DE10131653C2 - Method and device for supplying a breathing gas - Google Patents

Description

The invention relates to a method and a device for supplying a breath gases to a person. Such methods and devices are used especially in the field of sleep medicine for diagnosis and / or therapy sleep-related respiratory disorders.

The known devices for supplying a breathing gas comprise a breath Gas conveying device - for example in the form of a speed-controlled fan seeinrichtung, and provided downstream of the fan means breath Gas line for supplying the pressurized breathing gas to a Atemmas ke. To divert into the breathing mask during an expiration phase Tendes consumed breathing gas is in front of the breathing mask an opening seen through which the spent breathing gas due to the overpressure in the breathing mask can escape.

For controlling the ventilation pressure as well as for the diagnosis of the respiratory behavior of the person, it is possible, the current breathing gas flow through Sensor devices such as a pneumotachograph, and the Respiratory gas pressure by a preferably arranged in the region of the patient To detect pressure sensor. The measured values thus obtained can be recorded, evaluated and possibly used simultaneously to control the respiratory gas pressure become.

The invention has for its object to provide a method and an apparatus for Supply of a breathable gas to a person creating a ver improved diagnosis of the physiological condition of this person, and / or also an improved adapted to the physiological needs of the person Therapy is possible.  

This object is achieved by a device for supplying a breathing gas with the features specified in patent claim 1 .

This makes it possible in an advantageous manner, over a defined period of time away the absolute pressure of the breathing gas below the ambient pressure reduce. This will provide a more in-depth assessment of the airway's property enabled. In a particularly advantageous manner can by means of erfindungsge According to the device to be determined, to what extent need for a Überdruckbe respiration to achieve a pneumatic splint.

According to a particular aspect of the invention, it becomes possible in the context preoperative preparations to determine an intubation risk and based on it deciding, for example, if there is a possibility of an anesthetic gas administer nasally.

Furthermore, according to a particular aspect of the present invention Also possible is the risk of airway obstruction for postoperative Rekonva to determine reading periods.

In a further advantageous manner, it becomes possible, as part of a routine Dia gnostik among persons with snoring syndromes particularly vulnerable persons to classify reliably and the necessary preventive measures or Therapy forms (CPAP, UPPP, oral appliance, ...). The invention In accordance with this method, a high level of statement quality is possible Signed screening of the person to be examined with prognosis of one possibly therapeutically necessary respiratory therapy.

By the solution according to the invention, it is also possible, the influence of Drugs to detect alcohol and Thera after completing therapy classify success.

The investigations according to the invention can be carried out under the influence of short-acting drugs in normal sleep and when awake (u. after hyperventilation).  

In a further advantageous manner, it is also possible obstruction susceptibility also in the lower respiratory tract in case of bronchial asthma.

This makes it possible to make a diagnosis largely without the active participation of Pa perform.

Gem. A particularly preferred embodiment of the invention is ready Setting the different pressure levels a switching device, esp dere valve means provided over which the breathing gas line selectively with a conduit means for providing breathing gas on a, above the Ambient pressure lying pressure level, or at a second Leitungsseinrich tion to provide one on, or under the ambient pressure the pressure level is connectable.

Gem. A particularly preferred embodiment of the invention is the Um Switching device formed by a valve which has a comparatively large Has breathing gas passage cross-section.

The valve is preferably designed such that at the time of Ventilum circuit is a flow through the valve in two directions allows. Gem. According to a particularly preferred embodiment of the invention comprises Valve a rotary or swivel body, wherein the respective desired valve stood by appropriate positioning of the rotary or swivel body he can be enough.

