System and method for providing disordered breathing therapy

Abstract

Examples include a treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising at least one first stimulation lead, at least one second stimulation lead, and an implanted therapy controller configured to couple to the leads and to provide at least one phrenic-nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, provide at least one hypoglossal-nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead, and coordinate a relative timing of the electrical stimulation to the hypoglossal nerve with the electrical stimulation to the phrenic nerve of the patient.

Description

[0001] SYSTEM AND METHOD FOR PROVIDING DISORDERED BREATHING THERAPY

[0002] BACKGROUND

[0003] At least one example in accordance with the present disclosure relates generally to breathing disorders.

[0004] SUMMARY

[0005] Examples of the disclosure comprise a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether operational parameters comprise hypoglossal nerve electrical stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters comprise the hypoglossal nerve electrical stimulation parameters, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0006] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of hypoglossal nerve electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the hypoglossal nerve electrical stimulation parameters. In at least one example, the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period. In at least one example, the operational parameters determined prior to the at least one sleeping period are based at least in part on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

[0007] In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery stall time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

[0008] In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and one or more of phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations. In at least one example, the treatment system comprises at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration.

[0009] In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a prc-dctcrmincd collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the accumulated sensor data.

[0010] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device. In at least one example, the IPG is configured to compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

[0011] In at least one example, the treatment system comprises at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations. In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0012] In at least one example, the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters. In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

[0013] In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve.

[0014] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of an airway obstruction, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the airway obstruction, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.,

[0015] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of hypoglossal nerve electrical stimulation during the at least one sleeping period responsive to a determination that an indication of airway obstruction is absent from the sensor data indicative of patient respiration. In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations. In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG. In at least one example, the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data.

[0016] In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the sensor data.

[0017] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface. In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

[0018] In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0019] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

[0020] In at least one example, the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations.

[0021] In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accclcromctcr or an external accclcromctcr. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

[0022] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

[0023] In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve. In at least one example, the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to a lack of respiratory drive. In at least one example, the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a predetermined phrenic nerve stimulation rate. In at least one example, the IPG is configured to modify the phrenic nerve electrical stimulations based on the at least one indicator specific to the lack of respiratory drive.

[0024] In at least one example, the sensor data indicative of patient respiration comprises at least one indicator specific to the airway obstruction. In at least one example, the IPG is configured to modify the hypoglossal nerve electrical stimulations based on the at least one indicator specific to the airway obstruction. In at least one example, the sensor data indicative of patient respiration comprises combincd-cffcctivcncss parameters indicative of an effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations based on the combined-effectiveness parameters.

[0025] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether operational parameters comprise phrenic nerve electrical stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters comprise the phrenic nerve electrical stimulation parameters, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0026] In at least one example, the IPG is configured to provide the hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient during the at least one sleeping period via the at least one second stimulation lead in an absence of phrenic nerve electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the phrenic nerve electrical stimulation parameters. In at least one example, the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period. In at least one example, the operational parameters determined prior to the at least one sleeping period are based at least in part on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

[0027] In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

[0028] In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations.

[0029] In at least one example, the treatment system includes at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the accumulated sensor data.

[0030] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device. In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

[0031] In at least one example, the treatment system includes at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

[0032] In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and a second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0033] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

[0034] In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve. Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of a lack of respiratory drive, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the lack of central respiratory drive, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0035] In at least one example, the IPG is configured to provide the hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of phrenic nerve electrical stimulations during the at least one sleeping period responsive to a determination that an indication of a lack of respiratory drive is absent from the sensor data indicative of patient respiration. In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery star! time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

[0036] In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG. In at least one example, the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data.

[0037] In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the sensor data. In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

[0038] In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface. In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters. In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0039] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

[0040] In at least one example, the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor.

[0041] In at least one example, the system includes at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

[0042] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

[0043] In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve. In at least one example, the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to the lack of respiratory drive. In at least one example, the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a pre-determined phrenic nerve stimulation rate. In at least one example, the IPG is configured to modify the phrenic nerve stimulations based on the at least one indicator specific to the lack of respiratory drive. In at least one example, the sensor data indicative of patient respiration comprises at least one indicator specific to an airway obstruction.

[0044] In at least one example, the IPG is configured to modify the hypoglossal nerve stimulations based on the at least one indicator specific to the airway obstruction. In at least one example, the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of the effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve stimulations and the hypoglossal nerve stimulations based on the combined-effectiveness parameters.

[0045] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether the operational parameters comprise ansa cervicalis stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters comprise the ansa cervicalis electrical stimulation parameters, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0046] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of ansa cervicalis electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the ansa cervicalis electrical stimulation parameters. In at least one example, the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period. In at least one example, the operational parameters determined prior to the at least one sleeping period are based at least in part on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

[0047] In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa ccrvicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

[0048] In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations.

[0049] In at least one example, the treatment system includes at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the accumulated sensor data.

[0050] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device.

[0051] In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters. In at least one example, the system includes at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations.

[0052] In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0053] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured In at least one example, the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

[0054] In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

[0055] In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis. In at least one example, the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein the IPG is configured to determine whether the operational parameters comprise hypoglossal nerve stimulation parameters, and responsive to the determination that the operational parameters comprise the hypoglossal nerve stimulation parameters, the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

[0056] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of an airway obstruction, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the airway obstruction, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0057] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of ansa cervicalis electrical stimulation during the at least one sleeping period responsive to a determination that an indication of airway obstruction is absent from the sensor data indicative of patient respiration. In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery star! time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations. In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa ccrvicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG. In at least one example, the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data. In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the sensor data.

[0058] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular' time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface. In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa ccrvicalis electrical stimulation parameters.

[0059] In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0060] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

[0061] In at least one example, the phrenic nerve electrical stimulations and the ansa ccrvicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or the ansa ccrvicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, the system includes at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

[0062] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis.

[0063] In at least one example, the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to a lack of respiratory drive. In at least one example, the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a pre-determined phrenic nerve stimulation rate. In at least one example, the IPG is configured to modify the phrenic nerve stimulations based on the at least one indicator specific to the lack of respiratory drive. In at least one example, the sensor data indicative of patient respiration comprises at least one indicator specific to the airway obstruction. In at least one example, the IPG is configured to modify the ansa cervicalis stimulations based on the at least one indicator specific to the airway obstruction.

[0064] In at least one example, the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of the effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve stimulations and the ansa ccrvicalis stimulations based on the combincd-cffcctivcncss parameters. In at least one example, the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein, responsive to the determination that the sensor data indicative of patient respiration is indicative of the airway obstruction, the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

[0065] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether the operational parameters comprise phrenic nerve stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters comprise the phrenic nerve electrical stimulation parameters, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0066] In at least one example, the IPG is configured to provide the ansa cervicalis electrical stimulations to the ansa cervicalis of the patient during the at least one sleeping period via the at least one second stimulation lead in an absence of phrenic nerve electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the phrenic nerve electrical stimulation parameters. In at least one example, the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period. In at least one example, the operational parameters determined prior to the at least one sleeping period are based at least in part on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

[0067] In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

[0068] In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations.

[0069] In at least one example, the system further includes at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a prc-dctcrmincd collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the accumulated sensor data.

[0070] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device.

[0071] In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters. In at least one example, the system includes at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position. In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

[0072] In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations. In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processorexecutable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0073] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

[0074] In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa ccrvicalis. In at least one example, the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa ccrvicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

[0075] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of a lack of respiratory drive, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the lack of central respiratory drive, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

[0076] In at least one example, the IPG is configured to provide the ansa cervicalis electrical stimulations to the ansa cervicalis of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of phrenic nerve electrical stimulations during the at least one sleeping period responsive to a determination that an indication of lack of respiratory drive is absent from the sensor data indicative of patient respiration. In at least one example, to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

[0077] In at least one example, to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period. In at least one example, the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG. In at least one example, the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters. In at least one example, the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data. In at least one example, the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the pre-determined phrenic nerve stimulation rate based on the sensor data.

[0078] In at least one example, the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization. In at least one example, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface. In at least one example, the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters. In at least one example, the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

[0079] In at least one example, the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG. In at least one example, the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

[0080] In at least one example, the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations. In at least one example, the at least one first sensor comprises a transthoracic impedance sensor. In at least one example, the system includes at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

[0081] In at least one example, the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer. In at least one example, the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations. In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

[0082] In at least one example, the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period. In at least one example, the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis.

[0083] In at least one example, the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to the lack of respiratory drive. In at least one example, the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a pre-determined phrenic nerve stimulation rate. In at least one example, the IPG is configured to modify the phrenic nerve stimulations based on the at least one indicator specific to the lack of respiratory drive. Tn at least one example, the sensor data indicative of patient respiration comprises at least one indicator specific to an airway obstruction. In at least one example, the IPG is configured to modify the ansa cervical is stimulations based on the at least one indicator specific to the airway obstruction.

[0084] In at least one example, the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of the effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve stimulations and the ansa cervicalis stimulations based on the combined-effectiveness parameters. In at least one example, the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

[0085] Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, receive, from at least one airwayobstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detect the decreased airway patency of the patient based on the airway information, provide at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinate a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0086] In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient comprises an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient via the at least one second stimulation lead.

[0087] In at least one example, the at least one airway-obstruction sensor comprises at least one microphone. In at least one example, the airway information comprises audio information. In at least one example, detecting the decreased airway patency based on the airway information comprises determining that the audio information is indicative of the patient snoring. In at least one example, the at least one airway-obstruction sensor comprises a transthoracic impedance sensor. In at least one example, the airway information is indicative of a breathing rate of the patient. In at least one example, the airway information is indicative of a lung volume of the patient. In at least one example, the at least one airway-obstruction sensor comprises at least one accelerometer. In at least one example, the airway information is indicative of movement of the patient. In at least one example, the movement of the patient is indicative of a position of the patient.

[0088] In at least one example, the at least one accelerometer is implanted in the patient. In at least one example, the at least one accelerometer comprises a first accelerometer external to the patient. In at least one example, the at least one accelerometer comprises a second accelerometer implanted in the patient. In at least one example, the at least one airway-obstruction sensor comprises a pulse oximeter. In at least one example, the airway information comprises a blood oxygen level of the patient. In at least one example, the at least one airway-obstruction sensor comprises at least one heart-rate sensor. In at least one example, the airway information is indicative of a heart rate of the patient.

[0089] In at least one example, the at least one airway-obstruction sensor comprises one or more leads to sense electrical activity of the heart of the patient. In at least one example, the therapy data is indicative of a sleep stage of the patient. In at least one example, the at least one airwayobstruction sensor comprises at least one pressure sensor. In at least one example, the at least one first stimulation lead comprises one or more electrodes. In at least one example, one or more leads of the at least one first stimulation lead arc configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, the at least one second stimulation lead comprises one or more electrodes.

[0090] In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead comprises one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the hypoglossal nerve of the patient. In at least one example, the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on the airway information. In at least one example, the system includes at least one respiratory sensor configured to provide respiratory information indicative of at least one respiratory parameter, and wherein the implanted therapy controller is further configured to determine, based on the respiratory information, a therapyspecific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient.

[0091] In at least one example, the at least one respiratory sensor comprises at least one transthoracic impedance sensor. In at least one example, the at least one respiratory sensor comprises at least one accelerometer. In at least one example, the therapy- specific indicator comprises an entrainment index. In at least one example, the implanted therapy controller is further configured to determine whether the therapy- specific indicator satisfies at least one therapy-effectiveness criterion by determining whether the entrainment index is within a threshold range of capture-index values. In at least one example, the implanted therapy controller is further configured to provide, simultaneously with the at least one phrenic nerve electrical stimulation, at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency. In at least one example, the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the implanted therapy controller is configured to: determine one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation, and adjust one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation.

[0092] In at least one example, the implanted therapy controller is further configured to receive sleep parameters indicative of a sleep stage of the patient. In at least one example, the therapy data is indicative of the patient’s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency. In at least one example, the implanted therapy controller is configured to: evaluate an effect of the at least one hypoglossal nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjust one or more parameters of the at least one hypoglossal nerve electrical stimulation based on the evaluation.

[0093] In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient. In at least one example, the preprogrammed stimulation rate is an entrainment frequency.

[0094] In at least one example, the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient. In at least one example, the indication of the combination sleep apnea is an indication of a mixed apnea. In at least one example, the system includes one or more implanted respiratory parameter sensors. In at least one example, the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one hypoglossal nerve stimulation lead or the at least one phrenic nerve stimulation lead. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff.

[0095] In at least one example, the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability. In at least one example, the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity. In at least one example, the one or more implanted respiratory parameter sensors are implanted unilaterally. In at least one example, the one or more implanted respiratory parameter sensors are implanted bilaterally. In at least one example, the system includes one or more respiratory parameter sensors disposed externally on the patient. In at least one example, the implanted therapy controller is configured to coordinate the relative timing to provide the at least one hypoglossal nerve electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

[0096] In at least one example, the system includes at least one sensor, wherein the implanted therapy controller is further configured to: receive sensor data from the at least one sensor; and determine, based on the sensor data, that the patient is asleep. In at least one example, the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one hypoglossal nerve electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy. Examples of the disclosure include a treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, receive, from at least one airwayobstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detect the decreased airway patency of the patient based on the airway information, provide at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via the at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinate a relative timing of the at least one ansa cervicalis electrical stimulation to the ansa cervicalis with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0097] In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient comprises an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more ansa cervicalis electrical stimulations to the ansa cervicalis of the patient via the at least one second stimulation lead.

[0098] In at least one example, the at least one airway-obstruction sensor comprises at least one microphone. In at least one example, the airway information comprises audio information. In at least one example, detecting the decreased airway patency based on the airway information comprises determining that the audio information is indicative of the patient snoring. In at least one example, the at least one airway-obstruction sensor comprises a transthoracic impedance sensor. In at least one example, the airway information is indicative of a breathing rate of the patient. In at least one example, the airway information is indicative of a lung volume of the patient. In at least one example, the at least one airway-obstruction sensor comprises at least one accelerometer. In at least one example, the airway information is indicative of movement of the patient. In at least one example, the movement of the patient is indicative of a position of the patient.

[0099] In at least one example, the at least one accelerometer is implanted in the patient. In at least one example, the at least one accelerometer comprises a first accelerometer external to the patient. In at least one example, the at least one accelerometer comprises a second accelerometer implanted in the patient. In at least one example, the at least one airway-obstruction sensor comprises a pulse oximeter. In at least one example, the airway information comprises a blood oxygen level of the patient. In at least one example, the at least one airway-obstruction sensor comprises at least one heart-rate sensor. In at least one example, the airway information is indicative of a heart rate of the patient. In at least one example, the at least one airway - obstruction sensor comprises one or more leads to sense electrical activity of the heart of the patient.

[0100] In at least one example, the therapy data is indicative of a sleep stage of the patient. In at least one example, the at least one airway-obstruction sensor comprises at least one pressure sensor. In at least one example, the at least one first stimulation lead comprises one or more electrodes. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead comprises one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, the at least one second stimulation lead comprises one or more electrodes. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

[0101] In at least one example, the at least one second stimulation lead comprises one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the ansa cervicalis of the patient. In at least one example, the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of ansa cervicalis electrical stimulations provided via the at least one ansa ccrvicalis electrical stimulation lead based on the airway information. In at least one example, the system includes at least one respiratory sensor configured to provide respiratory information indicative of at least one respiratory parameter, and wherein the implanted therapy controller is further configured to determine, based on the respiratory information, a therapy- specific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient.

[0102] In at least one example, the at least one respiratory sensor comprises at least one transthoracic impedance sensor. In at least one example, the at least one respiratory sensor comprises at least one accelerometer. In at least one example, the therapy- specific indicator comprises an entrainment index. In at least one example, the implanted therapy controller is further configured to determine whether the therapy- specific indicator satisfies at least one therapy-effectiveness criterion by determining whether the entrainment index is within a threshold range of capture-index values. In at least one example, the implanted therapy controller is further configured to provide, simultaneously with the at least one phrenic nerve electrical stimulation, at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

[0103] In at least one example, the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the implanted therapy controller is configured to: determine one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation, and adjust one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation. In at least one example, the implanted therapy controller is further configured to receive sleep parameters indicative of a sleep stage of the patient.

[0104] In at least one example, the therapy data is indicative of the patient’s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency. In at least one example, the implanted therapy controller is configured to: evaluate an effect of the at least one ansa cervicalis electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjust one or more parameters of the at least one ansa cervicalis electrical stimulation based on the evaluation.

[0105] In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient. In at least one example, the preprogrammed stimulation rate is an entrainment frequency.

[0106] In at least one example, the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient. In at least one example, the indication of the combination sleep apnea is an indication of a mixed apnea. In at least one example, the system includes one or more implanted respiratory parameter sensors. In at least one example, the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one ansa cervicalis stimulation lead or the at least one phrenic nerve stimulation lead.

[0107] In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability. In at least one example, the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity. In at least one example, the one or more implanted respiratory parameter sensors are implanted unilaterally. In at least one example, the one or more implanted respiratory parameter sensors arc implanted bilaterally.

[0108] In at least one example, the system includes one or more respiratory parameter sensors disposed externally on the patient. In at least one example, the implanted therapy controller is configured to coordinate the relative timing to provide the at least one ansa cervicalis electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation. In at least one example, the system includes at least one sensor, wherein the implanted therapy controller is further configured to: receive sensor data from the at least one sensor; and determine, based on the sensor data, that the patient is asleep. In at least one example, the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one ansa cervicalis electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

[0109] According to at least one aspect of the present disclosure, a treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising at least one first stimulation lead, at least one second stimulation lead, and an implanted therapy controller coupled to the at least one first stimulation lead and the at least one second stimulation lead, the implanted controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, receive, from at least one airway-obstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detect the decreased airway patency of the patient based on the airway information, provide at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinate a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0110] In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 500 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 300 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0111] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 100 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery staid time of the at least one hypoglossal nerve electrical stimulation is at most 50 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 10 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 5 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0112] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 1 millisecond earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 0.1 milliseconds earlier than the delivery staid time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 0.5 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0113] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 1 millisecond earlier than the delivery stall time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 5 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 10 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 50 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0114] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 100 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 500 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 300 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0115] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 100 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 50 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 10 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 5 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0116] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at most 1 millisecond later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 0.1 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 0.5 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0117] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 1 millisecond later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 5 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 10 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery staid time of the at least one hypoglossal nerve electrical stimulation is at least 50 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0118] In at least one example, the delivery start time of the at least one hypoglossal nerve electrical stimulation is at least 100 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient via the at least one second stimulation lead.

