "tissue hypoxia". State in which a reduced amount of oxygen delivered by the blood to the tissues, is defined as "hypoxemia". Obviously, it is impossible to identify tissue hypoxia and hypoxemia, because the shift of dissociation curve of oxyhemoglobin changes the value of oxygen consumption by the tissues. It is necessary to distinguish between two States: hypoxemia fabric normoxia and hypoxemia with tissue hypoxia. Understanding phenomena allows to assess significance of respiratory disorders, leading to the development of conditions of hypoxia and hypercapnia in patients with different lung diseases.Thus, in order to realistically assess respiratory sleep patterns and discover a state of pathological disorders of breathing during sleep (apnea-hypopnea sleep) to evaluate the range of values obtained in the course of specialized tests ('questionnaires) and holding polysomnography.Logistics method.Used polysomnographically system "ALICE-3" (HealthDyne Devision of Respironics, USA) registration certificate MSMPR 97/1402 from 02.12.97, the certificate of conformity 3301046 valid until 05.2000 issued by the authority on certificados positive pressure "Tranquility" (HealthDyne Division of Respironics, USA) registration certificate MSMPR 97/471 from 13.05.97, the certificate of conformity 3301047 valid until 05.2000 issued by the certification body for medical devices ANO "CCME-VNIIMP".Diagnostic markers of symptoms SOAKS on questionnaire survey.On the basis of "special survey" revealed the main symptoms and markers of the disease (table 1).The combination of "2 symptoms+3 token" or "3 symptom+2 token" (rule of five characteristic set of symptoms and markers SOAGS is considered positive.The phenomenon of excessive daytime sleepiness - sleep in case the situation against their will - is a sign of having a significantly high degree of correlation (p<0,001) with SOAGS. Diagnostics "daytime sleepiness" is on a scale of "Daytime Sleepiness" (table 2).Possible grade ball marks from 0 to 24. Values normal values are in the range of from 4 to 8. Manifestations of sleepiness in the range of 8-16 characteristic of SOAGS, drowsiness within 14-21 characteristic of narcolepsy. The response in the range of 8-16 points gives a positive result when testing.Two positive response - symptoms-markers and daytime sleepiness - vyyavleny identify objective indicators of SOAGS.If you have less than 2 positive responses when tested using somnologica questionnaires impossible to establish objective indications for polysomnography.Polysomnographically survey
Polysomnographically the survey is conducted at night time with the use of specialized systems - polysomnographically installations that allow us to determine the main indicators of carotid flow process (cyclic sleep, sleep, sleep efficiency, frequency of awakenings) and accompanying sleep state, such as gipoksemicescuu disorders, hypoventilation, respiratory arrest, etc. Received during polysomnography indicators are objective, are numeric in nature and allow to objectify picture of the pathologic condition (Fig.1, 2).THE INDEX, APNEA-HYPOPNEA SLEEP (AHI).Is the main parameter to assess the degree of respiratory disorders, in which it may be split by severity:
- if the index is 5 < AHI < 15 to talk about disorders of breathing during sleep in if there are phenomena of persistent hypoxemia with numbers Sat2< 80%. Such disorders trojstvo of breathing during sleep mild severity.- 30 index < AHI < 50 to talk about disorders of breathing during sleep moderate severity.- if the index is 50 < AHI < 100, to talk about disorders of breathing during sleep severe.- if the index is 100 < AHI to talk about disorders of breathing during sleep is extremely heavy flow, in which the patient needs to conduct emergency activities for health reasons, because the risk of sudden death during sleep in these patients is extremely high.THE INDEX OF SATURATION OF ARTERIAL BLOOD WITH OXYGEN (SATO2).Is the main parameter for evaluating the degree of oxygenation of arterial blood, by which it is possible to separate the breathing degrees of hypoxia:
- with an average index value of 80%<Sat2<95% say about moderate hypoxia accompanying respiratory disorders.- with an average value of the indexmSat2<80% say about severe hypoxia that accompanies respiratory disorders.Special singles out a rule enhance the severity of the condition defined bymSatO2: indexmSat2<80% that accompanies existing respiratory disorder, is fine.).INDEX THORACOABDOMINAL PARADOX BREATHING (TR/AB OR LBI).Is the main parameter to assess the degree of discoordination respiratory effort, by which it is possible to separate the breathing degrees thoracoabdominal paradox:
- with an average index value of 1 <mLBI < 3 it is customary to speak about moderate thoracoabdominal paradox that accompanies respiratory disorder.- with an average index value of 3 <mLBI to talk about severe thoracoabdominal paradox that accompanies respiratory disorder.Special singles out a rule enhance the severity of the condition defined mLBI: index mLBI > 3, accompanying the existing respiratory disorder, increases the severity on the same level. (Example: AN=25,mLBI=3,5 - respiratory distress severe.)
