US20100139667A1 - Devices and methods for treating sleep disorders - Google Patents

Devices and methods for treating sleep disorders Download PDF

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Publication number
US20100139667A1
US20100139667A1 US12625255 US62525509A US2010139667A1 US 20100139667 A1 US20100139667 A1 US 20100139667A1 US 12625255 US12625255 US 12625255 US 62525509 A US62525509 A US 62525509A US 2010139667 A1 US2010139667 A1 US 2010139667A1
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Prior art keywords
figs
shown
tension
pressure
neck
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Abandoned
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US12625255
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Robert E. Atkinson
Chad J. Kugler
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Cyberonics Inc
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Apnex Medical Inc
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/56Devices for preventing snoring
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61FFILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, E.G. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/56Devices for preventing snoring
    • A61F5/566Intra-oral devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/06Extra-oral force transmitting means, i.e. means worn externally of the mouth and placing a member in the mouth under tension
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61CDENTISTRY; APPARATUS OR METHODS FOR ORAL OR DENTAL HYGIENE
    • A61C7/00Orthodontics, i.e. obtaining or maintaining the desired position of teeth, e.g. by straightening, evening, regulating, separating, or by correcting malocclusions
    • A61C7/08Mouthpiece-type retainers or positioners, e.g. for both the lower and upper arch
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B33ADDITIVE MANUFACTURING TECHNOLOGY
    • B33YADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y70/00Materials specially adapted for additive manufacturing
    • BPERFORMING OPERATIONS; TRANSPORTING
    • B33ADDITIVE MANUFACTURING TECHNOLOGY
    • B33YADDITIVE MANUFACTURING, i.e. MANUFACTURING OF THREE-DIMENSIONAL [3-D] OBJECTS BY ADDITIVE DEPOSITION, ADDITIVE AGGLOMERATION OR ADDITIVE LAYERING, e.g. BY 3-D PRINTING, STEREOLITHOGRAPHY OR SELECTIVE LASER SINTERING
    • B33Y80/00Products made by additive manufacturing
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S602/00Surgery: splint, brace, or bandage
    • Y10S602/902Antisnoring or mouth closing devices

Abstract

Devices and methods for maintaining an open airway are described. Systems and methods are described for maintaining an opening of an airway by application of force to a patient's tissues in one of inferior, anterior, and lateral directions.