Gem. According to a particularly preferred embodiment of the invention, a conduit means is further provided for supplying a defined Volumenstro mes of oxygen-containing breathing gas in the immediate vicinity of the patient. This device preferably comprises a thin tube with an inner cross-section of, for example, 8-14 mm ² . About this thin hose can preferably via a hydrostatic conveyor - for example, a gear pump - continuously fresh air or possibly also additionally enriched with oxygen breathing gas in the immediate vicinity of Pati ducks out. The respiratory gas flow which takes place in alternating directions in the context of the respiratory activity of the patient takes place via the larger-volume breathing gas line, within which the required analysis pressure level prevails. As a result, it is ensured in an advantageous manner that regardless of the, prevailing in the breathing mask breathing gas pressure sufficient oxygen supply of the patient is ensured. In this embodiment, breathing gas purging openings in the region of the mask can advantageously be dispensed with. However, it is also possible to provide such scavenging ports in combination with the said conduit means, for the forced supply of oxygen-containing breathing gas.

Gem. Another particularly preferred embodiment of the invention the respiratory mask provided on the patient side provided with a valve device, through which in the case of a relative to the ambient pressure increased beat discharge pressure level via leakage openings a defined gas flow can. In the case of a ventilation below the ambient pressure level pressure level takes the mask side provided valve means a valve a state in which a supply of breathing gas from the environment in the Can be done inside the mask, for supplying oxygen to the patient th.

The mask side provided valve device is gem. a particularly be preferred embodiment of the invention controlled by a control device. The valve device may be a Venti formed from an elastomeric material Have lelement inserted in accordance with a by the control device put control printer occupies a closed position or an open position. the This elastomeric valve element, for example, by an elastic Hose wall be formed. Alternatively, or in combination with it it is possible to form the valve element like a flap.

The provision of the breathing gas at different pressure levels is carried out before preferably using a first and a second Atemgasförderein direction. The first breathing gas delivery device is preferably arranged such that it provides a defined controllable respiratory gas overpressure level can be.  

The second breathing gas delivery device is preferably designed such that by means of these a defined adjustable negative pressure in the breathing gas line bar is. Advantageously, at least one of the breathing gas delivery devices designed as a fan device with variable adjustable speed. The Provision of the breathing gas on a relative to the ambient pressure he Elevated pressure level is preferably via a line section, with the outer peripheral portion of an impeller of a variable speed fan device is connected.

The object specified above is further achieved by a method for Supply of a breathable gas to a person in which a breathing gas a pressure level above or above the ambient pressure of the patient In the context of selected measuring periods the breath is supplied Gas pressure is gradually lowered, with within the measurement periods with lowered breathing gas pressure with respect to the degree of obstruction of the patient indicative signal is generated, in which case when at ambient Pressure lying breathing gas pressure a given obstruction criterion not he is filled, the breathing gas pressure is lowered below the ambient pressure level.

The reduction of the pressure against a therapy pressure is in an advantageous Way chosen step by step until a predetermined obstruction criterion is fulfilled. For example, this obstruction criterion can be a null Describe flow state. It can also be a state in which another widely specified physiological condition.

Preferably takes place between the individual pressure reduction steps Return to the - therapy pressure. The duration of the pressure reduction steps is preferably with regard to a possibly adaptively determined number of breaths, or for example, limited in time.

The pressure reduction stages are preferably timed with the At mung activity of the person synchronizes that by performing the pressure reduction cycles  the sleep course of the person to be examined is not inappropriate is greatly disturbed casual.

Preferably, the beginning and end of the pressure changes are temporally in the range the transition between successive respiratory phases.

Preferably, a pressure reduction stage extends beyond a predetermined one Number of breaths - or a predetermined amount of time. The respiratory gas pressure is preferably lowered gradually below the ambient pressure level, oh ne that this is a return to the ambient or therapy pressure level he follows.

The phase of the breathing gas supply at a below the ambient pressure level lie lowing pressure level is then terminated in an advantageous manner, if a preg obesity criterion is reached.

At least in phases with a level below the ambient pressure level Pressure level is preferably an active supply of oxygen-containing breath gas in the area of the breathing mask.

As part of a preparatory process step takes place in an advantageous manner a calibration of a pressure and / or Atemgasflusserfassungssystemes.