[0119] In at least one example, each of the one or more phrenic nerve electrical stimulations includes a first plurality of pulses, and wherein each of the one or more hypoglossal nerve electrical stimulations includes a second plurality of pulses. In at least one example, the second plurality of pulses ramps up over a first period of time within at least one breathing cycle. In at least one example, the second plurality of pulses remains constant over a second period of time after the first period of time within the at least one breathing cycle. In at least one example, the second plurality of pulses ramps down over a third period of time after the second period of time within the at least one breathing cycle. In at least one example, the first plurality of pulses ramps up over a fourth period of time within the at least one breathing cycle. In at least one example, the fourth period of time at least partially overlaps with the first period of time during a fifth period of time. In at least one example, first ramping-up pulses of the first plurality of pulses are synchronized with second ramping-up pulses of the second plurality of pulses during the fifth period of time. In at least one example, first ramping-up pulses of the first plurality of pulses are independent of second ramping-up pulses of the second plurality of pulses during the fifth period of time. In at least one example, a number of ramping- up pulses of the first plurality of pulses during the first period of time is synchronized with a number of ramping-up pulses of the second plurality of pulses during the fourth period of time. In at least one example, the first period of time begins prior to the fourth period of time.

[0120] In at least one example, the first period of time ends at approximately the same time as the fourth period of time. In at least one example, the first period of time ends after the fourth period of time. In at least one example, the first period of time ends before the fourth period of time. In at least one example, the first period of time begins after the fourth period of time. In at least one example, the first period of time ends at approximately the same time as the fourth period of time. In at least one example, the first period of time ends after the fourth period of time. In at least one example, the first period of time ends before the fourth period of time. In at least one example, the first period of time begins at approximately the same time as the fourth period of time.

[0121] In at least one example, the first period of time ends at approximately the same time as the fourth period of time. In at least one example, the first period of time ends after the fourth period of time. In at least one example, the first period of time ends before the fourth period of time. In at least one example, the first plurality of pulses remains constant over a sixth period of time after the fourth period of time within the at least one breathing cycle. In at least one example, the sixth period of time at least partially overlaps with the second period of time during a seventh period of time. In at least one example, first constant pulses of the first plurality of pulses are synchronized with second constant pulses of the second plurality of pulses during the seventh period of time.

[0122] In at least one example, first constant pulses of the first plurality of pulses are independent of second constant pulses of the second plurality of pulses during the seventh period of time. In at least one example, a number of constant pulses of the first plurality of pulses during the second period of time is synchronized with a number of constant pulses of the second plurality of pulses during the sixth period of time. Tn at least one example, the second period of time begins prior to the sixth period of time. In at least one example, the second period of time ends at approximately the same time as the sixth period of time. In at least one example, the second period of time ends after the sixth period of time.

[0123] In at least one example, the second period of time ends before the sixth period of time. In at least one example, the second period of time begins after the sixth period of time. In at least one example, the second period of time ends at approximately the same time as the sixth period of time. In at least one example, the second period of time ends after the sixth period of time. In at least one example, the second period of time ends before the sixth period of time. In at least one example, the second period of time begins at approximately the same time as the sixth period of time. In at least one example, the second period of time ends at approximately the same time as the sixth period of time. In at least one example, the second period of time ends after the sixth period of time. In at least one example, the second period of time ends before the sixth period of time.

[0124] In at least one example, the first plurality of pulses ramps down over an eighth period of time after the sixth period of time within the at least one breathing cycle. In at least one example, the eighth period of time at least partially overlaps with the third period of time during a ninth period of time. In at least one example, first ramping-down pulses of the first plurality of pulses are synchronized with second ramping-down pulses of the second plurality of pulses during the ninth period of time. In at least one example, first ramping-down pulses of the first plurality of pulses are independent of second ramping-down pulses of the second plurality of pulses during the ninth period of time. In at least one example, a number of constant ramping-down of the first plurality of pulses during the third period of time is synchronized with a number of rampingdown pulses of the second plurality of pulses during the eighth period of time.

[0125] In at least one example, the third period of time begins prior to the eighth period of time. In at least one example, the third period of time ends at approximately the same time as the eighth period of time. In at least one example, the third period of time ends after the eighth period of time. In at least one example, the third period of time ends before the eighth period of time. In at least one example, the third period of time begins after the eighth period of time. In at least one example, the third period of time ends at approximately the same time as the eighth period of time. In at least one example, the third period of time ends after the eighth period of time. In at least one example, the third period of time ends before the eighth period of time. In at least one example, the third period of time begins at approximately the same time as the eighth period of time.

[0126] In at least one example, the third period of time ends at approximately the same time as the eighth period of time. In at least one example, the third period of time ends after the eighth period of time. In at least one example, the third period of time ends before the eighth period of time. In at least one example, the at least one airway-obstruction sensor includes at least one microphone. In at least one example, the airway information includes audio information. In at least one example, detecting the decreased airway patency based on the airway information includes determining that the audio information is indicative of the patient snoring. In at least one example, determining that the audio information is indicative of the patient snoring includes determining that an amplitude of an audio waveform in the audio information is within a threshold range of amplitude values.

[0127] In at least one example, determining that the audio information is indicative of the patient snoring includes determining that an audio waveform in the audio information matches at least one stored waveform. In at least one example, determining that the audio information is indicative of the patient snoring includes determining that a frequency of an audio waveform in the audio information is within a threshold range of frequency values. In at least one example, the at least one airway-obstruction sensor includes a transthoracic impedance sensor. In at least one example, the airway information is indicative of a breathing rate of the patient. In at least one example, the airway information is indicative of a lung volume of the patient. In at least one example, the at least one airway-obstruction sensor includes at least one accelerometer.

[0128] In at least one example, the airway information is indicative of movement of the patient. In at least one example, the movement of the patient is indicative of movement of the chest of the patient relative to the torso of the patient. In at least one example, the movement of the patient is indicative of a position of the patient. In at least one example, the position of the patient includes one of a left side position, a right side position, a supine position, or a prone position. In at least one example, the at least one accelerometer is implanted in the patient. In at least one example, the at least one accelerometer includes a first accelerometer external to the patient. In at least one example, the at least one accelerometer includes a second accelerometer implanted in the patient. Tn at least one example, the movement of the patient is indicative of movement of the head of the patient relative to the torso of the patient.

[0129] In at least one example, the airway information is indicative of the position of the patient, and wherein detecting the decreased airway patency based on the airway information includes determining that the position of the patient is on a stored list of one or more positions. In at least one example, the airway information is indicative of a position of the head of the patient relative to the torso of the patient, and wherein detecting the decreased airway patency based on the airway information includes determining that an angle between the head of the patient and the torso of the patient is within a threshold range of degrees. In at least one example, the at least one airway-obstruction sensor includes a pulse oximeter. In at least one example, the airway information includes a blood oxygen level of the patient.

[0130] In at least one example, detecting the decreased airway patency based on the airway information includes determining that the blood oxygen level of the patient is within a threshold range of blood oxygen levels. In at least one example, detecting the decreased airway patency based on the airway information includes: determining that the blood oxygen level of the patient is within the threshold range of blood oxygen levels; and determining that the lung volume of the patient is within a threshold range of volume values.

[0131] In at least one example, detecting the decreased airway patency based on the airway information includes: determining that the blood oxygen level of the patient is within the threshold range of blood oxygen levels; and determining that the movement of the chest of the patient relative to the torso of the patient is within a threshold range of distance values. In at least one example, the at least one airway-obstruction sensor includes at least one heart-rate sensor. In at least one example, the airway information is indicative of a heart rate of the patient. In at least one example, the at least one airway-obstruction sensor includes one or more leads to sense electrical activity of the heart of the patient.

[0132] In at least one example, the therapy data is indicative of a sleep stage of the patient. In at least one example, the implanted therapy controller is further configured to determine, based on at least one of the heart rate of the patient or the movement of the patient, the sleep stage of the patient. In at least one example, the sleep stage includes one of light sleep, deep sleep, and rapideye-movement sleep. In at least one example, the airway information includes the sleep stage of the patient, and wherein detecting the decreased airway patency based on the airway information includes determining that the sleep stage of the patient is on a stored list of sleep stages. Tn at least one example, the at least one airway-obstruction sensor includes at least one pressure sensor.

[0133] In at least one example, the airway information includes pressure information indicative of a pressure exerted by movement of the chest of the patient relative to the torso of the patient. In at least one example, detecting the decreased airway patency based on the airway information includes: determining that a blood oxygen level of the patient is within a threshold range of blood oxygen levels; and determining that the pressure exerted by the movement of the chest of the patient relative to the torso of the patient is within a threshold range of pressure values. In at least one example, the at least one first stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

[0134] In at least one example, the at least one first stimulation lead includes one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, the at least one second stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the hypoglossal nerve of the patient. In at least one example, the at least one first stimulation lead includes one or more first electrodes and the at least one second stimulation lead includes one or more second electrodes.

[0135] In at least one example, one or more first leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, one or more second stimulation leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one first stimulation lead includes one or more nerve cuffs and the at least one second stimulation lead includes one or more electrodes. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient.

[0136] In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs and the at least one first stimulation lead includes one or more electrodes. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the hypoglossal nerve of the patient. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

[0137] In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead includes one or more first nerve cuffs and the at least one second stimulation lead includes one or more second nerve cuffs. In at least one example, one or more first nerve cuffs of the at least one first nerve cuff are configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, one or more second nerve cuffs of the at least one second nerve cuff are configured to be operatively coupled to the hypoglossal nerve of the patient. In at least one example, one or more nerve cuffs of the at least one second nerve cuff are configured to be operatively coupled to the hypoglossal nerve of the patient.

[0138] In at least one example, the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on the airway information. In at least one example, at least one of the first parameters or the second parameters includes a plurality of parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping- up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0139] In at least one example, at least one of the first parameters or the second parameters includes a number of pulses. In at least one example, at least one of the first parameters or the second parameters includes a current magnitude. In at least one example, at least one of the first parameters or the second parameters includes a voltage magnitude. In at least one example, at least one of the first parameters or the second parameters includes a frequency at which pulses are applied. In at least one example, at least one of the first parameters or the second parameters includes a time over which pulses are ramped up. In at least one example, at least one of the first parameters or the second parameters includes a time over which pulses are ramped down. In at least one example, at least one of the first parameters or the second parameters includes a number of ramping-up pulses.

[0140] In at least one example, at least one of the first parameters or the second parameters includes a number of ramping-down pulses. In at least one example, at least one of the first parameters or the second parameters includes a magnitude of at least one ramping-up pulse. In at least one example, at least one of the first parameters or the second parameters includes a magnitude of at least one ramping-down pulse. In at least one example, at least one of the first parameters or the second parameters includes a pulse width. In at least one example, at least one of the first parameters or the second parameters includes a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation. In at least one example, at least one of the first parameters or the second parameters includes a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0141] In at least one example, at least one of the first parameters or the second parameters includes at least three parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0142] In at least one example, at least one of the first parameters or the second parameters includes at least four parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0143] In at least one example, at least one of the first parameters or the second parameters includes at least five parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0144] In at least one example, at least one of the first parameters or the second parameters includes at least six parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0145] In at least one example, at least one of the first parameters or the second parameters includes at least seven parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0146] In at least one example, at least one of the first parameters or the second parameters includes at least eight parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0147] In at least one example, at least one of the first parameters or the second parameters includes at least nine parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0148] In at least one example, at least one of the first parameters or the second parameters includes at least 10 parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0149] In at least one example, at least one of the first parameters or the second parameters includes at least 11 parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0150] In at least one example, at least one of the first parameters or the second parameters includes at least 12 parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0151] In at least one example, at least one of the first parameters or the second parameters includes a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation.

[0152] In at least one example, the system includes at least one respiratory sensor configured to provide respiratory information indicative of at least one respiratory parameter, and wherein the implanted therapy controller is further configured to determine, based on the respiratory information, a therapy- specific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient.

[0153] In at least one example, the at least one respiratory sensor includes at least one transthoracic impedance sensor. In at least one example, the at least one respiratory sensor includes at least one accelerometer. In at least one example, the at least one respiratory sensor includes at least one pressure sensor. In at least one example, the at least one respiratory parameter includes a breathing rate of the patient. In at least one example, the at least one respiratory parameter includes a lung volume of the patient. In at least one example, the therapyspecific indicator includes an entrainment index. In at least one example, the implanted therapy controller is further configured to determine whether the therapy-specific indicator satisfies at least one therapy-effectiveness criterion by determining whether the entrainment index is within a threshold range of capture-index values.

[0154] In at least one example, the at least one respiratory sensor includes a pulse oximeter. In at least one example, the at least one respiratory parameter includes a blood oxygen level of the patient. In at least one example, the therapy-specific indicator includes the blood oxygen level of the patient. In at least one example, the implanted therapy controller is further configured to determine whether the therapy-specific indicator satisfies at least one therapy-effectiveness criterion by determining whether the blood oxygen level of the patient is within a threshold range of blood oxygen levels. In at least one example, the implanted therapy controller is further configured to provide, simultaneously with the at least one phrenic nerve electrical stimulation, at least one ansa cervicalis electrical stimulation to the ansa cervicalis of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

[0155] In at least one example, the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the implanted therapy controller is configured to: determine one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation, and adjust one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation.

[0156] In at least one example, the one or more combined-effectiveness parameters comprise one or more of an indication of decreased respiratory drive and an indication of decreased airway patency. In at least one example, the implanted therapy controller is further configured to receive sleep parameters indicative of a sleep stage of the patient. In at least one example, the sleep parameters include at least one of a heart rate of the patient or movement of the patient. In at least one example, the implanted therapy controller is further configured to determine, based on at least one of the heart rate of the patient or the movement of the patient, a sleep stage of the patient. In at least one example, the sleep stage includes one of light sleep, deep sleep, rapid-eye- movement sleep, and awake. In at least one example, the implanted therapy controller is configured to provide at least one of the at least one phrenic nerve electrical stimulation or the at least one hypoglossal nerve electrical stimulation responsive to determining that the sleep stage of the patient is one of the light sleep, the deep sleep, or the rapid-eye-movement sleep stage.

[0157] In at least one example, the therapy data is indicative of the patient’s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’ s respiration rate and the entrainment frequency. In at least one example, the entrainment index comprises a ratio indicative of a degree of entrainment of a patient.

[0158] In at least one example, the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, the entrainment index is a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the implanted therapy controller is configured to adjust at least one parameter of the plurality of phrenic nerve stimulations based on the entrainment index. In at least one example, the implanted therapy controller is configured to coordinate the relative timing based at least in part on the entrainment frequency.

[0159] In at least one example, the implanted therapy controller is configured to: evaluate an effect of the at least one hypoglossal nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjust one or more parameters of the at least one hypoglossal nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration.

[0160] In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient. In at least one example, the preprogrammed stimulation rate is an entrainment frequency. In at least one example, the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient. In at least one example, the indication of the combination sleep apnea is an indication of a mixed apnea. In at least one example, the indication of the mixed apnea comprises a detection of lack of respiratory drive followed by a respiratory effort against a restricted or restricting airway within a single apnea event.

[0161] In at least one example, the system includes one or more implanted respiratory parameter sensors. In at least one example, the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one hypoglossal nerve stimulation lead or the at least one phrenic nerve stimulation lead. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability.

[0162] In at least one example, the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity. In at least one example, the one or more implanted respiratory parameter sensors are implanted unilaterally. In at least one example, the one or more implanted respiratory parameter sensors are implanted bilaterally. In at least one example, the system includes one or more respiratory parameter sensors disposed externally on the patient. In at least one example, the implanted therapy controller is configured to coordinate the relative timing to provide the at least one hypoglossal nerve electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

[0163] According to at least one example of the disclosure, a treatment system for providing disordered breathing therapy to a sleeping patient is provided, the system comprising at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller coupled to the at least one first stimulation lead and the at least one second stimulation lead, the implanted controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, receive, from at least one airway-obstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detect the decreased airway patency of the patient based on the airway information, provide at least one ansa cervical is electrical stimulation to the ansa cervicalis of the patient via the at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinate a relative timing of the at least one ansa cervicalis electrical stimulation to the ansa cervicalis with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 500 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 300 milliseconds earlier than the delivery staid time of the at least one phrenic nerve electrical stimulation.

[0164] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 100 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 50 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 10 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 5 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0165] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 1 millisecond earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 0.1 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery star! time of the at least one ansa cervicalis electrical stimulation is at least 0.5 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0166] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 1 millisecond earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. Tn at least one example, the delivery start time of the at least one ansa ccrvicalis electrical stimulation is at least 5 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 10 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 50 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0167] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 100 milliseconds earlier than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 500 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 300 milliseconds later than the delivery staid time of the at least one phrenic nerve electrical stimulation.

[0168] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 100 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 50 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 10 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 5 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0169] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at most 1 millisecond later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa ccrvicalis electrical stimulation is at least 0.1 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 0.5 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0170] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 1 millisecond later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 5 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 10 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 50 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation.

[0171] In at least one example, the delivery start time of the at least one ansa cervicalis electrical stimulation is at least 100 milliseconds later than the delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more ansa cervicalis electrical stimulations to the ansa cervicalis of the patient via the at least one second stimulation lead.

[0172] In at least one example, each of the one or more phrenic nerve electrical stimulations includes a first plurality of pulses, and wherein each of the one or more ansa cervicalis electrical stimulations includes a second plurality of pulses. In at least one example, the second plurality of pulses ramps up over a first period of time within at least one breathing cycle. In at least one example, the second plurality of pulses remains constant over a second period of time after the first period of time within the at least one breathing cycle. In at least one example, the second plurality of pulses ramps down over a third period of time after the second period of time within the at least one breathing cycle. In at least one example, the first plurality of pulses ramps up over a fourth period of time within the at least one breathing cycle.

[0173] In at least one example, the fourth period of time at least partially overlaps with the first period of time during a fifth period of time. In at least one example, first ramping-up pulses of the first plurality of pulses are synchronized with second ramping-up pulses of the second plurality of pulses during the fifth period of time. In at least one example, first ramping-up pulses of the first plurality of pulses are independent of second ramping-up pulses of the second plurality of pulses during the fifth period of time. In at least one example, a number of ramping- up pulses of the first plurality of pulses during the first period of time is synchronized with a number of ramping-up pulses of the second plurality of pulses during the fourth period of time.

[0174] In at least one example, the first period of time begins prior to the fourth period of time. In at least one example, the first period of time ends at approximately the same time as the fourth period of time. In at least one example, the first period of time ends after the fourth period of time. In at least one example, the first period of time ends before the fourth period of time. In at least one example, the first period of time begins after the fourth period of time. In at least one example, the first period of time ends at approximately the same time as the fourth period of time. In at least one example, the first period of time ends after the fourth period of time. In at least one example, the first period of time ends before the fourth period of time. In at least one example, the first period of time begins at approximately the same time as the fourth period of time.

[0175] In at least one example, the first period of time ends at approximately the same time as the fourth period of time. In at least one example, the first period of time ends after the fourth period of time. In at least one example, the first period of time ends before the fourth period of time. In at least one example, the first plurality of pulses remains constant over a sixth period of time after the fourth period of time within the at least one breathing cycle. In at least one example, the sixth period of time at least partially overlaps with the second period of time during a seventh period of time. In at least one example, first constant pulses of the first plurality of pulses are synchronized with second constant pulses of the second plurality of pulses during the seventh period of time. In at least one example, first constant pulses of the first plurality of pulses are independent of second constant pulses of the second plurality of pulses during the seventh period of time.