It should be noted that with increasing gravity must be remembered that regardless of the combination of indexes that increase the severity, the gain is only one step. (Example: EN,mSat2=77%, mLBI=3,5 - respiratory distress severe.)
Therapeutic correction method SOAKS.
constor CPAP). The selection of one of the above types of therapy or their combination provides for the strengthening of therapeutic effects and the ineffectiveness of the previous level (table 3).After conducting polysomnographical survey reveals the severity of SOAGS. At the easy course of SOAGS first attempted surgical correction of structural abnormalities in oropharyngeal region or dental correction in the form of retropositional repositioning the lower jaw in the night time with the help of the oral applicator. At the same time carries out a range of measures to reduce the weight of patients, increase their activity and diet therapy. Monitoring patients on an outpatient basis for at least 9 months, during which the estimated dynamics martaban with the evaluation of basic parameters for 9 months. The patient is considered as having SOAKS moderate flow. Low effectiveness of therapy and the presence of side effects retrying polysomnographically examination and extended investigations to determine the causes and comorbidities. Possible additional surgery for oropharyngeal region or integrated treatment (a combination of CPAP and applicator). Such patients are considered to have SOAGS heavy flow and are subject to a mandatory 5-year observation with regular 6-monthly polysomnographically surveys. Thus, the evaluation of the severity of the disease and breadth of therapeutic effects occur stepwise according to the available views about the dynamic flow of SOAGS.The evaluation of the severity, you can reduce the degree and breadth of therapeutic effects, it is necessary to produce in the range of 6-9 months from the time of diagnosis. The criteria will be positive dynamics of symptoms and markers of disease, compliance of the patient to therapy, no side effects and possible complications.The efficiency of the method.The introduction of this method, as in pulmonary and General therapeutic practice will allow doctors to conduct a qualitative diagnosis of SOAGS, choose the best methods for correction of morbid state clearly identify whether the destination as drug therapy, and medical practices in the treatment of patients with respiratory disorders during sleep.2. Sullivan, S. E., Jssa F. Q., Berton-Jones m, Eves L. Reversal of obstructive sleep apnea by continuous positive pressure applied through the nares. // Lancet, 1981; v.1-862-865. 1. A method for the diagnosis and correction of disorders of respiration by polysomnographically registration with the determination of the degree of apnea-hypopnea sleep and non-invasive ventilation, characterized in that it further when polysomnographically register determine the degree of oxygenation of the blood and the degree of respiratory paradox, at the same time exercise questionnaire and the data obtained establish the severity of the disease and the scope and sequence of correction, the last carried out comprehensively, using surgical, dental, and therapeutic effects.2. The method according to p. 1, characterized in that the dental correction is to change the location of the upper jaw relative to the bottom using non-invasive removable devices, such as oral applicators.3. The method according to p. 1, characterized in that surgical correction is the elimination of malformations of the skeleton of the face and oropharyngeal tissue region with mild disease methods of invasive and non-invasive chelust the
SUBSTANCE: method involves measuring cardio- and hemodynamic values, calculating estimates of the values and displaying the estimates on monitor. Measuring and calculating each cardio- and hemodynamic value is carried out during basic periods of their oscillations corresponding to heart contraction cycle and respiratory cycle related to absolute time.