An adaptation of the respiratory gas pressure to a suitable therapy pressure takes place preferably in the context of a self- or computer-controlled Autotitrati onsphase. In the context of this self-titration phase are advantageously in terms of obstruction indicative signals by an electronic Control device based in particular on correlation considerations of the breathing gas flow, evaluated.

As part of the self - titration phase and / or on the basis of the Self-titration phase determined data can be a vote of depth and Län of the DROP sequences and / or the length and synchronization of the RUN Phases take place.  

The adaptation of the respiratory gas pressure to the initially applied therapy pressure is preferably carried out by successively increasing the respiratory gas pressure. From the The course of the examination may vary with regard to the condition of the examined per indicative information is generated.

Further details and features will be apparent from the following Be description in connection with the drawing:

Show it:

Fig. 1 is a diagram for explaining the critical Verschlußdruc kes the upper respiratory tract of people with different Atemwegsver final pressures;

Fig. 2 is a pressure / (peak) volumetric flow diagram for explaining the determination of the critical closure pressure in conjunction with a Regres sion straight line;

Fig. 3 is a schematic diagram for explaining the structure of a valve system according to the Invention, for the selective generation of a breathing pressure below the ambient pressure;

Fig. 4 is a diagram for explaining a first variant of inventions to the invention breathing gas pressure with designated as drops temporary pressure drops below a substantially static pressure levels - especially therapy pressure level;

Fig. A respiratory gas pressure guide according to the invention also 5 is another diagram for explaining a second variant designated as Drops temporary pressure reductions below a substantially static pressure levels - which however takes place in particular therapy pressure level, between the successive onset Drops within a sequence, no return to the therapeutic pressure level;

Fig. 6 is a diagram for explaining a longer period of an inventively carried out including the variant of Figure 4 measuring method with additional pre-as well as additional downstream measuring steps.

Fig. 7 is a conceptual diagram for explaining the internal structure of a device according to the invention;

Fig. 8 is a conceptual diagram for explaining a first variant of a CO2 deriving means;

Fig. 9 is a conceptual diagram for explaining a second variant of a CO2 deriving means;

FIG. 10 is a conceptual diagram for explaining a third variant of a CO2 deriving means with forced fresh gas supply line;

11 is a conceptual diagram explaining a system with an active derivative of CO2 and angesteuertem exhalation valve.

Fig. 12 is a conceptual diagram for explaining a blower device with integrated switching device.

The diagram shown in Fig. 1 shows the determined using the device according to the invention Shen critical upper airway occlusive pressure for persons with normal airway properties and for persons with increased obstruction susceptibility. The groups of measurements given in the diagram relate to persons with normal airway properties, snorers, respiratory tracts in the condition of obstructive hypopnea and in the condition of constructive apnea, starting from the left. The critical occlusion pressure Pcrit determined by the device according to the invention is suitable as a diagnostic parameter for assessing the severity of an apnea syndrome.

In Fig. 2 is a pressure-flow diagram. To determine this diagram, the inspiratory flow maxima are measured at a wide range of pressures. By means of the device according to the invention, it is possible also einzustel below the ambient pressure level Atemgasdrücke.

In the diagram, the inspiratory flow maxima are higher than the one for this plotted breathing gas pressure applied. The pressure value at the puncture point a regression line connecting the measuring points through the pressure axis corresponds to the critical closing pressure Pcrit. It is also possible to have a derar Consideration for you to perform Expirationsatemzyklen. This will be it possible, in particular for a breathing gas supply with abge on the respiratory cycles agreed, alternating pressure levels (BiLevel breathing gas supply) appropriate Re set gel parameters.

The invention is not limited to the embodiments described above limited. For example, it is also possible, the device according to the invention as to use the pneumonological therapy device outside of sleep therapy the. So it is possible, as part of a respiratory therapy in the context of selected Time window defines the breathing gas pressure at least during the expiration cycles Lower below the ambient pressure level.