[0176] In at least one example, a number of constant pulses of the first plurality of pulses during the second period of time is synchronized with a number of constant pulses of the second plurality of pulses during the sixth period of time. In at least one example, the second period of time begins prior to the sixth period of time. In at least one example, the second period of time ends at approximately the same time as the sixth period of time. In at least one example, the second period of time ends after the sixth period of time. In at least one example, the second period of time ends before the sixth period of time. In at least one example, the second period of time begins after the sixth period of time.

[0177] In at least one example, the second period of time ends at approximately the same time as the sixth period of time. In at least one example, the second period of time ends after the sixth period of time. In at least one example, the second period of time ends before the sixth period of time. In at least one example, the second period of time begins at approximately the same time as the sixth period of time. In at least one example, the second period of time ends at approximately the same time as the sixth period of time. In at least one example, the second period of time ends after the sixth period of time. In at least one example, the second period of time ends before the sixth period of time. In at least one example, the first plurality of pulses ramps down over an eighth period of time after the sixth period of time within the at least one breathing cycle. In at least one example, the eighth period of time at least partially overlaps with the third period of time during a ninth period of time.

[0178] In at least one example, first ramping-down pulses of the first plurality of pulses are synchronized with second ramping-down pulses of the second plurality of pulses during the ninth period of time. In at least one example, first ramping-down pulses of the first plurality of pulses are independent of second ramping-down pulses of the second plurality of pulses during the ninth period of time. In at least one example, a number of constant ramping-down of the first plurality of pulses during the third period of time is synchronized with a number of rampingdown pulses of the second plurality of pulses during the eighth period of time. In at least one example, the third period of time begins prior to the eighth period of time. In at least one example, the third period of time ends at approximately the same time as the eighth period of time. In at least one example, the third period of time ends after the eighth period of time. In at least one example, the third period of time before after the eighth period of time. In at least one example, the third period of time begins after the eighth period of time. In at least one example, the third period of time ends at approximately the same time as the eighth period of time. In at least one example, the third period of time ends after the eighth period of time. In at least one example, the third period of time ends before the eighth period of time. In at least one example, the third period of time begins at approximately the same time as the eighth period of time. In at least one example, the third period of time ends at approximately the same time as the eighth period of time. In at least one example, the third period of time ends after the eighth period of time.

[0179] In at least one example, the third period of time ends before the eighth period of time. In at least one example, the at least one airway-obstruction sensor includes at least one microphone. In at least one example, the airway information includes audio information. In at least one example, detecting the decreased airway patency based on the airway information includes determining that the audio information is indicative of the patient snoring. In at least one example, determining that the audio information is indicative of the patient snoring includes determining that an amplitude of an audio waveform in the audio information is within a threshold range of amplitude values. In at least one example, determining that the audio information is indicative of the patient snoring includes determining that an audio waveform in the audio information matches at least one stored waveform. In at least one example, determining that the audio information is indicative of the patient snoring includes determining that a frequency of an audio waveform in the audio information is within a threshold range of frequency values.

[0180] In at least one example, the at least one airway-obstruction sensor includes a transthoracic impedance sensor. In at least one example, the airway information is indicative of a breathing rate of the patient. In at least one example, the airway information is indicative of a lung volume of the patient. In at least one example, the at least one airway-obstruction sensor includes at least one accelerometer. In at least one example, the airway information is indicative of movement of the patient. In at least one example, the movement of the patient is indicative of movement of the chest of the patient relative to the torso of the patient. In at least one example, the movement of the patient is indicative of a position of the patient. In at least one example, the position of the patient includes one of a left side position, a right side position, a supine position, or a prone position. In at least one example, the at least one accelerometer is implanted in the patient.

[0181] In at least one example, the at least one accelerometer includes a first accelerometer external to the patient. In at least one example, the at least one accelerometer includes a second accelerometer implanted in the patient. In at least one example, the movement of the patient is indicative of movement of the head of the patient relative to the torso of the patient. In at least one example, the airway information is indicative of the position of the patient, and wherein detecting the decreased airway patency based on the airway information includes determining that the position of the patient is on a stored list of one or more positions. In at least one example, the airway information is indicative of a position of the head of the patient relative to the torso of the patient, and wherein detecting the decreased airway patency based on the airway information includes determining that an angle between the head of the patient and the torso of the patient is within a threshold range of degrees.

[0182] In at least one example, the at least one airway-obstruction sensor includes a pulse oximeter. In at least one example, the airway information includes a blood oxygen level of the patient. In at least one example, detecting the decreased airway patency based on the airway information includes determining that the blood oxygen level of the patient is within a threshold range of blood oxygen levels. In at least one example, detecting the decreased airway patency based on the airway information includes: determining that the blood oxygen level of the patient is within the threshold range of blood oxygen levels; and determining that the lung volume of the patient is within a threshold range of volume values. In at least one example, detecting the decreased airway patency based on the airway information includes: determining that the blood oxygen level of the patient is within the threshold range of blood oxygen levels; and determining that the movement of the chest of the patient relative to the torso of the patient is within a threshold range of distance values.

[0183] In at least one example, the at least one airway-obstruction sensor includes at least one heart-rate sensor. In at least one example, the airway information is indicative of a heard rate of the patient. In at least one example, the at least one airway-obstruction sensor includes one or more leads to sense electrical activity of the heart of the patient. In at least one example, the therapy data is indicative of a sleep stage of the patient. In at least one example, the implanted therapy controller is further configured to determine, based on at least one of the heart rate of the patient or the movement of the patient, the sleep stage of the patient. In at least one example, the sleep stage includes one of light sleep, deep sleep, and rapid-cyc-movcmcnt sleep. In at least one example, the airway information includes the sleep stage of the patient, and wherein detecting the decreased airway patency based on the airway information includes determining that the sleep stage of the patient is on a stored list of sleep stages.

[0184] In at least one example, the at least one airway-obstruction sensor includes at least one pressure sensor. In at least one example, the airway information includes pressure information indicative of a pressure exerted by movement of the chest of the patient relative to the torso of the patient. In at least one example, detecting the decreased airway patency based on the airway information includes: determining that a blood oxygen level of the patient is within a threshold range of blood oxygen levels; and determining that the pressure exerted by the movement of the chest of the patient relative to the torso of the patient is within a threshold range of pressure values. In at least one example, the at least one first stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one first stimulation lead arc configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, the at least one first stimulation lead includes one or more nerve cuffs.

[0185] In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, the at least one second stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the ansa cervicalis of the patient. In at least one example, the at least one first stimulation lead includes one or more first electrodes and the at least one second stimulation lead includes one or more second electrodes. In at least one example, one or more first leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

[0186] In at least one example, one or more second stimulation leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one first stimulation lead includes one or more nerve cuffs and the at least one second stimulation lead includes one or more electrodes. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

[0187] In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs and the at least one first stimulation lead includes one or more electrodes. In at least one example, at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the ansa cervicalis of the patient. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

[0188] In at least one example, the at least one first stimulation lead includes one or more first nerve cuffs and the at least one second stimulation lead includes one or more second nerve cuffs. In at least one example, one or more first nerve cuffs of the at least one first nerve cuff are configured to be operatively coupled to the phrenic nerve of the patient. In at least one example, one or more second nerve cuffs of the at least one second nerve cuff are configured to be operatively coupled to the ansa cervicalis of the patient. In at least one example, one or more nerve cuffs of the at least one second nerve cuff are configured to be operatively coupled to the ansa cervicalis of the patient.

[0189] In at least one example, the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of ansa cervicalis electrical stimulations provided via the at least one ansa cervicalis electrical stimulation lead based on the airway information. In at least one example, at least one of the first parameters or the second parameters includes a plurality of parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0190] In at least one example, at least one of the first parameters or the second parameters includes a number of pulses. In at least one example, at least one of the first parameters or the second parameters includes a current magnitude. In at least one example, at least one of the first parameters or the second parameters includes a voltage magnitude. In at least one example, at least one of the first parameters or the second parameters includes a frequency at which pulses are applied. In at least one example, at least one of the first parameters or the second parameters includes a time over which pulses are ramped up. In at least one example, at least one of the first parameters or the second parameters includes a time over which pulses are ramped down. In at least one example, at least one of the first parameters or the second parameters includes a number of ramping-up pulses.

[0191] In at least one example, at least one of the first parameters or the second parameters includes a number of ramping-down pulses. In at least one example, at least one of the first parameters or the second parameters includes a magnitude of at least one ramping-up pulse. In at least one example, at least one of the first parameters or the second parameters includes a magnitude of at least one ramping-down pulse. In at least one example, at least one of the first parameters or the second parameters includes a pulse width. In at least one example, at least one of the first parameters or the second parameters includes a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation. In at least one example, at least one of the first parameters or the second parameters includes a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0192] In at least one example, at least one of the first parameters or the second parameters includes at least three parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0193] In at least one example, at least one of the first parameters or the second parameters includes at least four parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0194] In at least one example, at least one of the first parameters or the second parameters includes at least five parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0195] In at least one example, at least one of the first parameters or the second parameters includes at least six parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0196] In at least one example, at least one of the first parameters or the second parameters includes at least seven parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0197] In at least one example, at least one of the first parameters or the second parameters includes at least eight parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0198] In at least one example, at least one of the first parameters or the second parameters includes at least nine parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0199] In at least one example, at least one of the first parameters or the second parameters includes at least 10 parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses arc ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0200] In at least one example, at least one of the first parameters or the second parameters includes at least 11 parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses arc ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0201] In at least one example, at least one of the first parameters or the second parameters includes at least 12 parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0202] In at least one example, at least one of the first parameters or the second parameters includes a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the ansa cervicalis electrical stimulation.

[0203] In at least one example, the system includes at least one respiratory sensor configured to provide respiratory information indicative of at least one respiratory parameter, and wherein the implanted therapy controller is further configured to determine, based on the respiratory information, a therapy- specific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient. In at least one example, the at least one respiratory sensor includes at least one transthoracic impedance sensor. In at least one example, the at least one respiratory sensor includes at least one accelerometer. In at least one example, the at least one respiratory sensor includes at least one pressure sensor.

[0204] In at least one example, the at least one respiratory parameter includes a breathing rate of the patient. In at least one example, the at least one respiratory parameter includes a lung volume of the patient. In at least one example, the therapy-specific indicator includes an entrainment index. In at least one example, the implanted therapy controller is further configured to determine whether the therapy-specific indicator satisfies at least one therapy-effectiveness criterion by determining whether the entrainment index is within a threshold range of entrainment-index values. In at least one example, the at least one respiratory sensor includes a pulse oximeter. In at least one example, the at least one respiratory parameter includes a blood oxygen level of the patient. In at least one example, the therapy-specific indicator includes the blood oxygen level of the patient.

[0205] In at least one example, the implanted therapy controller is further configured to determine whether the therapy-specific indicator satisfies at least one therapy-effectiveness criterion by determining whether the blood oxygen level of the patient is within a threshold range of blood oxygen levels. In at least one example, the implanted therapy controller is further configured to provide, simultaneously with the at least one phrenic nerve electrical stimulation, at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

[0206] In at least one example, the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the implanted therapy controller is configured to: determine one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one ansa ccrvicalis electrical stimulation, and adjust one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation. In at least one example, the one or more combined-effectiveness parameters comprise one or more of an indication of decreased respiratory drive and an indication of decreased airway patency.

[0207] In at least one example, the implanted therapy controller is further configured to receive sleep parameters indicative of a sleep stage of the patient. In at least one example, the sleep parameters include at least one of a heart rate of the patient or movement of the patient. In at least one example, the implanted therapy controller is further configured to determine, based on at least one of the heart rate of the patient or the movement of the patient, the sleep stage of the patient. In at least one example, the sleep stage includes one of light sleep, deep sleep, rapid-eye- movement sleep, and awake. In at least one example, the implanted therapy controller is configured to provide at least one of the at least one phrenic nerve electrical stimulation or the at least one ansa cervicalis electrical stimulation responsive to determining that the sleep stage of the patient is one of the light sleep, the deep sleep, or the rapid-eye-movement sleep stage.

[0208] In at least one example, the therapy data is indicative of the patient’s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency.

[0209] In at least one example, the entrainment index comprises a ratio indicative of a degree of entrainment of a patient. In at least one example, the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, the entrainment index is a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the implanted therapy controller is configured to adjust at least one parameter of the plurality of phrenic nerve stimulations based on the entrainment index. In at least one example, the implanted therapy controller is configured to coordinate the relative timing based at least in part on the entrainment frequency. In at least one example, the implanted therapy controller is configured to: evaluate an effect of the at least one ansa cervicalis electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’ s airway patency, and adjust one or more parameters of the at least one ansa cervicalis electrical stimulation based on the evaluation.

[0210] In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

[0211] In at least one example, the preprogrammed stimulation rate is an entrainment frequency. In at least one example, the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient. In at least one example, the indication of the combination sleep apnea is an indication of a mixed apnea. In at least one example, the indication of the mixed apnea comprises a detection of lack of respiratory drive followed by a respiratory effort against a restricted or restricting airway within a single apnea event. In at least one example, the system includes one or more implanted respiratory parameter sensors. In at least one example, the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one ansa cervicalis stimulation lead or the at least one phrenic nerve stimulation lead.

[0212] In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability. In at least one example, the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity. In at least one example, the one or more implanted respiratory parameter sensors are implanted unilaterally. In at least one example, the one or more implanted respiratory parameter sensors are implanted bilaterally. In at least one example, the system includes one or more respiratory parameter sensors disposed externally on the patient. In at least one example, the implanted therapy controller is configured to coordinate the relative timing to provide the at least one ansa cervicalis electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

[0213] According to at least one example of the disclosure, a method of providing disordered breathing therapy to a sleeping patient is provided, the method comprising providing at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via at least one first stimulation lead, receiving, from at least one airway-obstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detecting the decreased airway patency of the patient based on the airway information, providing at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinating a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0214] In at least one example, the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the method further comprises: determining one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation, and adjusting one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation.

[0215] In at least one example, the one or more combined-effectiveness parameters comprise one or more of an indication of decreased respiratory drive and an indication of decreased airway patency. In at least one example, the method includes receiving sleep parameters indicative of a sleep stage of the patient. In at least one example, the sleep parameters include at least one of a heart rate of the patient or movement of the patient. In at least one example, the method includes determining, based on at least one of the heart rate of the patient or the movement of the patient, the sleep stage of the patient. In at least one example, the sleep stage includes one of light sleep, deep sleep, rapid-eye-movement sleep, and awake. In at least one example, the method includes providing at least one of the at least one phrenic nerve electrical stimulation or the at least one hypoglossal nerve electrical stimulation responsive to determining that the sleep stage of the patient is one of the light sleep, the deep sleep, or the rapid-eye-movement sleep stage.

[0216] In at least one example, the therapy data is indicative of the patient’s respiratory drive, and wherein the method further comprises: evaluating an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjusting one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the method includes providing a plurality of phrenic nerve electrical stimulations at an entrainment frequency, wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency. In at least one example, the entrainment index comprises a ratio indicative of a degree of entrainment of a patient.

[0217] In at least one example, the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, the entrainment index is a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the method includes adjusting at least one parameter of the plurality of phrenic nerve stimulations based on the entrainment index. In at least one example, the method includes coordinating the relative timing based at least in part on the entrainment frequency. In at least one example, the method includes evaluating an effect of the at least one hypoglossal nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjusting one or more parameters of the at least one hypoglossal nerve electrical stimulation based on the evaluation.

[0218] In at least one example, the method includes providing the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient. In at least one example, the method includes providing the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration. In at least one example, the method includes providing the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

[0219] In at least one example, the preprogrammed stimulation rate is an entrainment frequency. In at least one example, the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient. In at least one example, the indication of the combination sleep apnea is an indication of a mixed apnea. In at least one example, the indication of the mixed apnea comprises a detection of lack of respiratory drive followed by a respiratory effort against a restricted or restricting airway within a single apnea event. In at least one example, the method includes providing one or more implanted respiratory parameter sensors. In at least one example, the method includes providing an implanted therapy controller, wherein the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller.

[0220] In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one hypoglossal nerve stimulation lead or the at least one phrenic nerve stimulation lead. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability. In at least one example, the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity. In at least one example, the one or more implanted respiratory parameter sensors are implanted unilaterally.

[0221] In at least one example, the one or more implanted respiratory parameter sensors are implanted bilaterally. In at least one example, the method includes providing one or more respiratory parameter sensors disposed externally on the patient. In at least one example, the method includes coordinating the relative timing to provide the at least one hypoglossal nerve electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is earlier than the delivery staid time of the at least one phrenic nerve electrical stimulation.

[0222] In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the method further comprises applying, for each breathing cycle of the patient, one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient via the at least one second stimulation lead. In at least one example, the at least one airway-obstruction sensor includes at least one microphone.

[0223] In at least one example, the at least one airway-obstruction sensor includes a transthoracic impedance sensor. In at least one example, the at least one airway-obstruction sensor includes at least one accelerometer. In at least one example, the at least one airway-obstruction sensor includes a pulse oximeter. In at least one example, the at least one airway-obstruction sensor includes at least one heart-rate sensor. In at least one example, the at least one airway -obstruction sensor includes one or more leads to sense electrical activity of the heart of the patient. In at least one example, the therapy data is indicative of a sleep stage of the patient. In at least one example, the at least one airway-obstruction sensor includes at least one pressure sensor. In at least one example, the at least one first stimulation lead includes one or more electrodes.

[0224] In at least one example, the at least one first stimulation lead includes one or more nerve cuffs. In at least one example, the at least one second stimulation lead includes one or more electrodes. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs. In at least one example, the at least one first stimulation lead includes one or more first electrodes and the at least one second stimulation lead includes one or more second electrodes. In at least one example, the at least one first stimulation lead includes one or more nerve cuffs and the at least one second stimulation lead includes one or more electrodes. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs and the at least one first stimulation lead includes one or more electrodes. In at least one example, the at least one first stimulation lead includes one or more first nerve cuffs and the at least one second stimulation lead includes one or more second nerve cuffs. In at least one example, the method includes modifying at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on the airway information. In at least one example, the method includes receiving respiratory information indicative of at least one respiratory parameter from at least one respiratory sensor, and determining, based on the respiratory information, a therapy- specific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient. In at least one example, the therapy-specific indicator includes an entrainment index. In at least one example, the method includes providing, simultaneously with the at least one phrenic nerve electrical stimulation, at least one ansa cervicalis electrical stimulation to ansa cervicalis of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

[0225] According to at least one example of the disclosure, a method of providing disordered breathing therapy to a sleeping patient is provided, the method comprising providing at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via at least one first stimulation lead, receiving, from at least one airway-obstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detecting the decreased airway patency of the patient based on the airway information, providing at least one ansa cervicalis electrical stimulation to ansa cervicalis of the patient via at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinating a relative timing of the at least one ansa cervicalis electrical stimulation to the ansa cervicalis with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0226] In at least one example, the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the method further comprises: determining one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation, and adjusting one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation. In at least one example, the one or more combined-effectiveness parameters comprise one or more of an indication of decreased respiratory drive and an indication of decreased airway patency.