EFFECT: high accuracy of estimation.
4 dwg, 1 tbl
SUBSTANCE: method involves recording electrocardiogram and cardiorhythmogram on the background of medicamentous therapy beginning from 7-10 day of the disease. The cardiorhythmogram is shown to the patient. Respiratory training session is carried out. Inspiration and expiration are to be equal in duration, each making Ѕ of cardiorhythmogram breathing wave.
EFFECT: enhanced effectiveness of treatment.
2 cl, 3 tbl
FIELD: medical engineering.
SUBSTANCE: selected reference point in every cardiac cycle on TP-segment. Values of neighboring N=2n+1 reference points also belonging to TP-segment are recorded, n=1,2,…, beginning from the first reference point. Other reference points are set to zero. The central reference point value is left without changes in a group of 2n+1 member. Reference point values of each of n pairs of reference points symmetrically arranged relative to the central reference point are scaled relative to condition Uj=U0Kj, where U0 is the central reference point amplitude, Uj is amplitude of j-th reference point pair, j=1,2,…,n is the number of each reference point pair relative to the central reference point, Kj is the scaling coefficients determined from received signal suppression condition of the first n spectral zones in spectrum. The so formed electrocardiogram signal reference point groups sequence is let pass through lower frequency filter with isoline drift signal being obtained being produced on output. The signal is amplified and subtracted from the initial electrocardiogram signal that is preliminarily delayed for lower frequency filter delay time. Device has the first lower frequency filter, discretization unit and unit for selecting anchor reference points connected in series, as well as subtraction unit, unit for saving N reference points, scaling unit, the second lower frequency filter, amplifier and delay unit. Output of the unit for selecting anchor reference points is connected to the first input of memory unit the second input of which is connected to discretization unit output. Each of N memory unit outputs is connected to one of N inputs of scaling units. Scaling unit output is connected to the second lower frequency filter input which output is connected to amplifier input. Amplifier output is connected to the first input of subtraction unit, the second output of subtraction unit is connected to delay unit output. Its input is connected to output of the first lower frequency filter. Subtraction unit output is the device output.
EFFECT: reliable removal of isoline drift.
2 cl, 8 dwg
FIELD: medicine, anesthesiology-resuscitation, traumatology, surgery.
SUBSTANCE: according to 4-point scale one should evaluate the state of 10 clinical, hemodynamic and instrumental values in patients: patient's skin by detecting its color and moisture; hemodynamic values: heart rate, systolic arterial pressure, central venous pressure, shock index; central nervous system by studying the value of Glasgow scale; respiratory system - the frequency of respiratory movements and blood saturation; cardio-vascular system - myocardial necessity in oxygen. Each value has its own point, moreover, 0 points corresponds to that fact that the index under inspection is within age standard, 1 point - when physiological parameters at rest are different against the standard, but their functions are compensated by organs of one or two systems, 2 points - compensation is kept due to alterations in more than 2 systems and it reaches its peak, 3 points correspond to adaptation failure or affected function of one or several systems, and the sum of points being 0-4 in patients one should diagnose the absence of hemorrhagic shock, at 5-9 points - the severity of hemorrhagic shock corresponds to degree I, at 10-19 points - to degree II, at 20 points and more - to degree III.
EFFECT: higher efficiency and accuracy of diagnostics.
4 ex, 1 tbl
SUBSTANCE: method involves recording peripheral differential upper extremity blood vessel rheogram and phonocardiogram in synchronous way. The second phonocardiogram beginning and the deepest rheogram points are detected. Pulse way propagation time reduction being found, arterial bloodstream tone growth conclusions are drawn.