In the present case, the pressure referred to here as Pcrit is to be understood as a closing pressure of the upper respiratory tract. This pressure is suitable as a meaningful diagnostic parameter for assessing the severity of sleep apnea (see FIG. 1).

To determine the Pcrit are advantageously the inspiratory Flow maxima measured at different mask pressures. By the invention  Solution it becomes possible to have a pressure range of between approx. 20 mbar (healthy people) to about 10 mbar (seriously ill people) through run by the device according to the invention "PCRIT device" both below ambient pressure, as well as above the ambient pressure can be set.

To determine the Pcrit, a so-called pressure-flow diagram (PV diagram) is recorded. In this diagram, the inspiratory flow maxima are plotted against the therapy pressure. ( Figure 2). The point of penetration of the regression ridge through these points through the pressure axis gives the Pcrit.

The following are possibilities of the technical Realisie invention tion of Pcrit measurement described. Starting from a pressure level, wel The complete opening of the upper respiratory tract is guaranteed (basic pressure) the mask pressure during so-called drops ever further lowered. Between two Drops is created for a given duration of the base pressure. This means, that during a Pcrit measurement, the pressure is changed several times. How already mentioned above, mask pressures can also be set in this case below the ambient pressure level. The switchover happens at the beginning a drop in the transition from inspiration to expiration, - or to the end of egg no drops, d. H. after a certain number of breaths, at the transition from expiration to inspiration

The change of pressure is realized in an advantageous manner by negati by mask pressure, a valve is switched at the beginning of an inspiratory phase, which leads to the intake duct of a blower device and to the respiratory mask coupling respiratory gas path. The constructed by the blower device Pressure gradient thus reduces the pressure prevailing in the mask under the order impression pressure. To stop a drop, the valve is zurückge puts.

The valve is advantageously designed so that this a Umschal within about 100 ms, without a noticeable pressure wave in the Breathing gas hose is caused. The valve according to the invention is characterized  Furthermore, characterized in that this an extremely low flow resistance caused. The device according to the invention advantageously delivers at a Pressure of 10 mbar with constant engine control and turbine vorzugswei se a maximum flow of approx. 115 l / min.

The valve is preferably actuated without significant auxiliary forces. According to one particular aspect of the present invention, the valve is designed such that this always be a free gas path even in the case of malfunction provides, so that the breathing gas supply to the patient is not interrupted.

As a basis for the Pcrit device can advantageously the MAP device nCPAP Max II be used, preferably for a pure Überdruckthera Pie provided blower housing is replaced by a fan housing with egg ner integrated switching device. This suitable for negative pressure generation Blower is preferably so be in terms of its outer dimensions measure this in a simple way against that for positive pressure ventilation seen blower is interchangeable.

It is also according to a particularly preferred embodiment of the invention possible, which provided for performing a negative pressure diagnosis Kompo components in a modular dockable unit, preferably a substructure unit to arrange. For this purpose, it is possible, usually provided on the inlet side Cover replaced by a connection plate to which a Leitungsseinrich tion in a sealing manner can be coupled.

The control provided for performing a negative pressure diagnosis Components preferably take place at least partially through one in the device integrated, programmable control device.

Fig. 3 shows a schematic diagram for explaining a valve 40 through which selectively the suction side 33 or the pressure side 34 of a blower device 35 a with a line leading to a patient 39 can be coupled. The actuation of the valve 40 may be pneumatic or electromagnetic.

In Fig. 4, the time course of a Druckfüh tion according to the invention is shown by way of example. The term "drop" used in this illustration as well as in the following explanation is to be understood as meaning a pressure stage which is characterized by a rapid drop in pressure and which is generated for a specific number of atmospheres.