[0227] In at least one example, the method includes receiving sleep parameters indicative of a sleep stage of the patient. In at least one example, the sleep parameters include at least one of a heart rate of the patient or movement of the patient. In at least one example, the method includes determining, based on at least one of the heard rate of the patient or the movement of the patient, the sleep stage of the patient. In at least one example, the sleep stage includes one of light sleep, deep sleep, rapid-eye-movement sleep, and awake. In at least one example, the method includes providing at least one of the at least one phrenic nerve electrical stimulation or the at least one ansa cervicalis electrical stimulation responsive to determining that the sleep stage of the patient is one of the light sleep, the deep sleep, or the rapid-eye-movement sleep stage.

[0228] In at least one example, the therapy data is indicative of the patient’s respiratory drive, and wherein the method further comprises: evaluating an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjusting one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the method includes providing a plurality of phrenic nerve electrical stimulations at an entrainment frequency, wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency.

[0229] In at least one example, the entrainment index comprises a ratio indicative of a degree of entrainment of a patient. In at least one example, the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, the entrainment index is a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the method includes adjusting at least one parameter of the plurality of phrenic nerve stimulations based on the entrainment index. In at least one example, the method includes coordinating the relative timing based at least in part on the entrainment frequency. In at least one example, the method includes evaluating an effect of the at least one ansa cervicalis electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjusting one or more parameters of the at least one ansa ccrvicalis electrical stimulation based on the evaluation.

[0230] In at least one example, the method includes providing the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient. In at least one example, the method includes providing the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration. In at least one example, the method includes providing the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

[0231] In at least one example, the preprogrammed stimulation rate is an entrainment frequency. In at least one example, the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient. In at least one example, the indication of the combination sleep apnea is an indication of a mixed apnea. In at least one example, the indication of the mixed apnea comprises a detection of lack of respiratory drive followed by a respiratory effort against a restricted or restricting airway within a single apnea event. In at least one example, the method includes providing one or more implanted respiratory parameter sensors. In at least one example, the method includes providing an implanted therapy controller, wherein the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller.

[0232] In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one ansa cervicalis stimulation lead or the at least one phrenic nerve stimulation lead. In at least one example, the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability. In at least one example, the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity. In at least one example, the one or more implanted respiratory parameter sensors are implanted unilaterally. In at least one example, the one or more implanted respiratory parameter sensors are implanted bilaterally. In at least one example, the method includes providing one or more respiratory parameter sensors disposed externally on the patient. In at least one example, the method includes coordinating the relative timing to provide the at least one ansa cervicalis electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is earlier than the delivery stall time of the at least one phrenic nerve electrical stimulation.

[0233] In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the method further comprises applying, for each breathing cycle of the patient, one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more ansa cervicalis electrical stimulations to the ansa cervicalis of the patient via the at least one second stimulation lead. In at least one example, the at least one airwayobstruction sensor includes at least one microphone.

[0234] In at least one example, the at least one airway-obstruction sensor includes a transthoracic impedance sensor. In at least one example, the at least one airway-obstruction sensor includes at least one accelerometer. In at least one example, the at least one airway -obstruction sensor includes a pulse oximeter. In at least one example, the at least one airway-obstruction sensor includes at least one heart-rate sensor. In at least one example, the at least one airway -obstruction sensor includes one or more leads to sense electrical activity of the heart of the patient. In at least one example, the therapy data is indicative of a sleep stage of the patient. In at least one example, the at least one airway-obstruction sensor includes at least one pressure sensor. In at least one example, the at least one first stimulation lead includes one or more electrodes.

[0235] In at least one example, the at least one first stimulation lead includes one or more nerve cuffs. In at least one example, the at least one second stimulation lead includes one or more electrodes. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs. In at least one example, the at least one first stimulation lead includes one or more first electrodes and the at least one second stimulation lead includes one or more second electrodes. In at least one example, the at least one first stimulation lead includes one or more nerve cuffs and the at least one second stimulation lead includes one or more electrodes. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs and the at least one first stimulation lead includes one or more electrodes.

[0236] In at least one example, the at least one first stimulation lead includes one or more first nerve cuffs and the at least one second stimulation lead includes one or more second nerve cuffs. In at least one example, the method includes modifying at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of ansa cervicalis electrical stimulations provided via the at least one ansa cervicalis electrical stimulation lead based on the airway information. In at least one example, the method includes receiving respiratory information indicative of at least one respiratory parameter from at least one respiratory sensor, and determining, based on the respiratory information, a therapyspecific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient. In at least one example, the therapy-specific indicator includes an entrainment index. In at least one example, the method includes providing, simultaneously with the at least one phrenic nerve electrical stimulation, at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

[0237] According to at least one example of the disclosure, a treatment system for providing disordered breathing therapy to a sleeping patient is provided, the system comprising at least one first stimulation lead, at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, provide at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead, and coordinate a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0238] In at least one example, the at least one first stimulation lead includes one or more first electrodes configured to provide at least one first anode-cathode pair configured to deliver the at least one phrenic nerve electrical stimulation, and wherein the at least one second stimulation lead includes one or more second electrodes configured to provide at least one second anode- cathodc pair configured to deliver the at least one hypoglossal nerve electrical stimulation. In at least one example, one or more of the at least one first stimulation lead or the at least one second stimulation lead is a transvenous stimulation lead configured to be implanted in a lumen proximate a target nerve of the patient.

[0239] In at least one example, the at least one first stimulation lead is configured to be implanted in at least one of a brachiocephalic vein or a pericardiophrenic vein to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve. In at least one example, the at least one second stimulation lead is configured to be implanted in a ranine vein to provide the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve. In at least one example, one or more of the at least one first stimulation lead or the at least one second stimulation lead comprises at least one nerve cuff, and wherein one or more of the one or more first electrodes or the one or more second electrodes are disposed on the at least one nerve cuff.

[0240] In at least one example, the implanted therapy controller comprises at least two connector ports. In at least one example, the at least one first stimulation lead and the at least one second stimulation lead each comprise at least one terminal pin configured to couple a respective stimulation lead to at least one of the at least two connector ports. In at least one example, the implanted therapy controller comprises at least three connector ports, and wherein at least one connector port is configured to couple to a sensor lead comprising a sensor. In at least one example, the sensor comprises at least one of an electromyography sensor or a transthoracic impedance sensor.

[0241] In at least one example, the implanted therapy controller comprises at least one connector port that is unused during a particular implant. In at least one example, the implanted therapy controller comprises: at least one communications interface configured to wirelessly receive one or more of firmware or software configured to provide programmable parameters for the implanted therapy controller, and a memory configured to store the one or more of firmware or software. In at least one example, the implanted therapy controller comprises at least three connector ports including: at least one first connector port configured to couple to the at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to the at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and at least one third connector port configured to couple to at least one sensor lead comprising at least one sensor, wherein the implanted therapy controller is configured to execute the one or more of firmware or software to determine which of the at least three connector ports is the at least one first connector port, the at least one second connector port, and the at least one third connector port.

[0242] In at least one example, the implanted therapy controller is configured to download the one or more of firmware or software before implantation of the implanted therapy controller. In at least one example, the implanted therapy controller is configured to download the one or more of firmware or software after implantation of the implanted therapy controller. In at least one example, the at least one communications interface comprises a telemetry interface. In at least one example, the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol. In at least one example, the one or more of firmware or software is configured to provide at least one of first parameters of phrenic nerve electrical stimulation or second parameters of hypoglossal nerve electrical stimulations, and wherein the implanted therapy controller is further configured to modify at least one of the first parameters of the phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or the second parameters of the hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on therapy sensor data.

[0243] In at least one example, at least one of the first parameters or the second parameters includes a plurality of parameters from a list including a number of pulses, a current magnitude, a voltage magnitude, a frequency at which the pulses are applied, a time over which the pulses are ramped up, a time over which the pulses are ramped down, a number of ramping-up pulses, a number of ramping-down pulses, a magnitude of at least one of the ramping-up pulses, a magnitude of at least one of the ramping-down pulses, a pulse width of the pulses, a time between applying the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation, and a time between one or more first pulses of the phrenic nerve electrical stimulation and one or more second pulses of the hypoglossal nerve electrical stimulation. In at least one example, the implanted therapy controller comprises at least one processor and stimulation circuitry, and wherein the at least one processor is configured to determine an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency, and control the stimulation circuitry to provide a one or more of the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation based at least in part on the entrainment index.

[0244] According to at least one example, a treatment system for providing disordered breathing therapy to a sleeping patient is provided, the system comprising at least one first stimulation lead, at least one second stimulation lead, and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted therapy controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, provide at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead, and coordinate a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0245] In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one hypoglossal nerve electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient via the at least one second stimulation lead.

[0246] In at least one example, the system includes at least one sensor configured to provide sensor data indicative of a sleep state of the patient, wherein the implanted therapy controller is configured to: determine sleep parameters of the patient based on the sensor data; determine that the patient is asleep based on the sleep parameters; and provide the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation based on the determination that the patient is asleep. In at least one example, the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one hypoglossal nerve electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

[0247] In at least one example, the at least one sensor includes at least one accelerometer. In at least one example, the sensor data is indicative of movement of the patient. In at least one example, the movement of the patient is indicative of a position of the patient. In at least one example, the at least one accelerometer is implanted in the patient. In at least one example, the at least one accelerometer is external to the patient. In at least one example, the sensor data is indicative of the position of the patient, and wherein determining that the patient is asleep is based on the position of the patient. In at least one example, the at least one first stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

[0248] In at least one example, the at least one first stimulation lead includes one or more nerve cuffs. In at least one example, the at least one second stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs. In at least one example, the system includes at least one respiratory parameter sensor. In at least one example, the at least one respiratory parameter sensor is disposed externally on the patient. In at least one example, the at least one respiratory parameter sensor is an implantable sensor. In at least one example, the at least one respiratory parameter sensor is disposed at the implanted therapy controller.

[0249] In at least one example, the at least one respiratory parameter sensor is disposed at one or more of the at least one hypoglossal nerve stimulation lead or the at least one phrenic nerve stimulation lead. In at least one example, the at least one respiratory parameter sensor is disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the at least one respiratory parameter sensor is disposed on an implanted lead without nerve stimulation capability. In at least one example, the at least one respiratory parameter sensor comprises at least one of a transthoracic impedance sensor, a motion sensor, an acoustic sensor, an electromyography sensor, or a pressure sensor. In at least one example, the implanted therapy controller is further configured to: receive, from the at least one respiratory parameter sensor, therapy sensor data, and evaluate the therapy sensor data to determine a therapy-specific indicator. In at least one example, the therapy-specific indicator includes an entrainment index.

[0250] In at least one example, the entrainment index is indicative of a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the particular time period is a pre-determined collection period. In at least one example, the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on the therapy sensor data. In at least one example, the implanted therapy controller is further configured to modify at least one of the first parameters or the second parameters based on the entrainment index falling outside of a range of acceptable entrainment-index values.

[0251] In at least one example, the therapy sensor data is indicative of the patient’ s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy sensor data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency. In at least one example, the entrainment index comprises a ratio indicative of a degree of entrainment of the patient.

[0252] In at least one example, the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, the implanted therapy controller is configured to coordinate the relative timing based at least in part on the entrainment frequency. In at least one example, the implanted therapy controller is configured to: evaluate an effect of the at least one hypoglossal nerve electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one hypoglossal nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

[0253] In at least one example, the implanted therapy controller is configured to coordinate the relative timing to provide the at least one hypoglossal nerve electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation. In at least one example, the at least one phrenic nerve electrical stimulation includes a plurality of phrenic nerve electrical stimulations and the at least one hypoglossal nerve electrical stimulation includes a plurality of hypoglossal nerve electrical stimulations, and wherein the implanted therapy controller is further configured to increase an amplitude of at least one of the plurality of phrenic nerve electrical stimulations or the plurality of hypoglossal nerve stimulation over time.

[0254] At least one example of the disclosure includes a treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted therapy controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, provide at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via the at least one second stimulation lead, and coordinate a relative timing of the at least one ansa cervicalis electrical stimulation to the ansa cervicalis with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

[0255] In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, a delivery start time of the at least one ansa cervicalis electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation. In at least one example, each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more ansa cervicalis electrical stimulations to the ansa cervicalis of the patient via the at least one second stimulation lead.

[0256] In at least one example, the system includes at least one sensor configured to provide sensor data indicative of a sleep state of the patient, wherein the implanted therapy controller is configured to determine sleep parameters of the patient based on the sensor data; determine that the patient is asleep based on the sleep parameters; and provide the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation based on the determination that the patient is asleep. In at least one example, the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one ansa cervicalis electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

[0257] In at least one example, the at least one sensor includes at least one accelerometer. In at least one example, the sensor data is indicative of movement of the patient. In at least one example, the movement of the patient is indicative of a position of the patient. In at least one example, the at least one accelerometer is implanted in the patient. In at least one example, the at least one accelerometer is external to the patient. In at least one example, the sensor data is indicative of the position of the patient, and wherein determining that the patient is asleep is based on the position of the patient. In at least one example, the at least one first stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

[0258] In at least one example, the at least one first stimulation lead includes one or more nerve cuffs. In at least one example, the at least one second stimulation lead includes one or more electrodes. In at least one example, one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient. In at least one example, the at least one second stimulation lead includes one or more nerve cuffs. In at least one example, the system includes at least one respiratory parameter sensor. In at least one example, the at least one respiratory parameter sensor is disposed externally on the patient. In at least one example, the at least one respiratory parameter sensor is an implantable sensor.

[0259] In at least one example, the at least one respiratory parameter sensor is disposed at the implanted therapy controller. In at least one example, the at least one respiratory parameter sensor is disposed at one or more of the at least one ansa cervicalis stimulation lead or the at least one phrenic nerve stimulation lead. In at least one example, the at least one respiratory parameter sensor is disposed at one or more of a lead body, an electrode, or a nerve cuff. In at least one example, the at least one respiratory parameter sensor is disposed on an implanted lead without nerve stimulation capability. In at least one example, the at least one respiratory parameter sensor comprises at least one of a transthoracic impedance sensor, a motion sensor, an acoustic sensor, an electromyography sensor, or a pressure sensor. In at least one example, the implanted therapy controller is further configured to: receive, from the at least one respiratory parameter sensor, therapy sensor data, and evaluate the therapy sensor data to determine a therapy-specific indicator.

[0260] In at least one example, the therapy- specific indicator includes an entrainment index. In at least one example, the entrainment index is indicative of a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period. In at least one example, the particular time period is a pre-determined collection period. In at least one example, the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of ansa cervicalis electrical stimulations provided via the at least one ansa cervicalis electrical stimulation lead based on the therapy sensor data. In at least one example, the implanted therapy controller is further configured to modify at least one of the first parameters or the second parameters based on the entrainment index falling outside of a range of acceptable entrainment-index values.

[0261] In at least one example, the therapy sensor data is indicative of the patient’ s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy sensor data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency. In at least one example, the entrainment index comprises a ratio indicative of a degree of entrainment of the patient.

[0262] In at least one example, the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band. In at least one example, the implanted therapy controller is configured to coordinate the relative timing based at least in part on the entrainment frequency. In at least one example, the implanted therapy controller is configured to: evaluate an effect of the at least one ansa cervicalis electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one ansa cervicalis electrical stimulation based on the evaluation. In at least one example, the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

[0263] In at least one example, the implanted therapy controller is configured to coordinate the relative timing to provide the at least one ansa cervicalis electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation. In at least one example, the at least one phrenic nerve electrical stimulation includes a plurality of phrenic nerve electrical stimulations and the at least one ansa cervicalis electrical stimulation includes a plurality of ansa cervicalis electrical stimulations, and wherein the implanted therapy controller is further configured to increase an amplitude of at least one of the plurality of phrenic nerve electrical stimulations or the plurality of ansa cervicalis stimulation over time.

[0264] According to a further aspect of the disclosure we provide a treatment system for providing disordered breathing therapy to a sleeping patient, including an implantable controller configured to couple to at least one first stimulation lead for, when implanted, providing stimulation to a phrenic nerve of the patient, and configured to couple to at least one second stimulation lead, for, when implanted, providing stimulation to one or both of a hypoglossal nerve and the ansa cervicalis of the patient, wherein the implantable controller is configured to one or both of: receive operational parameters for the implantable controller, and receive a determination of whether to provide obstructive sleep apnea (OSA) therapy or central sleep apnea (CSA) therapy based on sensor data indicative of patient respiration. The operational parameters may include one or more of phrenic nerve electrical stimulation parameters, hypoglossal nerve electrical stimulation parameters, or ansa ccrvicalis electrical stimulation parameters. The implanted controller is configured to provide electrical stimulation including at least one of: phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve of the patient or ansa cervicalis stimulation to the ansa cervicalis of the patient via the at least one second stimulation lead, wherein said electrical stimulation is based on said one or both of: the received operational parameters and said received determination.

[0265] In one or more examples, the system includes the first lead and / or the second lead. In one or more examples, the operational parameters are received wirelessly. In one or more examples, the system includes a sensor configured to provide sensor data indicative of respiration to the implantable controller. In one or more examples, the implantable controller is configured to make said determination based on the sensor data, and, optionally, one or more predetermined rules that allow for a determination of the presence of OSA and / or CSA in data indicative of respiration.

[0266] According to a still further aspect of the disclosure we provide a treatment system for providing disordered breathing therapy to a sleeping patient, including: a controller, at least part or all of which is implantable, configured to couple to at least one first stimulation lead for, when implanted, providing stimulation to a phrenic nerve of the patient, and configured to couple to at least one second stimulation lead, for, when implanted, providing stimulation to one or both of a hypoglossal nerve and an ansa cervicalis of the patient, wherein the controller is configured to control the provision of, and / or control the timing and / or control a signal form of electrical stimulation provided as part of, one or both of: phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, and at least one of hypoglossal nerve electrical stimulation to the hypoglossal nerve of the patient or ansa cervicalis stimulation to the ansa cervicalis of the patient or upper-airway nerve stimulation to the upper-airway nerve of the patient via the at least one second stimulation lead.

[0267] In one or more examples, controlling when (provision of and / or how (timing and / or signal form) the electrical stimulation is provided during a sleep cycle of the patient may provide a treatment system that is capable of providing effective treatment of OSA and / or CSA and / or mixed apneas. It will be appreciated that the optional features of any of the previously described aspects may apply equally to this further aspect or still further aspect.