EFFECT: high reliability of the results.
18 dwg, 3 tbl
FIELD: medicine; medical engineering.
SUBSTANCE: method involves recording patient electrocardiogram in maximum comfort state in one lead and photopletysmogram. Vascular tone index (VTI) is measured as time interval from next in turn R-tooth peak to the next following pulse oscillation. Set of values is built and statistically processed. Mode value MoVTIR is calculated as patient rest state characteristic to estimate current functional state of patient regulation and control systems. Electrocardiogram in maximum comfort state is recorded in one lead and photopletysmogram at the same time. A set of RR-intervals and time intervals from next in turn R-tooth peak to the next following pulse oscillation is built and statistically processed. Amo, Mo and MoVTI values are calculated to estimate current functional state of patient. Neighboring cardio-interval values are additionally measured and mean square deviation MSDP is calculated and then variational pulse ametria SAT index is calculated from formula SAT=0.1 x Mo/MSDP and integral regulation and control system stress index of patient (IRCSS)is calculated from formula IRCSS=(SAT) x [1+(Movtir-MoVTI)MoVTI. Patient organism regulation and control system state is estimated as one corresponding to normative neuropsychic stress characteristic for rest state or when working without significant psychic tension with IRCSS value being within interval from 40 to 300, working neuropsychic stress characteristic for significant tension belonging interval from 300 to 900. Neuropsychic overstress showing necessity of rest belongs to an interval from 900 to 3000. Neuropsychic overstress threatening health belongs to an interval from 3000 to 10000. Attrition showing emergency of escaping from the current state with obligatory cardiologist advice takes place when the value is greater than 10000. The device has unit for recording electrocardiogram, data processing unit and calculation unit connected to estimation unit with its output and unit for recording pulse oscillations, analog-to-digital converter unit having inputs connected to electrocardiogram-recording unit and pulse oscillations-recording unit outputs and its output are connected to calculating unit inputs via the data processing unit, and display unit for showing patient regulation and control systems state. Units for processing and calculating are manufactured on microprocessor base. Signals are form on exit from the microprocessor, their values being corresponding to integral regulation and control system stress index value of a patient(IRCSS). The unit for recording pulse oscillations is designed as electronic transducer set on patient finger. The unit for recording electrocardiogram, records cardiac pulses in single lead.
EFFECT: high accuracy in estimating functional state of human organism regulation and control system.
3 cl, 2 dwg
FIELD: medical equipment.
SUBSTANCE: device can be used in practical and sports medicine. Device has breath detector and pulse rate detector, clamp having ability of fastening to frame of glasses, joint mounted onto clamp, unit in form of clip for placing light source and photo-resistor which both are parts of pulse rate detector, and pipe. Breath thermal detector is mounted at one end of pipe. The pipe is mounted in clamp for displacement to control position of breath detector in projection of jet of breath-out air. Pulse rate detector is connected with joint through flexible wires. Wires of thermal detector are placed inside pipe. Pulse rate detector and breath detector are connected with corresponding amplifiers through joint. Output of any amplifier is connected with commutator.
EFFECT: simplified design; improved comfort for patient.
FIELD: medicine; cardiology.