"Run" refers to a period comprising several drops that is considered to be completed when a zero flow of the volume flow has been detected within the last and / or last but one drop. The pressure levels (drops) can meet different criteria such. B. Sleep state, sleep position, blood oxygen content prehistoric time, time interval to falling asleep, respiratory rate) programmatically triggered:
As seen from Fig. 4, starting from the therapy pressure for a certain number of breaths (. For example, 5 breaths), the pressure by a certain amount (z. B. 2 mbar) lowered. Thereafter, the pressure is immediately increased back to the Thera piedruck. The number of drops depends, for example, on the occurrence of a zero flow signal with regard to the volumetric flow caused by the patient. If a zero flux is detected in a drop, the run period can be ended after preferably only one further drop.

Alternatively, or in phases also in combination with the method described above, it is also possible, as illustrated in FIG. 5, to carry out the PCRIT measurement, preferably starting from the therapy pressure, so that after each drop the pressure is gradually increased by a further step Hö hey, for example, 2 mbar is lowered. If a zero flow sets in within the last and / or second to last drop, the measurement is ended. The steps can have lower heights with increasing negative pressure.

The two variants of the PCRIT measurement described above in conjunction with FIGS . 4 and 5 make it possible to determine the airway closure pressure PCRIT in certain clinical pictures even before the ambient pressure is reached, ie without lowering the pressure below the ambient pressure.

FIG. 6 shows a preferred method sequence for a PCRIT measurement according to the invention. Preferably, a predetermined number of runs, preferably 3 consecutive runs, are performed.

The method according to the invention can furthermore comprise the following steps.

• 1. Calibrating the system;
• 2. finding the therapy pressure;
• 3. Start the PCRIT measurement - for example, three RUNs and the follow Measurement is completed;
• 4. Re-system calibration

The PCRIT measurement based on switched-on drops can be carried out by way of example under different pressure control concepts:

• 1.-a.) The PCRIT measurement is carried out with an at least phase-fixed CPAP Pressure z. 5 hPA;
• 2. -b.) Before the measurement, the current therapy pressure of the patient is determined z. B. about an auto-irritation;
• 3.-c.) The patient breathes under atmospheric pressure - only during the drops a pressure below the ambient pressure level is applied.

The inventive method can be carried out in an advantageous manner with a Vorrich device as described below in connection with FIG. 7 example. The device shown in Fig. 7 comprises a gas conveyor formed by a blower 1 conveyor for the promotion of breath. The blower device comprises a vibration isolated suspended blower housing 2 , in the interior of a not visible here impeller is added. The impeller is driven by a high-speed motor 3 , the sen speed is variable in accordance with a control device. About the speed of the engine, the pressure gradient generated by the impeller can be set defined.

The blower housing 2 comprises a low-pressure region, not visible here, which is in communication with the hub zone of the rotor. Furthermore, the blower housing 2 comprises a high-pressure region 4 , in which the respiratory gas pressure generated in the outer region of the impeller prevails.

The blower device 1 is received in a soundproof cassette 5 . In this soundproof cassette 5 more labyrinth-like line sections 6 , 7 are formed. In the line section 6 , there is essentially ambient pressure, since an initial region of the line section 6 is open to the surrounding environment. The line section 7 is connected via a breathing gas line, not shown here, in particular a flexible breathing gas hose with a breathing mask. In this line section 7 , the patient-side breathing gas pressure prevails. About a changeover valve 8 , the connection of the line sections 6 and 7 are changed by the blower device such that the pressure gradient generated by the blower selectively causes a pressure increase or a pressure drop in the mask-side power section 7 relative to the environmental side line section 6 .

In the embodiment shown here, the changeover valve device comprises by a pivoting body 9 , which is designed here as a rotary flap. This results in a comparatively short time required for switching between the two coupling states of the blower device 1 to the Leitungsab section. 7

The swivel body 9 is in this representation in a position in wel cher by the blower 1 in the line section 7, a pressure is generated, which is in accordance with the fan speed below the pressure prevailing in the line section 6 pressure. By the impeller of the fan device 1 is generated here at a certain by the impeller speed differential pressure. The impeller in this case forms a permanent permeable pressure lock which one of mung At activity of the patient corresponding to gas exchange by the device 1 through Gebläseein possible.