[0268] BRIEF DESCRIPTION OF THE DRAWINGS

[0269] Various aspects of at least one embodiment are discussed below with reference to the accompanying figures, which are not intended to be drawn to scale. The figures are included to provide an illustration and a further understanding of the various aspects and embodiments, and are incorporated in and constitute a part of this specification, but are not intended as a definition of the limits of any particular embodiment. The drawings, together with the remainder of the specification, serve to explain principles and operations of the described and claimed aspects and embodiments. In the figures, each identical or nearly identical component that is illustrated in various figures is represented by a like numeral. For purposes of clarity, not every component may be labeled in every figure. In the figures:

[0270] FIG. 1A illustrates a block diagram of a disordered breathing therapy system according to an example;

[0271] FIG. IB depicts a histogram illustrating an entrainment index calculation according to an example;

[0272] FIG. 2 illustrates a block diagram of computing components of the disordered breathing therapy system according to an example;

[0273] FIGS. 3A, 3B, and 3C illustrate perspective views of respective disordered breathing therapy systems implemented in connection with a patient according to respective examples;

[0274] FIGS. 4A, 4B, and 4C illustrate perspective views of respective disordered breathing therapy systems implemented in connection with a patient according to respective examples;

[0275] FIGS. 5A, 5B, and 5C illustrate examples of a disordered breathing therapy system implemented with implanted sensors disposed on leads;

[0276] FIG. 6 illustrates a perspective view of a disordered breathing therapy system implemented in connection with implanted sensor(s) disposed on a pulse generator according to an example;

[0277] FIG. 7 illustrates a perspective view of external sensors of a disordered breathing therapy system according to an example; FIG. 8A illustrates a process of operating a disordered breathing therapy system according to an example;

[0278] FIG. 8B illustrates operational modes and time periods associated with disordered breathing therapy according to an example;

[0279] FIG. 8C illustrates a process of operating a disordered breathing therapy system according to an example;

[0280] FIG. 9A illustrates a process of executing a treatment stage of disordered breathing therapy according to an example;

[0281] FIG. 9B illustrates a process of executing a treatment stage of disordered breathing therapy according to an example

[0282] FIG. 10A illustrates a graphical depiction of electrical stimulation according to an example;

[0283] FIG. 10B illustrates a graphical depiction of an electrical stimulation trace according to an example;

[0284] FIG. 11 A illustrates a process of operating a disordered breathing therapy system according to an example; and

[0285] FIG. 1 IB illustrates a process of operating a disordered breathing therapy system according to an example.

[0286] DETAILED DESCRIPTION

[0287] Examples of the methods and systems discussed herein are not limited in application to the details of construction and the arrangement of components set forth in the following description or illustrated in the accompanying drawings. The methods and systems are capable of implementation in other embodiments and of being practiced or of being carried out in various ways. Examples of specific implementations are provided herein for illustrative purposes only and are not intended to be limiting. In particular, acts, components, elements and features discussed in connection with any one or more examples are not intended to be excluded from a similar’ role in any other examples.

[0288] Also, the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. Any references to examples, embodiments, components, elements or acts of the systems and methods herein referred to in the singular may also embrace embodiments including a plurality, and any references in plural to any embodiment, component, element or act herein may also embrace embodiments including only a singularity. References in the singular or plural form arc not intended to limit the presently disclosed systems or methods, their components, acts, or elements. The use herein of including, comprising, having, containing, involving, and variations thereof is meant to encompass the items listed thereafter and equivalents thereof as well as additional items.

[0289] References to the term or may be construed as inclusive so that any terms described using or may indicate any of a single, more than one, and all of the described terms. In addition, in the event of inconsistent usages of terms between this document and documents incorporated herein by reference, the term usage in the incorporated features is supplementary to that of this document; for irreconcilable differences, the term usage in this document controls.

[0290] Sleep disordered breathing exists in a variety of forms including obstructive sleep apnea (OSA), central sleep apnea (CSA), and combination apneas. In OSA, the patient's central breathing drive remains intact, but the pulmonary airways collapse or otherwise become fully or partially obstructed during inspiration, which may prevent air flow causing a form of apnea, or lack of breathing. Such patients may awaken or be aroused or otherwise have sleep disturbance as a result of the apnea event. An obstruction of airflow may result from a partial or complete obstruction of the airway resulting in a reduction in airflow relative to airflow without an obstruction and may be caused by a reduction in airway stiffness and / or airway patency relative to an unobstructed airway. With CSA, patients have episodes of a lack of central breathing drive for a period of time, which may be on the order of seconds, before the breathing drive returns. The loss of respiratory drive is due to a dysfunction in the patient's central respiratory control located in the brain. This dysfunction causes the patient's breathing pattern to exhibit periods of apnea. Apneas may cause a variety of adverse consequences for a patient including, for example, large variations in arterial blood gases (i.e., oxygen and carbon dioxide), arousals and shifts to light sleep, large changes in intrathoracic pressure, decreased oxygen flow to the heart, activation of the sympathetic nervous system, endothelial cell dysfunction, pulmonary arteriolar vasoconstriction, and so forth. Heart failure patients may be particularly adversely affected by these conditions and see a deterioration in health as a result. Patients presenting with combination apnea may experience CSA events occurring predominantly with residual or less- often-occurring OSA events, OSA events occurring predominantly with residual or less-often- occurring CSA events, or a mixed apnea event. In order to treat disordered breathing, for example due to apnea events, a disordered- brcathing-trcatmcnt system may provide electrical stimulation of various nerves. For example, electrical stimulation of the phrenic nerve, which stimulates diaphragm contraction, may restore and maintain respiratory effort to restore ordered breathing patterns for patients with a loss of respiratory drive. In examples discussed herein, a disordered-breathing-treatment system may include an implantable device to deliver electrical stimulation to at least the phrenic nerve.

[0291] As another example, electrical stimulation of the hypoglossal nerve and / or the ansa cervicalis along with the phrenic nerve provides therapy that accounts for reduced airway patency due to obstruction by the tongue and / or soft palate and / or a reduction in airway stiffness. Stimulating the aforementioned nerves may cause the tongue and / or soft palate to move, clearing or stiffening the patient’s airway.

[0292] In examples discussed herein, the implantable device of the disordered-breathing- treatment system may provide dual therapy by delivering electrical stimulation to the hypoglossal nerve in addition to the phrenic nerve. In some examples, the disordered-breathing- treatment system may be used to provide electrical stimulation to the ansa cervicalis in addition to, or in lieu of, the hypoglossal nerve in addition to the phrenic nerve. In examples discussed herein, the disordered-breathing-treatment system may include an implantable device to deliver electrical stimulation to the hypoglossal nerve and / or the ansa cervicalis without stimulation of the phrenic nerve. In examples discussed herein, the disordered-breathing-treatment system may include an implantable device to deliver electrical stimulation to the phrenic nerve without stimulation of the hypoglossal nerve or the ansa cervicalis.

[0293] Over the course of a sleeping period, the patient with combination apnea may experience OSA-only events, CSA-only events, and combined events, where the ratios of these events may wax and wane over time. Thus, a system designed to treat combination apneas as described herein may at any particular point in time provide nerve stimulations directed at OSA-only events, CSA-only events, or combined events.

[0294] The various dual stimulation therapies discussed herein to improve airway patency and maintain respiratory effort are not merely a combination of two separate and independent therapies. Rather, the treatment for combination apneas is a single therapy that provides stimulations targeted at at least two different nerves to address mechanisms of sleep apnea that are interrelated. The upper airway and diaphragm are not independent physiologically but rather are interrelated components of the respiratory system that work together to enable ordered and efficient respiration. For example, in some cases, stimulation of the phrenic nerve by a phrenic nerve stimulation subsystem may indirectly improve airway patency due to the effects of diaphragm contractions on the upper airway. Thus, a stimulation of a nerve associated with central respiratory drive may affect and change airway patency. Similarly, stimulation of upper-airway nerves affecting airway patency and stiffness may benefit respiration caused by diaphragm contractions and effect the degree of diaphragm contraction necessary. Thus, coordination and central control of interventions that stimulate various nerves responsible for the function of respiration improves efficacy of disordered breathing treatment, such as apnea treatment, by addressing the respiratory function wholistically. Therefore, a central control system as described herein that coordinates the relative timing of these stimulations of different nerves may improve the efficacy of this treatment. Thus, as described herein, the dual stimulation therapies discussed herein leverage a coordination of timing between the various nerve stimulation mechanisms.

[0295] As another consideration, airway patency and respiratory drive or effort are dynamic and not static during a sleep cycle. The subsystems of the disordered breathing therapy system 100 (for example, the phrenic nerve stimulation subsystem 902 and the upper-airway nerve stimulation subsystem 904 as shown in FIGS. 9A and 9B) may adapt their respective stimulations to changes in airway patency and respiratory drive during a sleep cycle. Additionally, each subsystem may adapt its respective stimulation based on changes in occurrences of apneas targeted by the other subsystem and / or based on changes in elements of the respiratory system targeted by the other subsystem. For example, parameters for stimulation targeted at the hypoglossal nerve may require modifications based on changes in parameters for stimulation targeted at the phrenic nerve, and vice versa.

[0296] As one example, the stimulation duration of the hypoglossal nerve stimulation may determine the efficacy of the phrenic nerve stimulation because the degree to which an airway is unobstructed may determine the ability of a particular diaphragm contraction to effectively cause airflow into the lungs. As another example, and as mentioned above, contractions of the diaphragm may affect airway patency.

[0297] FIG. 1A illustrates a block diagram of a disordered breathing therapy system 100 according to an example. A quantity of each component in FIG. 1A is an example only and other quantities of each, or any, component could be used. The disordered breathing therapy system 100 may be implemented in connection with a patient to treat disordered breathing that occurs while the patient is sleeping, such as one or more forms of sleep apnea. For example, the disordered breathing therapy system 100 may be implemented in connection with a patient experiencing CSA events, OSA events, or combination apnea events which may include mixed apnea events.

[0298] The disordered breathing therapy system 100 includes an implantable treatment system 10 and an external computing device 210. FIG. 2 illustrates a block diagram of computing components of a disordered breathing therapy system 100 according to an example. The description of FIG. 2 is provided following the discussion of FIG. 1 A and provides details of the external computing device 210 along with networks 34 and networked components 38.

[0299] The treatment system 100 includes an implantable treatment system 10 and external components (for example, the external computing device 210 and, in some examples, external sensors 18). The implantable treatment system 10 includes an implantable device 12 (for example, an implantable pulse generator 12, or IPG 12, wherein the terms may be used interchangeably depending on the context), one or more phrenic nerve stimulation leads 14 (for example, first leads), and one or more upper- airway nerve stimulation leads 16 (for example, second leads). Thus, the one or more phrenic nerve stimulation leads or first leads 14 are for placement to provide electrical stimulation to a phrenic nerve of a patient. The one or more upper- airway nerve stimulation leads or second leads 16 are for placement to provide electrical stimulation to one or more upper-airway nerves of a patient.

[0300] The IPG 12 includes at least one processor 50, at least one communications interface 52 (or comms interface 52), at least one power supply 54, at least one memory 56, stimulation circuitry 58, and at least one connector port (for example, a first connector port 60, a second connector port 62, a third connector port 64, and / or additional connector ports). Although three connector ports 60, 62, and 64 are shown in FIG. 1A, this is an example only and the IPG 12 may include other quantities of connector ports. As discussed in more detail below, the IPG 12 may be configured to be coupled to the leads 14, 16, and / or 20 via respective connector ports. In some examples, one or more of the connector ports may be omitted and / or may be unused during operation of the IPG 12. For example, if the system 10 does not include the optional additional leads 20, then the third connector port 64 may be omitted in some examples. In other examples, the IPG 12 may include the third connector port 64 even if the system 10 does not include the optional additional leads 20. In some examples, the IPG 1 may include more connector ports than a quantity of leads and / or a quantity of lead terminals included in the system 10. More generally, the system 100 includes leads 14, 16 and / or 20 which may be, or configured to be, electrically coupled to the implantable device / pulse generator 12. In one or more examples, the electric coupling may be provided by the leads 14, 16 and / or 20 coupling to the connector ports 60, 62, 64 or the leads 14, 16 and / or 20 may be provided integrally with the implantable device / pulse generator 12 and extend therefrom without the need for connector ports 60, 62, 64.

[0301] The implantable treatment system 10 may include one or more physiologic sensors.

[0302] These physiologic sensors may directly or indirectly provide information indicative of patient respiration (e.g., sensed respiratory data) and may be referred to as respiration sensors. For example, the respiration sensors may not directly measure air flow in the manner of a flow meter but rather may measure physiologic conditions representative or indicative of respiration. For example, a transthoracic impedance sensor may directly measure transthoracic impedance and indirectly indicate changes in respiration that result in changes in the transthoracic impedance. In some examples, the respiration sensor may be an airway-obstruction sensor. The physiologic sensors, or respiration sensors, may include implantable sensors 19 and / or external sensors 18. In some examples, the implantable treatment system 10 may include one or more implantable sensors 19 (for example, disposed on or within the implantable device 12 and / or on or within the phrenic nerve stimulation leads 14, the upper-airway nerve stimulation leads 16, and / or the one or more additional leads 20) and / or the one or more implantable sensors 19 may be coupled by the system 10 by the one or more additional leads 20. In various examples, the disordered breathing therapy system 100 may include one or more additional external sensors 18. The external sensors 18 are external to the patient (that is, not implanted or implantable). The external sensors 18 may be wearable or otherwise coupled to the patient. The external sensors 18 may be communicatively coupled to one or more of the implantable device 12 or the external computing device 210, or to the implantable device 12 via the external computing device 210. The external sensors 18 may be electrically coupled to the external computing device 210.

[0303] Each of the implantable sensors 19 and the external sensors 18 may include various types and / or numbers of sensors. For example, the implantable sensors 19 and / or the external sensors 18 may include one or more of electrical-signal sensors, including, for example, electromyography (EMG) sensors, motion sensors, pressure sensors, acoustic sensors, and so forth. The motion sensors may include one or more external accelerometers. These are discussed in further detail below, for example, in regard to FIG. 5A. As discussed above, when functioning as respiration sensors, these sensors may not directly measure respiration but rather may measure physiologic conditions representative or indicative of respiration. As further examples, the sensed information may include respiratory- and cardiac-related measures indicative of improvements in a patient’s respiration and / or improvements in physiologic function as a result of electrical stimulations provided by the implantable treatment system 10.

[0304] In some examples, the stimulation leads 14 and / or 16 may include the implantable sensors 19, whereas in other examples, the sensors 19 may be separate from the leads 14 and / or 16. In some examples, the additional leads 20 may be implanted in a patient in addition to the stimulation leads 14, 16. In some examples, the additional leads 20 may be configured to deliver an electrical stimulation and / or may be configured to sense information. The additional leads 20 may be coupled to the implantable device 12 and provide signals to the implantable device 12 indicative of the sensed information. For example, the additional leads 20 may include and / or be coupled to the one or more implantable sensors 19. Although illustrated separately in FIG. 1A for clarity, in some implementations, the additional leads 20 and the implantable sensors 19 may be a same physical element.

[0305] For example, the implantable sensors 19 may be configured to sense a transthoracic impedance of a patient. The transthoracic impedance may vary based on the volume of the patient’s chest cavity, and may therefore vary as the patient breathes. Accordingly, in some examples, the device 12 may sense transthoracic impedance using the stimulation leads 14 and / or 16 and / or the additional leads 20 that include the implantable sensors 19.

[0306] The treatment system 10 is configured to be communicatively coupled to the computing system 210. In some examples, the treatment system 10 is configured to be communicatively coupled to the external sensors 18. The communications interface 52 may include wireless communications circuitry for communications 66 between the system 10 and one or more of the external computing device 210 and / or the external sensors 18. The communications interface 52 may be a telemetry interface. For example, the telemetry interface may include an electromagnetic telemetry transceiver along with at least one antenna for telemetry-based data communication and programming. For example, the system 100 may include a programming wand configured for telemetric communications, also referred to as a telemetry wand. Alternatively or additionally, the communications interface 52 may include a transmitter, a receiver, and / or a transceiver configured for wireless communications, for example, according to a Bluetooth® communication protocol or other short-range communication protocol.

[0307] The treatment system 10 may be communicatively coupled to the computing system 210 via a first communication connection. In some examples (for example, where the external sensors 18 are included), the computing system 210 is configured to be communicatively coupled to the sensors 18 via a wired and / or wireless communication connection (for example, a second communication connection). In some examples (for example, where the external sensors 18 are included), the treatment system 10 is configured to be communicatively coupled to the external sensors 18 via a third communication connection. The communication connection between the treatment system 10 and the computing system 210 (for example, the first communication connection) may be the same or different than the connection between the treatment system 10 and the external sensors 18 (for example, the third communication connection).

[0308] In various implementations, wireless communications may be exchanged pursuant to a short-range wireless communication protocol such as, for example, the Bluetooth® wireless communication protocol, or inductive telemetry, or another telemetry method. In some implementations, one or more of the wired communication connections may include components of one or both of the leads 14, 16. In such an example, the leads 14, 16 may include lead bodies, such as one or more wires, configured to convey electrical currents and deliver nerve stimulation, and lead bodies may additionally be used to communicatively couple the implantable device 12 to the implantable sensors 19. In some implementations, communication connections may include a combination of wired and wireless communication connections.

[0309] The IPG 12 may be configured to be coupled to the leads 14, 16, and / or 20 via respective connector ports. Each of the connector ports 60, 62, 64 may include a physical receptacle configured to couple with a terminal of a respective lead, such as the leads 14, 16, 20. A lead may include one or more terminals and the lead may couple to the IPG 12 via one or more connector ports. For example, the IPG 12 may be configured to be coupled to the phrenic nerve stimulation lead 14 via at least one first connector port 60. The IPG 12 may be configured to be coupled to the upper- airway nerve stimulation lead 16 via at least one second connector port 62. The IPG 12 may be configured to be coupled to the additional leads 20, in examples in which the additional leads 20 are included, via at least one third connector port 64. Although the IPG 1 may include three connector ports in some examples (for example, the connector ports 60, 62, 64), in other examples the IPG 12 may include at least two connector ports, at least three connector ports, at least four connector ports, and so forth. The IPG 12 may provide more connector ports than are used in some implanted configurations in order to provide flexibility to accommodate a variety of lead arrangements based on the patient and / or the desired therapy provision.

[0310] Each lead 14, 16, 20 may provide at least one pair of electrodes. In one or more examples, each of the ports 60, 62, 64 may correspond to, and be configured to be coupled to, at least one pair of electrodes (for example, a single lead electrode and an IPG casing 520, discussed in greater detail below, forming an anode / cathode pair, or two lead electrodes forming an anode / cathode pair). In an example, a lead providing two or more electrode pairs may include two or more terminal pins configured to couple with two or more connector ports of the IPG 12. Alternatively, a lead providing two or more electrode pairs may include a single in-line-style terminal pin connector with multiple electrical contacts that correspond to pairs of electrodes at a distal end of the lead. The single in-line-style terminal pin connector may be configured to couple with a single connector port on the IPG 12. For example, the ports 60, 62, 64 may be configured to be coupled to respective lead terminals (for example, of at least one of the leads 14, 16, 20) inserted into the ports 60, 62, 64. The lead terminals may include terminal pins configured to removably couple with connector ports such as the ports 60, 62, 64. During implantation of the system 10, an implanter may couple the each of the leads 14, 16, 20, as available, to a respective one of the ports 60, 62, 64.

[0311] A number of connector ports (that is, a quantity of connector ports) may be equal to a number of connected leads (that is, a quantity of connected leads). In other examples, a number of connector ports may be greater than a number of connected leads, such that one or more of the connector ports remains unused. Accordingly, while the ports 60, 62, 64 and leads 14, 16, 20 may be implemented in a one-to-one relationship in some examples, other implementations are within the scope of the disclosure. For example, a single connector port may be configured to couple to a lead assembly that includes two or more of said leads 14, 16, 20. For example, the lead assembly may include a hub to couple with the single connector port and wherein the two or more of said leads 14, 16, 20 may be configured to branch in different directions for providing the stimulation and / or sensor signals from sensor(s). A selection of leads and / or lead assemblies may be provided including different numbers of said leads 14, 16, 20. Furthermore, leads may be added or removed via a subsequent surgical procedure after an initial implant procedure.