SUBSTANCE: method allows registering differential sphygmograms by means of computer and piezoelectric transducer providing high precision. Registration is carried out continuously and doesn't take much labor input. On the base of sphygmograms by using method of finding of "coding" points, two main characteristics of heart beat rate can be found by express analysis. Two main characteristics have to be rhythm and pulse oscillations of arterial pressure induced by periodical throwing of shock volume of blood into aorta. Algorithm of data processing which is developed on purpose, provides automatic placing of "coding" (received on the base of calculation) points onto averaged graph of cardiologic cycle that provides higher precision of determination of amplitude-time parameters at any recognized normal pulsation of selected fragment of pulsogram together with additional visual correction of localization of those points. Fragment of pulsogram with duration of no less than 2 minutes (standard duration equals to 5 minutes) is used for measuring and analyzing time factors which characterize rhythm of heart beating and its variability. After that the calibration factor is calculated to transfer conditional units of computer "digitization" into common units of measurement of blood arterial pressure (in mm of mercury column) and values of pulsation increase in blood arterial pressure in mm of mercury column are determined by integrating cardiologic cycles at selected fragment of pulsogram for corresponding areas. The meanings achieved are used for calculating all the amplitude-time cardiologic hemo-dynamic factors which depend on blood arterial pressure and which characterize systole of myocardium of left ventricle and elastic-resilient properties of walls of arterial channel. Continuous monitoring of changes in amplitude-time factors of pulsogram is provided as well as practically real time scale of getting of all the computational data and quick performance of all the mathematical transformations for making spectral analysis of variability of heart beat rate and selected amplitude-time cardiologic hemo-dynamic factors to determine their total and differential spectral power of oscillations. Results of static and spectral analysis of variability of measured parameters the functional condition and character of vegetative regulation of cardio-vascular system are estimated due to comparison of measured values with average statistical numerical values of the same factors which were specified for cardio-vascular system in relation to age, sex, state of health and signs for groups of people chosen as a test group.
EFFECT: improved precision; widened number of informative factors for estimation of cardio-vascular system.
8 dwg, 2 tbl
FIELD: medical equipment; veterinary equipment.
SUBSTANCE: device is used for measurement of volumetric parameters of breathing and electrocardiogram by methods of impedance pneumography and electrocardiography. Device is intended for physiological testing under natural conditions of life and activity of patient - at work, in sports, at home as well as at checking of natural conditions of maintenance and existence of animals. Device has two generator and two signal electrodes, stable ac generator and two filters. First filter is intended for selecting cardiographic signal and the second one - for selecting respiratory signal. Stable ac generator is made with symmetrical differential output. Two T-shaped units are introduced into circuit of connection of mentioned generator with generator electrodes. Two resistors, connected in series, of first and second T-shaped unit are connected to circuit of connection of first (second) generator electrode with output of generator. Passive member (resistor or inductance) of any T-shaped unit is connected between point of connection of two resistors from the unit and case of device. Four dischargers and two resistors are additionally introduced into four-electrode device.
EFFECT: improved noise immunity for co-phase error: widened area of application.
4 cl, 2 dwg
SUBSTANCE: one should determine ECG values, saturation (S), response of arterial pressure (AP) to inotropic support due to introducing dopamine (IS), microcirculation (M), central venous pressure (CVP), average arterial pressure (AvAP), hourly diuresis (D). In case of individual extrasystoles on ECG, C value being 91-90, IS being below 5 mcg kg/min, M being 2-3 sec, CVP being 4-6 cm watery column, AvAP 70 and more mm mercury column, D 30-40 ml/h each of these parameters should be evaluated as 0 points. In case of polytopic extrasystoles on ECG, at C value being 91-90 at FiO2 being below 0.5, IS 5-10 mcg kg/min, M being equal to 3-5 sec, CVP of 1-4 cm watery column, AvAP 60 and more mm mercury column, D 20-30 ml/h each of these parameters should be evaluated as 1 point. At combination of polytopic extrasystoles and myocardial ischemia on ECG, C value being 91-90 at FiO2 being above 0.5, IS above 10 mcg kg/min, M above 5 sec, CVP being below 0 or above 14 cm watery column, Av.AP 50 and more mm mercury column, D below 20 ml/h one should evaluate every value as 2 points. The values should be summarized and at total value ranged 0-6 severely affected patients should be considered as transportable people, at its value ranged 0-10 the preparation should be desired, at its value being 11 and more - it should be concluded upon nontransportability. The innovation enables to perform objective evaluation of severe state in affected patients.
EFFECT: higher accuracy of evaluation.
4 ex, 5 tbl