If the swivel body 9 is pivoted by a direction not shown here Antriebsein direction in the direction indicated by dashed lines position, the prevailing between the line sections 6 and 7 pressure gradient is reversed. In this position too, a gas exchange corresponding to the breathing activity of the patient can only take place by overcoming the pressure gradient of the blower device.

The device according to the invention can be explained as follows with reference to an appli cation example, find application:
To examine the breathing characteristics of a patient, he goes to a sleep laboratory. In this sleep laboratory, a breathing mask is placed on the patient in a sealing manner. The breathing mask is connected via a flexible hose with a source of breathing gas. The respiratory gas source is provided with a valve device, by means of which the respiratory gas can be provided at defined selectable pressure levels. As part of a first investigation cycle, a respiratory gas pressure is regulated within the breathing gas line which is above the ambient pressure level. The resulting hereby as a result of the respiratory activity of the patient measured values for p and v are detected by a measuring device and recorded.

After a predetermined titration period, a successive Ab takes place Lowering the ventilation pressure to a lower than the ambient pressure Pressure level. For this purpose, a valve device within the Atemgaslei tion system made a switch, by which a respect ner speed controllable fan is arranged in the line system such that the radially inner portion of the impeller of the fan on the side the patient and the radially outward portion of the impeller of the fan It faces the environment. By controlling the speed of the fan according to a predetermined examination procedure are distinguished Lich high, at least in phases below the ambient pressure lying absolute Pressure level set. The resulting measurements of Atemgasstro mes are recorded and in accordance with predetermined analysis and Klas sification procedures.  

At the latest when the supply of the breathing gas at a pressure level, not more than 4 mbar above the ambient pressure level, takes place via a second breath Gasleitungseinrichtung a forced supply of oxygen-containing breathing gas in the immediate vicinity of the patient. This is the second one Breathing gas line designed as a hose line, in the interior of the am Patient applied breathing mask empties. This second breathing gas line is on an oxygen source, for example, by a high pressure or hydrostati cal pump can be realized, connected. About this second breathing gas line is continuously a defined gas flow of oxygen-containing breathing gas supplied to the patient. On these intended for oxygenation Measures may be waived provided it is ensured that the vacuum Examination cycle a predetermined period of time, for example 180 Se customer does not exceed.

In Fig. 8 in the form of a diagrammatic sketch is a Ausatemelement 10 shown, through which an adequate CO2 washout is possible even with a ambient pressure below the pressure level Conversely. The exhalation 10 includes a plurality of Spülbohrungen 11 and one, with respect to a valve opening 12 se lektiv in an open position (shown here) or in a closed position bringba ren valve spool 13th

The valve spool 13 is coupled to a drive device which is embodied here in elec tromechanischer form and includes an electrically driven motor 14 or magnet. Between the motor 14 and the valve spool 13 , a coupling device 15 is provided, which here comprises a linear gear.

The exhalation element 10 is preferably used in the immediate vicinity of a respiratory mask applied to the patient in the respiratory gas conduit system - or integrated into the breathing mask in an advantageous manner.

The selectively provideable cross section of the valve opening is preferably about 10 to 25 mm ² . The cross section of the flushing holes 11 is preferably kept so small that even in the closed position of the valve spool 13 on the device side provided blowing device, the required negative pressure can be established.

FIG. 9 shows a further variant of an exhalation element 10 , in which a cushion 16 is provided for the selective closing / opening of a flushing opening (not visible here) which can be brought into the closed position in a pressure-actuated manner.

In the illustrated embodiment, the control of the pad 16 via a thin control hose 17 which is connected to a pump 18 .

The pillow itself forms an elastically expandable chamber 19 whose wall covers the purging opening, not shown here, in the inflated state. The flushing opening may alternatively be formed by a plurality of smaller openings tion to a single, preferably slot-shaped Publ.