[0312] The ports 60, 62, 64 may enable bidirectional communications between the IPG 12 (including, for example, the processor 50) and connected leads. Accordingly, the IPG 12 may receive sensor signals from one or more leads (for example, the leads 14, 16, and / or 20), and may provide stimulation signals to electrodes on one or more leads (for example, the leads 14 and / or 16).

[0313] In some examples, the connector ports 60, 62, 64 may be implemented as header ports (for example, ports in a header section of the IPG 12), as discussed in greater detail below. In this or other examples, the connector ports 60, 62, 64 may be configured and / or re-configured as sensor ports, stimulation ports, sensor-and-stimulation ports, and so forth according to operational parameters such as programmed configuration settings provided to the processor 50 through firmware and / or software. For example, a sensor port may be configured to couple to, and communicate with, a sensing lead (such as the additional leads 20), and a stimulation port may be configured to couple to, and communicate with, a stimulation lead (such as the leads 14, 16). A sensor-and-stimulation port may be configured to couple to, and communicative with, a lead that acts as a sensing lead and a stimulation lead, such as examples of the leads 14, 16 that include sensors.

[0314] Additionally, connector ports configured as stimulation ports may be configured and / or re-configured as phrenic nerve lead ports or upper- airway nerve lead ports. Further, connector ports configured as stimulation ports may be configured and / or re-configured as right phrenic nerve lead ports, left phrenic nerve lead ports, right upper-airway nerve lead ports, or left upperairway nerve lead ports. The configuration of a particular stimulation connector port may enable connection of a lead corresponding to the configuration to the IPG 12 during implantation (for example, a right phrenic nerve lead may connect to a port configured for the right phrenic nerve lead, a left phrenic nerve lead may connect to a port configured for the left phrenic nerve lead, and so forth). Each connector ports may also be configured to correspond to particular electrode pairs of a particular lead. The configuration of a port with respect to stimulation of a particular target nerve reflects the specific stimulation parameters suitable to the target nerve and / or the lead used to deliver the stimulation. Thus, once configured, the ports may not he interchangeable with respect to the target nerve and / or the connected lead.

[0315] As discussed in greater detail below, configuring the connector ports 60, 62, 64 for respective types of leads or lead assemblies may include the processor 50 executing firmware and / or software to program the processor 50 to communicate with and / or control the connector ports 60, 62, 64 as sensor ports, stimulation ports, sensor-and-stimulation ports, or stimulation ports for particular leads and / or for particular electrode pairs. That is, while the physical structure of the connector ports 60, 62, 64 may not be affected by configuring the ports 60, 62, 64 as sensor ports, stimulation ports, or sensor-and-stimulation ports, the manner in which the device 12 or processor 50 interfaces with the ports 60, 62, 64 may be affected. Programmable settings in the IPG 12 may be modified over time to reconfigure the connector ports 60, 62, 64 as different types of ports.

[0316] Each of the stimulation leads 14, 16 may provide at least one anode / cathode pair to enable delivery of stimulation to a target nerve. The physical and electrical configuration of the stimulation lead and electrodes may be specific to the target nerve. Therefore, for example, a stimulation lead configured to stimulate a hypoglossal nerve may not be suitable for a phrenic nerve or other nerve, and vice versa. Each anode / cathode pair may form a stimulation channel. Based on operational parameters provided in the firmware and / or software, the processor 50 and the stimulation circuitry 58 may support various numbers of channels. The processor 50 may control or otherwise cause the stimulation circuitry 58 to deliver electrical stimulation to the leads 14, 16. For example, the stimulation circuitry 58 may at least include one or more switches to draw electrical power from the power supply 54 (which may include, for example, at least one battery), condition the drawn power to generate the electrical stimulation, and provide the electrical stimulation to the leads 14, 16 via the connector ports 60, 62. The processor 50 may control the stimulation circuitry 58 to deliver and adjust the electrical stimulation energy provided to the target nerves according to operational parameters provided in firmware and / or software which may include electrical stimulation parameters. In general, the operational parameters provided in the firmware and / or software include parameters or other elements referred to herein as “pre-programmed.” These include, but are not limited to, one or more of range or threshold criteria, stimulation parameters, triggers, timing, metrics, therapy delivery, etc. For example, the stimulation circuitry 58 and the processor 50 may support singlechannel operations. Single-channel operations support stimulation of only one of an upperairway nerve or a phrenic nerve (for example, for unilateral stimulation of either the upperairway nerve or the phrenic nerve). Accordingly, single-channel operations may support communications with only one of the leads 14, 16.

[0317] As another example, the stimulation circuitry 58 and the processor 50 may support dualchannel operations to support stimulation of two upper- airway nerves or two phrenic nerves. Such dual-channel operation allows bilateral stimulation of the upper-airway nerve(s) (for example, the hypoglossal nerve or the ansa cervicalis) or the phrenic nerve(s).

[0318] As a further example, the stimulation circuitry 58 and the processor 50 may support dualchannel operations to support stimulation of a combination of an upper-airway nerve and a phrenic nerve. Such dual-channel operations allow unilateral stimulation of the upper-airway nerve and unilateral stimulation of the phrenic nerve. In other examples, the processor 50 and the stimulation circuitry 58 may support more than two channels to provide stimulation to three or more nerves which may include bilateral stimulations.

[0319] The processor 50 may include one or more processors, microprocessors, controllers, a combination thereof, and so forth. The processor 50 may send and receive signals to and from one or more components of the system 100, and may execute stored instructions to control operation of the system 10. In various examples, the processor 50 may be used to provide control of stimulation parameters for the stimulation circuitry 58 and may process signals including, but not limited to, digitizing analog signals, calculating various physiological data, mo...

Claims

What is claimed is:

1. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether operational parameters include hypoglossal nerve electrical stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters include the hypoglossal nerve electrical stimulation parameters, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

2. The treatment system of claim 1, wherein the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of hypoglossal nerve electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the hypoglossal nerve electrical stimulation parameters.

3. The treatment system of claim 1, wherein the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period.

4. The treatment system of claim 3, wherein the operational parameters determined prior to the at least one sleeping period arc based at least in part on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

5. The treatment system of claim 1, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

6. The treatment system of any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

7. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation rate, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations.

8. The treatment system of any preceding claim, further comprising at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration.

9. The treatment system of claim 8, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data.

10. The treatment system of claim 8, wherein the at least one first sensor comprises a transthoracic impedance sensor.

11. The treatment system of claim 8, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation frequency, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the accumulated sensor data.

12. The treatment system of claim 11, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

13. The treatment system of claim 11 , wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

14. The treatment system of claim 11, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

15. The treatment system of claim 11, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device.

16. The treatment system of claim 11, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

17. The treatment system of any preceding claim, further comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

18. The treatment system of claim 17, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

19. The treatment system of claim 17, wherein the IPG comprises a clock and is configured to:receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

20. The treatment system of any preceding claim, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

21. The treatment system of any preceding claim, wherein the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters.

22. The treatment system of claim 21, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

23. The treatment system of claim 21, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

24. The treatment system of claim 21 , wherein the at least one communications interface comprises a telemetry interface.

25. The treatment system of claim 21, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

26. The treatment system of any one of claims 1 to 25, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

27. The treatment system of claim 26, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

28. The treatment system of any one of claims 1 to 25, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

29. The treatment system of any one of claims 1 to 28, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

30. The treatment system of any one of claims 1 to 28, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

31. The treatment system of any of claims 1 to 30, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

32. The treatment system of any one of claims 1 to 30, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve.

33. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of an airway obstruction, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the airway obstruction, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.,34. The treatment system of claim 33, wherein the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of hypoglossal nerve electrical stimulation during the at least one sleeping period responsive to a determination that an indication of airway obstruction is absent from the sensor data indicative of patient respiration.

35. The treatment system of claim 33, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

36. The treatment system of any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

37. The treatment system of claim any preceding claim, wherein the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG.

38. The treatment system of claim 37, wherein the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

39. The treatment system of claim 38, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data.

40. The treatment system of claim 37, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the sensor data.

41. The treatment system of claim 40, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

42. The treatment system of claim 40, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

43. The treatment system of claim 40, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

44. The treatment system of claim 40, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive thedegree of synchronization from the external computing device via the at least one communications interface.

45. The treatment system of claim 40, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

46. The treatment system of claim 37, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

47. The treatment system of claim 37, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

48. The treatment system of claim 37, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

49. The treatment system of claim 37, wherein the at least one communications interface comprises a telemetry interface.

50. The treatment system of claim 37, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

51. The treatment system of claim 37, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

52. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations.

53. The treatment system of any preceding claim, wherein the at least one first sensor comprises a transthoracic impedance sensor.

54. The treatment system of any preceding claim, comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

55. The treatment system of claim 54, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

56. The treatment system of claim 54, wherein the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

57. The treatment system of any preceding claim, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

58. The treatment system of claim 57, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

59. The treatment system of any of claims 33-58, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

60. The treatment system of any of claims 33-58, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.61 . The treatment system of any of claims 33-60, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

62. The treatment system of any of claims 33-60, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve.

63. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to a lack of respiratory drive.

64. The treatment system of claim 63, wherein the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a predetermined phrenic nerve stimulation rate.

65. The treatment system of claim 63, wherein the IPG is configured to modify the phrenic nerve electrical stimulations based on the at least one indicator specific to the lack of respiratory drive.

66. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises at least one indicator specific to the airway obstruction.

67. The treatment system of claim 66, wherein the IPG is configured to modify the hypoglossal nerve electrical stimulations based on the at least one indicator specific to the airway obstruction.

68. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of an effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations based on the combined-effectiveness parameters.

69. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether operational parameters include phrenic nerve electrical stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters include the phrenic nerve electrical stimulation parameters, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

70. The treatment system of claim 69, wherein the IPG is configured to provide the hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient during the at least one sleeping period via the at least one second stimulation lead in an absence of phrenic nerve electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the phrenic nerve electrical stimulation parameters.

71. The treatment system of claim 69, wherein the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period.

72. The treatment system of claim 71 , wherein the operational parameters determined prior to the at least one sleeping period arc based at least in part on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

73. The treatment system of claim 69, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

74. The treatment system of claim any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

75. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations.

76. The treatment system of any preceding claim, further comprising at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration.

77. The treatment system of claim 76, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data.

78. The treatment system of claim 76, wherein the at least one first sensor comprises a transthoracic impedance sensor.

79. The treatment system of claim 76, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the accumulated sensor data.

80. The treatment system of claim 79, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.81 . The treatment system of claim 79, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

82. The treatment system of claim 79, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

83. The treatment system of claim 79, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device.

84. The treatment system of claim 79, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

85. The treatment system of any preceding claim, further comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

86. The treatment system of claim 85, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

87. The treatment system of claim 85, wherein the IPG comprises a clock and is configured to:receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

88. The treatment system of any preceding claim, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and a second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

89. The treatment system of any preceding claim, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

90. The treatment system of any preceding claim, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

91. The treatment system of any preceding claim, wherein the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters.

92. The treatment system of claim 91 , wherein the at least one communications interface comprises a telemetry interface.

93. The treatment system of claim 91, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

94. The treatment system of any one of claim 69-93, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

95. The treatment system of claim 94, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

96. The treatment system of any one of claim 69-93, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

97. The treatment system of any one of claims 69-96, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

98. The treatment system of any one of claims 69-96, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

99. The treatment system of any one of claims 69-98, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

100. The treatment system of any one of claims 69-98, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve.

101. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of a lack of respiratory drive, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the lack of central respiratory drive, provide hypoglossal nerve electrical stimulations to a hypoglossal nerve of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the hypoglossal nerve electrical stimulations to the hypoglossal nerve with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

102. The treatment system of claim 101 , wherein the TPG is configured to provide the hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of phrenic nerve electrical stimulations during the at least one sleeping period responsive to a determination that an indication of a lack of respiratory drive is absent from the sensor data indicative of patient respiration.

103. The treatment system of claim 101, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the hypoglossal nerve electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the hypoglossal nerve electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the hypoglossal nerve electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

104. The treatment system of any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the hypoglossal nerve electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

105. The treatment system of any preceding claim, wherein the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG.

106. The treatment system of claim 105, wherein the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

107. The treatment system of claim 106, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters based on the sensor data.

108. The treatment system of claim 105, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the sensor data.

109. The treatment system of claim 108, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

110. The treatment system of claim 108, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

111. The treatment system of claim 108, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

112. The treatment system of claim 108, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface.

113. The treatment system of claim 108, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or hypoglossal nerve electrical stimulation parameters.

114. The treatment system of claim 105, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

115. The treatment system of claim 105, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

116. The treatment system of claim 105, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

117. The treatment system of claim 105, wherein the at least one communications interface comprises a telemetry interface.

118. The treatment system of claim 105, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

119. The treatment system of claim 105, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

120. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or the hypoglossal nerve electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations.

121. The treatment system of any preceding claim, wherein the at least one first sensor comprises a transthoracic impedance sensor.

122. The treatment system of claim 121 , further comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

123. The treatment system of claim 122, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

124. The treatment system of claim 122, wherein the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the hypoglossal nerve electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of hypoglossal nerve electrical stimulations.

125. The treatment system of any preceding claim, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

126. The treatment system of claim 125, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

127. The treatment system of any of claims 101-126, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

128. The treatment system of any of claims 101-126, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

129. The treatment system of any of claims 101-128, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

130. The treatment system of any of claims 101-128, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the hypoglossal nerve.

131. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to the lack of respiratory drive.

132. The treatment system of claim 131, wherein the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a predetermined phrenic nerve stimulation rate.

133. The treatment system of claim 131, wherein the IPG is configured to modify the phrenic nerve stimulations based on the at least one indicator specific to the lack of respiratory drive.

134. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises at least one indicator specific to an airway obstruction.

135. The treatment system of claim 134, wherein the IPG is configured to modify the hypoglossal nerve stimulations based on the at least one indicator specific to the airway obstruction.

136. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of the effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve stimulations and the hypoglossal nerve stimulations based on the combined-effectiveness parameters.

137. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether the operational parameters include ansa cervicalis stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters include the ansa cervicalis electrical stimulation parameters, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

138. The treatment system of claim 137, wherein the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of ansa cervicalis electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the ansa cervicalis electrical stimulation parameters.

139. The treatment system of claim 137, wherein the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period.

140. The treatment system of claim 139, wherein the operational parameters determined prior to the at least one sleeping period are based at least in pail on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

141. The treatment system of claim 137, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

142. The treatment system of any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

143. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, andwherein one or more of phrenic nerve electrical stimulation parameters or the ansa ccrvicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations.

144. The treatment system of any preceding claim, further comprising at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration.

145. The treatment system of claim 144, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data.

146. The treatment system of claim 144, wherein the at least one first sensor comprises a transthoracic impedance sensor.

147. The treatment system of claim 144, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the accumulated sensor data.

148. The treatment system of claim 147, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the prc-dctcrmincd phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

149. The treatment system of claim 147, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

150. The treatment system of claim 147, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

151. The treatment system of claim 147, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device.

152. The treatment system of claim 147, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters.

153. The treatment system of any preceding claim, further comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

154. The treatment system of claim 1 3, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

155. The treatment system of claim 153, wherein the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations.

156. The treatment system of any preceding claim, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

157. The treatment system of any preceding claim, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

158. The treatment system of any preceding claim, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

159. The treatment system of any preceding claim, wherein the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters.

160. The treatment system of claim 159, wherein the at least one communications interface comprises a telemetry interface.

161. The treatment system of claim 159, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

162. The treatment system of any one of claims 137 to 161, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

163. The treatment system of claim 162, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

164. The treatment system of any one of claims 137 to 161, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined phrenic nerve stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

165. The treatment system of any preceding claim, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

166. The treatment system of any one of claims 137 to 164, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

167. The treatment system of any one of claims 137 to 166, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

168. The treatment system of any one of claims 137 to 166, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis.

169. The treatment system of any preceding claim, wherein the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein the IPG is configured to determine whether the operational parameters include hypoglossal nerve stimulation parameters, and responsive to the determination that the operational parameters include the hypoglossal nerve stimulation parameters, the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

170. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead;at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of an airway obstruction, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period responsive to a determination that the sensor data indicative of patient respiration is indicative of the airway obstruction, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

171. The treatment system of claim 170, wherein the IPG is configured to provide the phrenic nerve electrical stimulations to the phrenic nerve of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of ansa cervicalis electrical stimulation during the at least one sleeping period responsive to a determination that an indication of airway obstruction is absent from the sensor data indicative of patient respiration.

172. The treatment system of claim 170, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery star! time of the phrenic nerve electrical stimulations such that the delivery start time ofthe ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

173. The treatment system of any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

174. The treatment system of claim any preceding claim, wherein the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG.

175. The treatment system of claim 174, wherein the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters.

176. The treatment system of claim 175, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data.

177. The treatment system of claim 174, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to:provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the sensor data.

178. The treatment system of claim 177, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

179. The treatment system of claim 177, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

180. The treatment system of claim 177, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

181. The treatment system of claim 177, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface.

182. The treatment system of claim 177, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles,else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters.

183. The treatment system of claim 174, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

184. The treatment system of claim 174, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

185. The treatment system of claim 174, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

186. The treatment system of claim 174, wherein the at least one communications interface comprises a telemetry interface.

187. The treatment system of claim 174, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

188. The treatment system of claim 174,wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

189. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations.

190. The treatment system of any preceding claim, wherein the at least one first sensor comprises a transthoracic impedance sensor.

191. The treatment system of any preceding claim, comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

192. The treatment system of claim 191, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

193. The treatment system of claim 191, wherein the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, andin response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa ccrvicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations.

194. The treatment system of any preceding claim, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

195. The treatment system of claim 194, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

196. The treatment system of any of claims 170-195, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

197. The treatment system of any of claims 170-195, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

198. The treatment system of any of claims 170-197, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

199. The treatment system of any of claims 170-197, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis.

200. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to a lack of respiratory drive.

201. The treatment system of claim 200, wherein the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a predetermined phrenic nerve stimulation rate.

202. The treatment system of claim 200, wherein the IPG is configured to modify the phrenic nerve stimulations based on the at least one indicator specific to the lack of respiratory drive.

203. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises at least one indicator specific to the airway obstruction.

204. The treatment system of claim 203, wherein the IPG is configured to modify the ansa cervicalis stimulations based on the at least one indicator specific to the airway obstruction.

205. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of the effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve stimulations and the ansa cervicalis stimulations based on the combined-effectivenes s parameters .

206. The treatment system of any preceding claim, wherein the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein, responsive to the determination that the sensor data indicative of patient respiration is indicative of the airway obstruction, the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalistogether with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

207. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor, and a memory, the IPG configured to determine whether the operational parameters include phrenic nerve stimulation parameters, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to a determination that the operational parameters include the phrenic nerve electrical stimulation parameters, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

208. The treatment system of claim 207 wherein the IPG is configured to provide the ansa cervicalis electrical stimulations to the ansa cervicalis of the patient during the at least one sleeping period via the at least one second stimulation lead in an absence of phrenic nerve electrical stimulation during the at least one sleeping period responsive to a determination that the operational parameters exclude the phrenic nerve electrical stimulation parameters.