The sketch according to FIG. 10 shows an arrangement with an exhalation element 10 , wherein an active supply of oxygen-containing respiratory gas takes place in the immediate vicinity of a respiratory mask area. For this purpose, an additional line 20 is provided. In the present case, the forced supply of the oxygen-containing breathing gas using a hydrostatic conveyor example, gear pump takes place. This makes it possible to ensure a defined fresh gas flow regardless of the breathing gas pressure.

In Fig. 11, a system is shown in which the rich in the mask Be rich leading line network a first breathing gas line 21 and a second breathing gas line 22 , wherein in the two lines 21 , 22 , at least phase wise slightly different pressures prevail, so that a defi ned purge flow from the line of higher pressure in the line of lower pressure. In the line lower pressure (here the second Atemgaslei device 22 ) is preferably a discharge device for the discharge of CO2 before seen.

It is also possible, the defined purge flow in the multi-line shown System by check valves, for example, flap elements to produce.

Preferably, a controllable, selectively be brought into a fenstellung fenstellung scavenging port 12 is also provided in this variant.

In Fig. 12 is greatly simplified a blower 30 with integrated switching device 31 shown. The switching device 31 is arranged in a hous seelement 32 of the fan 30 and is located at a location at which a to the suction side 33 and a pressure side 34 of an impeller 35 leading channel 36 and 37 adjacent to each other.

The switching device 31 comprises a rotatably arranged flap element 38 . This flap member 38 forms a partition which selectively creates a Abtren tion / connection of the suction side 33 or the pressure side 34 of / with a leading to the breathing mask line section 39 .

The position of the flap element 38 in the position shown here by a solid vertical line allows the lowering of the pressure in the line section 39 below the ambient pressure (coupling of the suction side 33 ). The amount of negative pressure can be adjusted based on the speed of the impeller 35 .

In the position of the flap element shown here by a dotted line can be set in the line section 39 a in accordance with the speed of the impeller 35 increased pressure.

Claims (30)