209. The treatment system of claim 207, wherein the operational parameters comprise operational parameters determined prior to the at least one sleeping period and without sensed respiratory data acquired from the patient during the at least one sleeping period.

210. The treatment system of claim 209, wherein the operational parameters determined prior to the at least one sleeping period are based at least in pail on sensed respiratory data acquired from the patient in a monitoring mode of operation of the IPG prior to the at least one sleeping period, wherein the at least one sleeping period corresponds to a therapy mode of operation of the IPG.

211. The treatment system of claim 207, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

212. The treatment system of claim any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electrical stimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

213. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, and wherein one or more of the phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltagemagnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations.

214. The treatment system of any preceding claim, further comprising at least one first sensor communicatively coupled to the IPG, wherein the at least one first sensor is configured to provide sensor data indicative of patient respiration.

215. The treatment system of claim 214, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data.

216. The treatment system of claim 214, wherein the at least one first sensor comprises a transthoracic impedance sensor.

217. The treatment system of claim 214, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the accumulated sensor data.

218. The treatment system of claim 217, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

219. The treatment system of claim 217, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

220. The treatment system of claim 217, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.

221. The treatment system of claim 217, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device.

222. The treatment system of claim 217, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and, optionally, reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters.

223. The treatment system of any preceding claim, further comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

224. The treatment system of claim 223, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

225. The treatment system of claim 223, wherein the IPG comprises a clock and is configured to:receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations.

226. The treatment system of any preceding claim, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, and at least one second connector port configured to couple to at least one second stimulation lead, the at least one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

227. The treatment system of any preceding claim, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

228. The treatment system of any preceding claim, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

229. The treatment system of any preceding claim, wherein the IPG comprises at least one communications interface and is configured to wirelessly receive the operational parameters.

230. The treatment system of claim 229, wherein the at least one communications interface comprises a telemetry interface.

231. The treatment system of claim 229, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

232. The treatment system of any one of claim 207 to 231, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

233. The treatment system of claim 232, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

234. The treatment system of any one of claim 207 to 231, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

235. The treatment system of any one of claims 207 to 234, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

236. The treatment system of any one of claims 207 to 234, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

237. The treatment system of any one of claims 207 to 236, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa ccrvicalis of the patient.

238. The treatment system of any one of claims 207 to 236, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis.

239. The treatment system of any preceding claim, wherein the at least one second stimulation lead comprises a lead configured for stimulation of the ansa ccrvicalis and a lead configured for simulation of a hypoglossal nerve, and wherein the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

240. A treatment system for providing disordered breathing therapy to a sleeping patient during at least one sleeping period, the system comprising: at least one first stimulation lead; at least one second stimulation lead; at least one first sensor configured to provide sensor data indicative of patient respiration; and an implantable pulse generator (IPG) configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the IPG comprising a processor and a memory, the IPG configured to receive the sensor data indicative of patient respiration, determine whether the sensor data indicative of patient respiration is indicative of a lack of respiratory drive, provide phrenic nerve electrical stimulations to a phrenic nerve of a patient via the at least one first stimulation lead during the at least one sleeping period responsive to adetermination that the sensor data indicative of patient respiration is indicative of the lack of central respiratory drive, provide ansa cervicalis electrical stimulations to an ansa cervicalis of the patient via the at least one second stimulation lead during the at least one sleeping period, and coordinate a relative timing of the ansa cervicalis electrical stimulations to the ansa cervicalis with the phrenic nerve electrical stimulations to the phrenic nerve of the patient.

241. The treatment system of claim 240, wherein the IPG is configured to provide the ansa cervicalis electrical stimulations to the ansa cervicalis of the patient during the at least one sleeping period via the at least one first stimulation lead in an absence of phrenic nerve electrical stimulations during the at least one sleeping period responsive to a determination that an indication of lack of respiratory drive is absent from the sensor data indicative of patient respiration.

242. The treatment system of claim 240, wherein to coordinate the relative timing, the IPG is configured to align a delivery start time of the ansa cervicalis electrical stimulations with a delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is earlier than the delivery start time of the phrenic nerve electrical stimulations, or stagger the delivery start time of the ansa cervicalis electrical stimulations relative to the delivery start time of the phrenic nerve electrical stimulations such that the delivery start time of the ansa cervicalis electrical stimulations is later than the delivery start time of the phrenic nerve electrical stimulations.

243. The treatment system of any preceding claim, wherein to coordinate the relative timing, the phrenic nerve electrical stimulations provide a trigger for the ansa cervicalis electricalstimulations, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

244. The treatment system of any preceding claim, wherein the IPG further comprises at least one communications interface configured to wirelessly receive operational parameters for the IPG.

245. The treatment system of claim 244, wherein the operational parameters comprise one or more of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters.

246. The treatment system of claim 245, wherein the IPG is further configured to modify at least one of the phrenic nerve electrical stimulation parameters or the ansa cervicalis electrical stimulation parameters based on the sensor data.

247. The treatment system of claim 244, wherein the sensor data indicative of patient respiration is indicative of a respiration rate, wherein the operational parameters for the IPG comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to: provide the phrenic nerve electrical stimulations at the pre-determined phrenic nerve stimulation rate, receive the sensor data indicative of the respiration rate from the at least one first sensor, accumulate the sensor data over a pre-determined collection time period, and determine a degree of synchronization between the respiration rate and the predetermined phrenic nerve stimulation rate based on the sensor data.

248. The treatment system of claim 247, wherein the degree of synchronization is based on a ratio of a quantity of breaths within a predetermined range of the pre-determined phrenic nerve stimulation rate to a total quantity of breaths for a particular time period.

249. The treatment system of claim 247, wherein the degree of synchronization is based on a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

250. The treatment system of claim 247, wherein, to determine the degree of synchronization, the processor is configured to calculate the degree of synchronization.2 1. The treatment system of claim 247, wherein, to determine the degree of synchronization, the IPG is configured to provide the sensor data to an external computing device and receive the degree of synchronization from the external computing device via the at least one communications interface.

252. The treatment system of claim 257, wherein the IPG is configured to: compare the degree of synchronization to a degree of synchronization criterion comprising one of a target threshold or a target range, and if the degree of synchronization satisfies the degree of synchronization criterion, then maintain stimulation parameters for the disordered breathing therapy for one or more therapy cycles, else adjust the stimulation parameters and reevaluate the degree of synchronization, wherein the stimulation parameters comprise at least one of phrenic nerve electrical stimulation parameters or ansa cervicalis electrical stimulation parameters.

253. The treatment system of claim 244, wherein the IPG comprises at least two connector ports comprising: at least one first connector port configured to couple to at least one first stimulation lead, the at least one first stimulation lead comprising at least one first terminal pin configured to couple to the at least one first connector port, andat least one second connector port configured to couple to at least one second stimulation lead, the one second stimulation lead comprising at least one second terminal pin configured to couple to the at least one second connector port, and wherein the operational parameters comprise processor-executable instructions that determine which of the at least two connector ports is the at least one first connector port and which of the at least two connector ports is the at least one second connector port.

254. The treatment system of claim 244, wherein the IPG is configured to wirelessly receive the operational parameters before implantation of the IPG.

255. The treatment system of claim 244, wherein the IPG is configured to wirelessly receive the operational parameters after implantation of the IPG.

256. The treatment system of claim 244, wherein the at least one communications interface comprises a telemetry interface.

257. The treatment system of claim 244, wherein the at least one communications interface is configured to transmit and / or receive information according to a Bluetooth® communication protocol.

258. The treatment system of claim 244, wherein the operational parameters comprise a pre-determined phrenic nerve stimulation rate, and wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising the pre-determined stimulation rate, wherein the trigger excludes sensed respiration of the patient during the at least one sleeping period.

259. The treatment system of any preceding claim, wherein the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations are provided as pulse trains, each pulse train comprising a plurality of pulses, andwherein one or more of the phrenic nerve electrical stimulation parameters or the ansa ccrvicalis electrical stimulation parameters comprise one or more of a pulse train parameter, a stimulation pulse frequency, a time between stimulation pulses, a current magnitude, a voltage magnitude, a relative timing for the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations.

260. The treatment system of any preceding claim, wherein the at least one first sensor comprises a transthoracic impedance sensor.

261. The treatment system of claim 260, further comprising at least one second sensor communicatively coupled to the IPG, wherein the at least one second sensor is configured to provide sensor data indicative of one or more of patient movement or patient position.

262. The treatment system of claim 261, wherein the at least one second sensor comprises at least one of an implantable accelerometer or an external accelerometer.

263. The treatment system of claim 261, wherein the IPG comprises a clock and is configured to: receive the sensor data from the at least one second sensor, receive time information from the clock, identify a commencement of the at least one sleeping period based on the sensor data and the time information, and in response to the identification of the commencement of the at least one sleeping period, provide the phrenic nerve electrical stimulations and the ansa cervicalis electrical stimulations, or provide the phrenic nerve electrical stimulations in the absence of ansa cervicalis electrical stimulations.

264. The treatment system of any preceding claim, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising sensed respiration of the patient during the at least one sleeping period.

265. The treatment system of claim 264, wherein the IPG is configured to provide the phrenic nerve electrical stimulations in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration of the patient during the at least one sleeping period.

266. The treatment system of any of claims 240-265, wherein the at least one first stimulation lead is configured to be implanted in a lumen proximate the phrenic nerve of the patient.

267. The treatment system of any of claims 240-265, wherein the at least one first stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the phrenic nerve.

268. The treatment system of any of claims 240-267, wherein the at least one second stimulation lead is configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

269. The treatment system of any of claims 240-267, wherein the at least one second stimulation lead comprises electrodes in a nerve cuff configured to be operatively coupled to the ansa cervicalis.

270. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises a respiration rate and at least one indicator specific to the lack of respiratory drive.

271. The treatment system of claim 270, wherein the at least one indicator specific to the lack of respiratory drive comprises a degree of synchronization between the respiration rate and a predetermined phrenic nerve stimulation rate.

272. The treatment system of claim 270, wherein the IPG is configured to modify the phrenic nerve stimulations based on the at least one indicator specific to the lack of respiratory drive.

273. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises at least one indicator specific to an airway obstruction.

274. The treatment system of claim 273, wherein the IPG is configured to modify the ansa cervicalis stimulations based on the at least one indicator specific to the airway obstruction.

275. The treatment system of any preceding claim, wherein the sensor data indicative of patient respiration comprises combined-effectiveness parameters indicative of the effectiveness of the disordered breathing therapy and wherein, optionally, the IPG is configured to modify at least one of the phrenic nerve stimulations and the ansa cervicalis stimulations based on the combined-effectivenes s parameters .

276. The treatment system of any preceding claim, wherein the at least one second stimulation lead comprises a lead configured for stimulation of the ansa cervicalis and a lead configured for simulation of a hypoglossal nerve, and wherein the IPG is configured to provide the ansa cervicalis electrical stimulations via the lead configured for stimulation of the ansa cervicalis together with hypoglossal nerve electrical stimulations via the lead configured for simulation of the hypoglossal nerve.

277. A treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, receive, from at least one airway-obstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient,detect the decreased airway patency of the patient based on the airway information, provide at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinate a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

278. The treatment system of claim 277, wherein a delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with a delivery stall time of the at least one phrenic nerve electrical stimulation.

279. The treatment system of claim 277, wherein a delivery start time of the at least one hypoglossal nerve electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation.

280. The treatment system of claim 277, wherein a delivery start time of the at least one hypoglossal nerve electrical stimulation is later than a delivery staid time of the at least one phrenic nerve electrical stimulation.

281. The treatment system of any of claims 277-280, wherein each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient via the at least one second stimulation lead.

282. The treatment system of any of claims 277-281, wherein the at least one airwayobstruction sensor includes at least one microphone.

283. The treatment system of claim 282, wherein the airway information includes audio information.

284. The treatment system of claim 283, wherein detecting the decreased airway patency based on the airway information includes determining that the audio information is indicative of the patient snoring.

285. The treatment system of any of claims 277-284, wherein the at least one airwayobstruction sensor includes a transthoracic impedance sensor.

286. The treatment system of claim 285, wherein the airway information is indicative of a breathing rate of the patient.

287. The treatment system of any of claims 285 or 286, wherein the airway information is indicative of a lung volume of the patient.

288. The treatment system of any of claims 277-287, wherein the at least one airwayobstruction sensor includes at least one accelerometer.

289. The treatment system of claim 288, wherein the airway information is indicative of movement of the patient.

290. The treatment system of claim 289, wherein the movement of the patient is indicative of a position of the patient.

291. The treatment system of any of claims 288-290, wherein the at least one accelerometer is implanted in the patient.

292. The treatment system of any of claims 288-290, wherein the at least one accelerometer includes a first accelerometer external to the patient.

293. The treatment system of claim 292, wherein the at least one accelerometer includes a second accelerometer implanted in the patient.

294. The treatment system of any of claims 277-293, wherein the at least one airwayobstruction sensor includes a pulse oximeter.

295. The treatment system of claim 294, wherein the airway information includes a blood oxygen level of the patient.

296. The treatment system of any of claims 277-295, wherein the at least one airwayobstruction sensor includes at least one heart-rate sensor.

297. The treatment system of claim 296, wherein the airway information is indicative of a heart rate of the patient.

298. The treatment system of any of claims 277-297, wherein the at least one airwayobstruction sensor includes one or more leads to sense electrical activity of the heart of the patient.

299. The treatment system of any of claims 277-298, wherein the therapy data is indicative of a sleep stage of the patient.

300. The treatment system of any of claims 277-299, wherein the at least one airwayobstruction sensor includes at least one pressure sensor.

301. The treatment system of any of claims 277-300, wherein the at least one first stimulation lead includes one or more electrodes.

302. The treatment system of claim 301, wherein one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

303. The treatment system of any of claims 277-302, wherein the at least one first stimulation lead includes one or more nerve cuffs.

304. The treatment system of claim 303, wherein at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient.

305. The treatment system of any of claims 277-304, wherein the at least one second stimulation lead includes one or more electrodes.

306. The treatment system of claim 305, wherein one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

307. The treatment system of any of claims 277-306, wherein the at least one second stimulation lead includes one or more nerve cuffs.

308. The treatment system of claim 307, wherein at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the hypoglossal nerve of the patient.

309. The treatment system of any of claims 277-308, wherein the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on the airway information.

310. The treatment system of any of claims 277-309, further comprising at least one respiratory sensor configured to provide respiratory information indicative of at least one respiratory parameter, and wherein the implanted therapy controller is further configured to determine, based on the respiratory information, a therapy-specific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient.

311. The treatment system of claim 310, wherein the at least one respiratory sensor includes at least one transthoracic impedance sensor.

312. The treatment system of any of claims 310 or 311, wherein the at least one respiratory sensor includes at least one accelerometer.

313. The treatment system of any of claims 310-312, wherein the therapy-specific indicator includes an entrainment index.

314. The treatment system of claim 313, wherein the implanted therapy controller is further configured to determine whether the therapy- specific indicator satisfies at least one therapyeffectiveness criterion by determining whether the entrainment index is within a threshold range of capture-index values.

315. The treatment system of any of claims 277-314, wherein the implanted therapy controller is further configured to provide, simultaneously with the at least one phrenic nerve electrical stimulation, at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

316. The treatment system of claim 277, wherein the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the implanted therapy controller is configured to: determine one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation, and adjust one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one hypoglossal nerve electrical stimulation.

317. The treatment system of claim 277, wherein the implanted therapy controller is further configured to receive sleep parameters indicative of a sleep stage of the patient.

318. The treatment system of claim 277, wherein the therapy data is indicative of the patient’ s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation.

319. The treatment system of claim 318, wherein the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency.

320. The treatment system of claim 277, wherein the implanted therapy controller is configured to: evaluate an effect of the at least one hypoglossal nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjust one or more parameters of the at least one hypoglossal nerve electrical stimulation based on the evaluation.

321. The treatment system of claim 277, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient.

322. The treatment system of claim 277, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration.

323. The treatment system of claim 277, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

324. The treatment system of claim 323, wherein the preprogrammed stimulation rate is an entrainment frequency.

325. The treatment system of claim 277, wherein the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient.

326. The treatment system of claim 325, wherein the indication of the combination sleep apnea is an indication of a mixed apnea.

327. The treatment system of claim 277, further comprising one or more implanted respiratory parameter sensors.

328. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller.

329. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one hypoglossal nerve stimulation lead or the at least one phrenic nerve stimulation lead.

330. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors arc disposed at one or more of a lead body, an electrode, or a nerve cuff.

331. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability.

332. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity.

333. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors are implanted unilaterally.

334. The treatment system of claim 327, wherein the one or more implanted respiratory parameter sensors are implanted bilaterally.

335. The treatment system of claim 277, further comprising one or more respiratory parameter sensors disposed externally on the patient.

336. The treatment system of claim 277, wherein the implanted therapy controller is configured to coordinate the relative timing to provide the at least one hypoglossal nerve electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

337. The treatment system of any of claims 277-336, further comprising at least one sensor, wherein the implanted therapy controller is further configured to: receive sensor data from the at least one sensor; and determine, based on the sensor data, that the patient is asleep.

338. The treatment system of claim 337, wherein the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; andprovide the at least one hypoglossal nerve electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

339. A treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, receive, from at least one airway-obstruction sensor, therapy data comprising airway information indicative of a decreased airway patency of the patient, detect the decreased airway patency of the patient based on the airway information, provide at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via the at least one second stimulation lead responsive to detecting the decreased airway patency of the patient, and coordinate a relative timing of the at least one ansa cervicalis electrical stimulation to the ansa cervicalis with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

340. The treatment system of claim 339, wherein a delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation.

341. The treatment system of claim 339, wherein a delivery start time of the at least one ansa cervicalis electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation.

342. The treatment system of claim 339, wherein a delivery start time of the at least one ansa ccrvicalis electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation.

343. The treatment system of any of claims 339-342, wherein each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more ansa cervicalis electrical stimulations to the ansa cervicalis of the patient via the at least one second stimulation lead.

344. The treatment system of any of claims 339-343, wherein the at least one airwayobstruction sensor includes at least one microphone.

345. The treatment system of claim 344, wherein the airway information includes audio information.

346. The treatment system of claim 345, wherein detecting the decreased airway patency based on the airway information includes determining that the audio information is indicative of the patient snoring.

347. The treatment system of any of claims 339-346, wherein the at least one airwayobstruction sensor includes a transthoracic impedance sensor.

348. The treatment system of claim 347, wherein the airway information is indicative of a breathing rate of the patient.

349. The treatment system of any of claims 347 or 348, wherein the airway information is indicative of a lung volume of the patient.

350. The treatment system of any of claims 339-349, wherein the at least one airwayobstruction sensor includes at least one accelerometer.

351. The treatment system of claim 350, wherein the airway information is indicative of movement of the patient.

352. The treatment system of claim 351, wherein the movement of the patient is indicative of a position of the patient.

353. The treatment system of any of claims 350-352, wherein the at least one accelerometer is implanted in the patient.

354. The treatment system of any of claims 350-352, wherein the at least one accelerometer includes a first accelerometer external to the patient.