1. A device for supplying a breathing gas to a person with:
a breathing gas conduit system,
a connection device for coupling a respiratory gas line to the sheep tion of a connection between the breathing gas conduit system and a patient-side respiratory mask provided pati,
a pressure lock provided in the breathing gas piping for generating a difference between the pressure in the breathing gas piping and the surrounding pressure;
wherein the device is operable such that on the breathing mask selectively a below or above the ambient pressure level lying breathing gas pressure is adjustable. 2. Apparatus according to claim 1, characterized in that a device is provided for detecting the respiratory activity of the patient. 3. Apparatus according to claim 1 or 2, characterized in that a Druc Kerfassungsseinrichtung is provided for detecting the mask side gent blowing respiratory gas pressure. 4. Device according to at least one of claims 1 to 3, characterized gekenn records that the pressure lock is formed by a blower device. 5. Device according to at least one of claims 1 to 4, characterized gekenn shows that the pressure lock has a suction side and a pressure side, and that the conduit system is switchable such that the breathing gas line se on the pressure level of the suction side or the pressure level of the pressure side the pressure lock is located. 6. Device according to at least one of claims 1 to 5, characterized gekenn records that the line system a first line section and a Second line section, wherein the first line section to the Umge is open and the second line section is open towards the breathing mask,  and that a switching valve device is provided for selective coupling tion of the suction and the pressure side of the blower device to the first or the second line section. 7. Device according to at least one of claims 1 to 6, characterized marked records that the switching valve device is designed as a rotary valve. 8. Device according to at least one of claims 1 to 7, characterized marked records that the switching characteristic of the switching valve assembly ge such is selected that as part of the switching operation switching-related pressure fluctuations do not exceed an amount of 1.5 mbar. 9. Device according to at least one of claims 1 to 8, characterized marked records that a second blower device is provided to provide a second pressure lock. 10. The device according to at least one of claims 1 to 9, characterized records that a throttle device is provided for generating a Pressure gradient in the breathing gas pipeline system. 11. The device according to at least one of claims 1 to 10, characterized gekenn records that a check valve arrangement is provided to shut off Lei sections in the breathing gas line system in the event of a reversal of Gas flow direction. 12. The device according to at least one of claims 1 to 11, characterized marked records that a supply line is provided to supply a defi amount of oxygen-containing respiratory gas in the immediate vicinity area of the patient. 13. The device according to at least one of claims 1 to 12, characterized characterized in that the supply line device is designed such that the thereby conveyed amount of oxygen-containing breathing gas a predetermined limit not below.   14. The device according to at least one of claims 1 to 13, characterized gekenn characterized in that the coupling to the patient via a Atemmaskeneinrich tion occurs, and vorgese in the area of the breathing mask through holes hen to create a communication path between the interior the breathing mask device and the environment. 15. The device according to at least one of claims 1 to 7, characterized gekenn records that on the connecting path a valve device is provided for at least partial blocking of the connection path in dependence on the The direction of flow. 16. A method of delivering a breathable gas to a person in which a breathing gas is temporarily at or above the ambient pressure the pressure level is fed to the patient being selected within the framework Measuring periods of the breathing gas pressure is gradually lowered, being within the Measuring periods with lowered respiratory gas pressure in terms of obstruction grades of the patient indicative signal is generated, whereby phased then when at a pressure lying on ambient pressure breathing gas pressure a predetermined Obstruction criterion is not met, the respiratory gas pressure among the environment pressure level is lowered. 17. The method according to claim 16, characterized in that the lowering the pressure against a therapy pressure is gradually chosen as large until a predetermined obstruction criterion is met. 18. The method according to claim 16 or 17, characterized in that between the individual pressure reduction steps a return to the therapy pressure he follows. 19. The method according to at least one of claims 16 to 18, characterized gekenn records that the pressure reduction stages coincide with the respiratory activity of the Person are synchronized.   20. The method according to at least one of claims 16 to 19, characterized marked records that the pressure changes temporally in the area of the respiratory phase change lie. 21. The method according to at least one of claims 16 to 20, characterized gekenn characterized in that a pressure reduction stage over a predetermined number of breaths - or a predetermined period of time. 21. The method according to at least one of claims 16 to 20, characterized gekenn records that the breathing gas pressure gradually below the ambient pressure level is lowered, without causing a return to the ambient or The therapy pressure level takes place. 22. The method according to at least one of claims 16 to 21, characterized gekenn records that the phase of the breathing gas supply to a sub-ambient Pressure level lying pressure level is then terminated, if a predetermined Obstruction criterion is achieved. 23. The method according to at least one of claims 16 to 22, characterized gekenn records that, at least in phases with a below ambient pressure level an active supply of oxygen-containing breathing gas in the Area of the breathing mask takes place. 24. The method according to at least one of claims 16 to 23, characterized records that as part of a preparatory process step, a Kallibrie tion of a pressure and / or Atemgasflusserfassungssystemes takes place. 25. The method according to at least one of claims 16 to 24, characterized gekenn draws that in the context of a self-titration phase, an adaptation of the breath gas pressure to a suitable therapy pressure. 26. The method according to at least one of claims 16 to 25, characterized gekenn records that as part of the self-titration phase in terms of obstruction condition indicative signals by an electronic control device in particular  based on correlation considerations of the respiratory gas River course, to be evaluated. 27. The method according to at least one of claims 16 to 26, characterized gekenn records that in the context of the self-titration phase and / or on the basis of in the context of the self - titration phase, data were reconciled Depth and length of DROP sequences and / or length and sync tion of the RUN phases. 28. The method according to at least one of claims 16 to 27, characterized gekenn records that the adaptation by successively increasing the respiratory gas pressure he follows. 29. The method according to at least one of claims 16 to 28, characterized gekenn records that from the course of the investigation with respect to the state of un person's indicative information is generated.