355. The treatment system of claim 354, wherein the at least one accelerometer includes a second accelerometer implanted in the patient.

356. The treatment system of any of claims 339-355, wherein the at least one airwayobstruction sensor includes a pulse oximeter.

357. The treatment system of claim 356, wherein the airway information includes a blood oxygen level of the patient.

358. The treatment system of any of claims 339-357, wherein the at least one airwayobstruction sensor includes at least one heart-rate sensor.

359. The treatment system of claim 358, wherein the airway information is indicative of a heart rate of the patient.

360. The treatment system of any of claims 339-359, wherein the at least one airwayobstruction sensor includes one or more leads to sense electrical activity of the heart of the patient.

361. The treatment system of any of claims 339-360, wherein the therapy data is indicative of a sleep stage of the patient.

362. The treatment system of any of claims 339-361, wherein the at least one airwayobstruction sensor includes at least one pressure sensor.

363. The treatment system of any of claims 339-362, wherein the at least one first stimulation lead includes one or more electrodes.

364. The treatment system of claim 363, wherein one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

365. The treatment system of any of claims 339-364, wherein the at least one first stimulation lead includes one or more nerve cuffs.

366. The treatment system of claim 365, wherein at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the phrenic nerve of the patient.

367. The treatment system of any of claims 339-366, wherein the at least one second stimulation lead includes one or more electrodes.

368. The treatment system of claim 367, wherein one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

369. The treatment system of any of claims 339-368, wherein the at least one second stimulation lead includes one or more nerve cuffs.

370. The treatment system of claim 369, wherein at least one nerve cuff of the one or more nerve cuffs is configured to be operatively coupled to the ansa cervicalis of the patient.

371. The treatment system of any of claims 339-370, wherein the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of ansa cervicalis electrical stimulations provided via the at least one ansa cervicalis electrical stimulation lead based on the airway information.

372. The treatment system of any of claims 339-371, further comprising at least one respiratory sensor configured to provide respiratory information indicative of at least one respiratory parameter, and wherein the implanted therapy controller is further configured to determine, based on the respiratory information, a therapy-specific indicator indicative of an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient.

373. The treatment system of claim 372, wherein the at least one respiratory sensor includes at least one transthoracic impedance sensor.

374. The treatment system of any of claims 372 or 373, wherein the at least one respiratory sensor includes at least one accelerometer.

375. The treatment system of any of claims 372-374, wherein the therapy-specific indicator includes an entrainment index.

376. The treatment system of claim 375, wherein the implanted therapy controller is further configured to determine whether the therapy- specific indicator satisfies at least one therapy- effectiveness criterion by determining whether the entrainment index is within a threshold range of capture-index values.

377. The treatment system of any of claims 339-376, wherein the implanted therapy controller is further configured to provide, simultaneously with the at least one phrenic nerve electrical stimulation, at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via at least one third stimulation lead responsive to detecting the decreased airway patency.

378. The treatment system of claim 339, wherein the therapy data further comprises at least one of sensor data measurements or respiratory drive synchronization data, and wherein the implanted therapy controller is configured to: determine one or more combined-effectiveness parameters indicative of an effect on respiration of the patient of the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation, and adjust one or more therapy delivery parameters based on the one or more combined-effectiveness parameters for the coordinated at least one phrenic nerve electrical stimulation and at least one ansa cervicalis electrical stimulation.

379. The treatment system of claim 339, wherein the implanted therapy controller is further configured to receive sleep parameters indicative of a sleep stage of the patient.

380. The treatment system of claim 339, wherein the therapy data is indicative of the patient’s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s respiratory drive, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation.

381. The treatment system of claim 380,wherein the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency.

382. The treatment system of claim 339, wherein the implanted therapy controller is configured to: evaluate an effect of the at least one ansa ccrvicalis electrical stimulation on respiration of the patient based on the therapy data indicative of the patient’s airway patency, and adjust one or more parameters of the at least one ansa cervicalis electrical stimulation based on the evaluation.

383. The treatment system of claim 339, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising sensed respiration of the patient.

384. The treatment system of claim 339, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a lack of a sensed respiration of the patient within a predetermined interval of an expected time for the sensed respiration.

385. The treatment system of claim 339, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

386. The treatment system of claim 385, wherein the preprogrammed stimulation rate is an entrainment frequency.

387. The treatment system of claim 339, wherein the therapy data indicates a combination sleep apnea based on sensor data showing a decreased respiratory drive and a reduced patency of an airway of the patient.

388. The treatment system of claim 387, wherein the indication of the combination sleep apnea is an indication of a mixed apnea.

389. The treatment system of claim 339, further comprising one or more implanted respiratory parameter sensors.

390. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are disposed at the implanted therapy controller.

391. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are disposed at one or more of the at least one ansa cervicalis stimulation lead or the at least one phrenic nerve stimulation lead.

392. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are disposed at one or more of a lead body, an electrode, or a nerve cuff.

393. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are disposed on an implanted lead without nerve stimulation capability.

394. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are disposed proximate to the thoracic cavity.

395. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are implanted unilaterally.

396. The treatment system of claim 389, wherein the one or more implanted respiratory parameter sensors are implanted bilaterally.

397. The treatment system of claim 339, further comprising one or more respiratory parameter sensors disposed externally on the patient.

398. The treatment system of claim 339, wherein the implanted therapy controller is configured to coordinate the relative timing to provide the at least one ansa cervicalis electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

399. The treatment system of any of claims 339-398, further comprising at least one sensor, wherein the implanted therapy controller is further configured to: receive sensor data from the at least one sensor; and determine, based on the sensor data, that the patient is asleep.

400. The treatment system of claim 399, wherein the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one ansa cervicalis electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

401. A treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted therapy controller configured to provide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, provide at least one hypoglossal nerve electrical stimulation to a hypoglossal nerve of the patient via the at least one second stimulation lead, andcoordinate a relative timing of the at least one hypoglossal nerve electrical stimulation to the hypoglossal nerve with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

402. The treatment system of claim 401, wherein a delivery start time of the at least one hypoglossal nerve electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation.

403. The treatment system of claim 401, wherein a delivery start time of the at least one hypoglossal nerve electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation.

404. The treatment system of claim 401, wherein a delivery start time of the at least one hypoglossal nerve electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation.

405. The treatment system of any preceding claim, wherein each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more hypoglossal nerve electrical stimulations to the hypoglossal nerve of the patient via the at least one second stimulation lead.

406. The treatment system of any preceding claim, further comprising at least one sensor configured to provide sensor data indicative of a sleep state of the patient, wherein the implanted therapy controller is configured to: determine sleep parameters of the patient based on the sensor data; determine that the patient is asleep based on the sleep parameters; and provide the at least one phrenic nerve electrical stimulation and the at least one hypoglossal nerve electrical stimulation based on the determination that the patient is asleep.

407. The treatment system of claim 406, wherein the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one hypoglossal nerve electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

408. The treatment system of claim 406, wherein the at least one sensor includes at least one accelerometer.

409. The treatment system of claim 408, wherein the sensor data is indicative of movement of the patient.

410. The treatment system of claim 409, wherein the movement of the patient is indicative of a position of the patient.

411. The treatment system of any of claims 408-410, wherein the at least one accelerometer is implanted in the patient.

412. The treatment system of any of claims 408-410, wherein the at least one accelerometer is external to the patient.

413. The treatment system of any of claims 406-412, wherein the sensor data is indicative of the position of the patient, and wherein determining that the patient is asleep is based on the position of the patient.

414. The treatment system of any preceding claim, wherein the at least one first stimulation lead includes one or more electrodes.

415. The treatment system of claim 414, wherein one or more leads of the at least one first stimulation lead arc configured to be implanted in a lumen proximate the phrenic nerve of the patient.

416. The treatment system of claim 414, wherein the at least one first stimulation lead includes one or more nerve cuffs.

417. The treatment system of any preceding claim, wherein the at least one second stimulation lead includes one or more electrodes.

418. The treatment system of claim 417, wherein one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the hypoglossal nerve of the patient.

419. The treatment system of claim 417, wherein the at least one second stimulation lead includes one or more nerve cuffs.

420. The treatment system of any of the preceding claims, further comprising at least one respiratory parameter sensor.

421. The treatment system of claim 420, wherein the at least one respiratory parameter sensor is disposed externally on the patient.

422. The treatment system of claim 420, wherein the at least one respiratory parameter sensor is an implantable sensor.

423. The treatment system of claim 422, wherein the at least one respiratory parameter sensor is disposed at the implanted therapy controller.

424. The treatment system of claim 422, wherein the at least one respiratory parameter sensor is disposed at one or more of the at least one hypoglossal nerve stimulation lead or the at least one phrenic nerve stimulation lead.

425. The treatment system of claim 422, wherein the at least one respiratory parameter sensor is disposed at one or more of a lead body, an electrode, or a nerve cuff.

426. The treatment system of claim 422, wherein the at least one respiratory parameter sensor is disposed on an implanted lead without nerve stimulation capability.

427. The treatment system of claim 422, wherein the at least one respiratory parameter sensor comprises at least one of a transthoracic impedance sensor, a motion sensor, an acoustic sensor, an electromyography sensor, or a pressure sensor.

428. The treatment system of claim 420, wherein the implanted therapy controller is further configured to: receive, from the at least one respiratory parameter sensor, therapy sensor data, and evaluate the therapy sensor data to determine a therapy-specific indicator.

429. The treatment system of claim 428, wherein the therapy-specific indicator includes an entrainment index.

430. The treatment system of claim 429, wherein the entrainment index is indicative of a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period.

431. The treatment system of claim 430, wherein the particular' time period is a pre-determined collection period.

432. The treatment system of claim 420, wherein the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation viathe at least one phrenic nerve electrical stimulation lead or second parameters of hypoglossal nerve electrical stimulations provided via the at least one hypoglossal nerve electrical stimulation lead based on the therapy sensor data.

433. The treatment system of claim 432, wherein the implanted therapy controller is further configured to modify at least one of the first parameters or the second parameters based on the entrainment index falling outside of a range of acceptable entrainment-index values.

434. The treatment system of claim 420, wherein the therapy sensor data is indicative of the patient’ s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation.

435. The treatment system of claim 434, wherein the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy sensor data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency.

436. The treatment system of claim 435, wherein the entrainment index comprises a ratio indicative of a degree of entrainment of the patient.

437. The treatment system of claim 436, wherein the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.

438. The treatment system of claim 435, wherein the implanted therapy controller is configured to coordinate the relative timing based at least in part on the entrainment frequency.

439. The treatment system of any preceding claim, wherein the implanted therapy controller is configured to: evaluate an effect of the at least one hypoglossal nerve electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one hypoglossal nerve electrical stimulation based on the evaluation.

440. The treatment system of any preceding claim, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

441. The treatment system of any preceding claim, wherein the implanted therapy controller is configured to coordinate the relative timing to provide the at least one hypoglossal nerve electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

442. The treatment system of any preceding claim, wherein the at least one phrenic nerve electrical stimulation includes a plurality of phrenic nerve electrical stimulations and the at least one hypoglossal nerve electrical stimulation includes a plurality of hypoglossal nerve electrical stimulations, and wherein the implanted therapy controller is further configured to increase an amplitude of at least one of the plurality of phrenic nerve electrical stimulations or the plurality of hypoglossal nerve stimulation over time.

443. A treatment system for providing disordered breathing therapy to a sleeping patient, the system comprising: at least one first stimulation lead; at least one second stimulation lead; and an implanted therapy controller configured to couple to the at least one first stimulation lead and the at least one second stimulation lead, the implanted therapy controller configured toprovide at least one phrenic nerve electrical stimulation to a phrenic nerve of a patient via the at least one first stimulation lead, provide at least one ansa cervicalis electrical stimulation to an ansa cervicalis of the patient via the at least one second stimulation lead, and coordinate a relative timing of the at least one ansa cervicalis electrical stimulation to the ansa cervicalis with the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient.

444. The treatment system of claim 443, wherein a delivery start time of the at least one ansa cervicalis electrical stimulation is synchronized with a delivery start time of the at least one phrenic nerve electrical stimulation.

445. The treatment system of claim 443, wherein a delivery start time of the at least one ansa cervicalis electrical stimulation is earlier than a delivery start time of the at least one phrenic nerve electrical stimulation.

446. The treatment system of claim 443, wherein a delivery start time of the at least one ansa cervicalis electrical stimulation is later than a delivery start time of the at least one phrenic nerve electrical stimulation.

447. The treatment system of any preceding claim, wherein each breathing cycle of a plurality of breathing cycles of the patient includes an inspiration period and an expiration period, and wherein the implanted therapy controller is further configured, for each breathing cycle of the patient, to apply one or more phrenic nerve electrical stimulations to the phrenic nerve of the patient via the at least one first stimulation lead and to apply one or more ansa cervicalis electrical stimulations to the ansa cervicalis of the patient via the at least one second stimulation lead.

448. The treatment system of any preceding claim, further comprising at least one sensor configured to provide sensor data indicative of a sleep state of the patient, wherein the implanted therapy controller is configured to:determine sleep parameters of the patient based on the sensor data; determine that the patient is asleep based on the sleep parameters; and provide the at least one phrenic nerve electrical stimulation and the at least one ansa cervicalis electrical stimulation based on the determination that the patient is asleep.

449. The treatment system of claim 448, wherein the implanted therapy controller is further configured to: determine, responsive to determining that the patient is asleep, whether the implanted therapy controller is pre-programmed to provide obstructive sleep apnea therapy; and provide the at least one ansa cervicalis electrical stimulation responsive to determining that the implanted therapy controller is pre-programmed to provide the obstructive sleep apnea therapy.

450. The treatment system of claim 448, wherein the at least one sensor includes at least one accelerometer.

451. The treatment system of claim 450, wherein the sensor data is indicative of movement of the patient.

452. The treatment system of claim 451, wherein the movement of the patient is indicative of a position of the patient.

453. The treatment system of any of claims 450-452, wherein the at least one accelerometer is implanted in the patient.

454. The treatment system of any of claims 450-452, wherein the at least one accelerometer is external to the patient.

455. The treatment system of any of claims 448-454, wherein the sensor data is indicative of the position of the patient, and wherein determining that the patient is asleep is based on the position of the patient.

456. The treatment system of any preceding claim, wherein the at least one first stimulation lead includes one or more electrodes.

457. The treatment system of claim 456, wherein one or more leads of the at least one first stimulation lead are configured to be implanted in a lumen proximate the phrenic nerve of the patient.

458. The treatment system of claim 456, wherein the at least one first stimulation lead includes one or more nerve cuffs.

459. The treatment system of any preceding claim, wherein the at least one second stimulation lead includes one or more electrodes.

460. The treatment system of claim 459, wherein one or more leads of the at least one second stimulation lead are configured to be implanted in a lumen proximate the ansa cervicalis of the patient.

461. The treatment system of claim 459, wherein the at least one second stimulation lead includes one or more nerve cuffs.

462. The treatment system of any of the preceding claims, further comprising at least one respiratory parameter sensor.

463. The treatment system of claim 462, wherein the at least one respiratory parameter sensor is disposed externally on the patient.

464. The treatment system of claim 462, wherein the at least one respiratory parameter sensor is an implantable sensor.

465. The treatment system of claim 464, wherein the at least one respiratory parameter sensor is disposed at the implanted therapy controller.

466. The treatment system of claim 464, wherein the at least one respiratory parameter sensor is disposed at one or more of the at least one ansa cervicalis stimulation lead or the at least one phrenic nerve stimulation lead.

467. The treatment system of claim 464, wherein the at least one respiratory parameter sensor is disposed at one or more of a lead body, an electrode, or a nerve cuff.

468. The treatment system of claim 464, wherein the at least one respiratory parameter sensor is disposed on an implanted lead without nerve stimulation capability.

469. The treatment system of claim 464, wherein the at least one respiratory parameter sensor comprises at least one of a transthoracic impedance sensor, a motion sensor, an acoustic sensor, an electromyography sensor, or a pressure sensor.

470. The treatment system of claim 464, wherein the implanted therapy controller is further configured to: receive, from the at least one respiratory parameter sensor, therapy sensor data, and evaluate the therapy sensor data to determine a therapy-specific indicator.

471. The treatment system of claim 470, wherein the therapy-specific indicator includes an entrainment index.

472. The treatment system of claim 471, wherein the entrainment index is indicative of a ratio of a quantity of breaths within a predetermined range of a stimulation rate to a total quantity of breaths for a particular time period.

473. The treatment system of claim 472, wherein the particular time period is a pre-determined collection period.

474. The treatment system of claim 462, wherein the implanted therapy controller is further configured to modify at least one of first parameters of phrenic nerve electrical stimulation via the at least one phrenic nerve electrical stimulation lead or second parameters of ansa cervicalis electrical stimulations provided via the at least one ansa cervicalis electrical stimulation lead based on the therapy sensor data.

475. The treatment system of claim 474, wherein the implanted therapy controller is further configured to modify at least one of the first parameters or the second parameters based on the entrainment index falling outside of a range of acceptable entrainment-index values.

476. The treatment system of claim 462, wherein the therapy sensor data is indicative of the patient’ s respiratory drive, and wherein the implanted therapy controller is configured to: evaluate an effect of the at least one phrenic nerve electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one phrenic nerve electrical stimulation based on the evaluation.

477. The treatment system of claim 476, wherein the implanted therapy controller is configured to provide a plurality of phrenic nerve electrical stimulations at an entrainment frequency, and wherein the therapy sensor data comprises an entrainment index indicative of a degree of synchronization between the patient’s respiration rate and the entrainment frequency.

478. The treatment system of claim 477, wherein the entrainment index comprises a ratio indicative of a degree of entrainment of the patient.

479. The treatment system of claim 478, wherein the entrainment index is a ratio of spectral power in a stimulation frequency band to a spectral power in an intrinsic respiratory frequency band.Til480. The treatment system of claim 477, wherein the implanted therapy controller is configured to coordinate the relative timing based at least in part on the entrainment frequency.

481. The treatment system of any preceding claim, wherein the implanted therapy controller is configured to: evaluate an effect of the at least one ansa cervicalis electrical stimulation on respiration of the patient, and adjust one or more parameters of the at least one ansa cervicalis electrical stimulation based on the evaluation.

482. The treatment system of any preceding claim, wherein the implanted therapy controller is configured to provide the at least one phrenic nerve electrical stimulation to the phrenic nerve of the patient in response to a trigger comprising a preprogrammed stimulation rate, wherein the trigger excludes sensed respiration of the patient.

483. The treatment system of any preceding claim, wherein the implanted therapy controller is configured to coordinate the relative timing to provide the at least one ansa cervicalis electrical stimulation simultaneously with the at least one phrenic nerve electrical stimulation.

484. The treatment system of any preceding claim, wherein the at least one phrenic nerve electrical stimulation includes a plurality of phrenic nerve electrical stimulations and the at least one ansa cervicalis electrical stimulation includes a plurality of ansa cervicalis electrical stimulations, and wherein the implanted therapy controller is further configured to increase an amplitude of at least one of the plurality of phrenic nerve electrical stimulations or the plurality of ansa cervicalis stimulation over time.

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