Description

    CROSS REFERENCE TO RELATED APPLICATIONS
  • [0001]
    This application claims the benefit of U.S. Provisional Application No. 60/685,513, filed May 27, 2005, under 35 U.S.C. §119(e). This application also claims the benefit of U.S. Provisional Application No. 60/717,337, filed Sep. 15, 2005, under 35 U.S.C. §119(e). The entire disclosures of both of those provisional applications are incorporated herein by reference.
  • FIELD OF THE INVENTION
  • [0002]
    The inventions described herein relate to devices and associated methods for treating sleep disorders. More particularly, the inventions described herein relate to devices and methods for treating sleep disorders such as obstructive sleep apnea, snoring, etc.
  • BACKGROUND OF THE INVENTION
  • [0003]
    Obstructive sleep apnea (OSA) is a highly prevalent sleep disorder affecting an estimated 18 million people in the United States, and an estimated 36 million people world wide. Furthermore, the affected population is estimated to be growing at 22% per annum. OSA is not just a quality of sleep issue. OSA has several co-morbidities that drive treatment, including heart failure, hypertension, myocardial infarction, stroke, and diabetes. Despite the seriousness of the condition, it is estimated that only 5% to 8% of the affected population have been diagnosed and treated.
  • [0004]
    Approximately 80% of the patients diagnosed with OSA are prescribed continuous positive airway pressure (CPAP) therapy. Although CPAP is the first line of treatment for the majority of patients and is considered the gold-standard by most practitioners, it enjoys only 30-60% average patient compliance. Approximately 10-15% of patients will have surgical treatment, but the surgical options tend to be invasive and are not always effective. Approximately 5-10% of patients will use a mandibular advancement device, but such devices tend to have limited efficacy and are often associated with joint pain.
  • [0005]
    Thus, there is a need for improved OSA treatment devices in terms of patient compliance, invasiveness and efficacy.
  • SUMMARY OF THE INVENTION
  • [0006]
    To address these and other unmet needs, the present invention provides, in exemplary non-limiting embodiments, devices and methods for treating OSA and other sleep disorders. Exemplary embodiments are described in more detail hereinafter.
  • [0007]
    Some of the embodiments described herein may act directly or indirectly on tissues of the upper airway, including the oropharynx and/or hypopharynx, to increase the luminal size thereof or otherwise open the airway to mitigate against or reverse a compromise of airflow such as a hypopnea event, an apnea event, a snoring event, etc. The increase in airway size may be in the anterior, inferior and/or lateral directions, for example, and may occur at one or multiple levels. Although described with reference to the pharynx, the embodiments described herein may also be applied to other portions of the airway such as the nasopharynx, larygopharynx, and larynx and associated tissues with similar effect.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • [0008]
    It is to be understood that both the foregoing summary and the following detailed description are exemplary. Together with the following detailed description, the drawings illustrate exemplary embodiments and serve to explain certain principles. In the drawings:
  • [0009]
    FIGS. 1A and 1B are schematic illustrations of relevant anatomy;
  • [0010]
    FIGS. 2A and 2B are schematic illustrations of a negative pressure system shown disposed on a patient;
  • [0011]
    FIGS. 3A-3D are side, front, and cross-sectional views of the negative pressure device shown in FIGS. 2A and 2B;
  • [0012]
    FIGS. 4A-4C are schematic illustrations of alternative negative pressure devices shown disposed on a patient;
  • [0013]
    FIGS. 5A-5D are schematic illustrations of adhesive traction devices;
  • [0014]
    FIGS. 6A-6D are schematic illustrations of a resilient traction device;
  • [0015]
    FIGS. 7A-7D are schematic illustrations of an alternative resilient traction device;
  • [0016]
    FIGS. 8A and 8B are schematic diagrams illustrating force vectors acting on the hyoid bone;
  • [0017]
    FIGS. 8C-8N are schematic diagrams of various embodiments of tension members acting on the hyoid bone to achieve the force vectors shown in FIGS. 8A and 8B;
  • [0018]
    FIGS. 9A-9E are schematic illustrations of various tension members for use in the embodiments shown previously;
  • [0019]
    FIGS. 10A-10D are schematic illustrations of magnetic devices acting on the hyoid bone;
  • [0020]
    FIGS. 11A and 11B are schematic illustrations of a magnetic arrangement for use in the embodiments illustrated in FIGS. 10A-10D;
  • [0021]
    FIGS. 12A-12D are schematic illustrations of intra-oral devices providing an alternative airway passage; and
  • [0022]
    FIGS. 13A and 13B are schematic illustrations of an implantable device providing an alternative airway passage.
  • DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
  • [0023]
    The following detailed description should be read with reference to the drawings in which similar elements in different drawings are numbered the same. The drawings, which are not necessarily to scale, depict illustrative embodiments and are not intended to limit the scope of the invention.
  • [0024]
    With reference to FIGS. 1A and 1B, some of the anatomical features relevant to the embodiments described herein are schematically illustrated. Other anatomical features may be discussed hereinafter but not specifically illustrated or labeled. In such instances, reference may be made to Gray's Anatomy and/or Netter's Atlas of Human Anatomy for an understanding thereof.
  • [0025]
    With reference to FIGS. 2A and 2B, a negative pressure system is shown. The negative pressure system includes a neck appliance 30, shown disposed on the neck and under the jaw, and a source of controlled negative pressure 20. The neck appliance 30 generally includes a body portion 32 and a perimeter seal 34. The body portion 32, the perimeter seal 34 and the patient's skin thereunder define a negative pressure zone effecting tissues under the mandible and around the neck as will be described in more detail hereinafter. A port 38 provides fluid communication through the body portion 32 to the negative pressure zone for evacuation thereof.
  • [0026]
    The body portion 32 has sufficient structural integrity to resist collapse due to the negative pressure gradient between the negative pressure zone inside the device and the atmosphere outside the device. The body portion 32 is also impermeable or semi-permeable to gas (e.g., air) within the desired pressure range (e.g., 0.01-14.7 psi). The body portion 32 may comprise, for example, a rigid shell, a semi-rigid shell, or a flexible shell as shown in FIGS. 2A and 2B, or a bellows structure as shown in FIGS. 4A-4C.
  • [0027]
    With continued reference to FIGS. 2A and 2B, the body portion 32 is shown as a shell comprising, for example, a thermoplastic polymer (e.g., ABS) formed by vacuum molding, injection molding, stereo-lithography or fused deposition modeling. If a rigid or semi-rigid shell is used for the body portion 32, a sealed hinge 36 (such as a cut-out from the shell covered by an impermeable or semi-permeable membrane) may be utilized to permit relative articulation of the user's head and neck while maintaining the negative pressure zone.
  • [0028]
    The perimeter seal 34 provides a gas seal between the body portion 32 and the user's skin. The perimeter seal 34 may comprise, for example, low durometer closed cell foam such as PVC adhesively bonded to the body portion 32, for example. Alternatively, the perimeter seal 34 may comprise a sealing tape partially overlapping the body portion 32 and partially overlapping the user's skin.
  • [0029]
    The body portion 32 and the perimeter seal 34 provide a sufficient seal to maintain the desired level of negative pressure in the negative pressure zone. The body portion 32 and the perimeter seal 34 may be air-tight (impermeable) or may have a limited and/or controlled leak rate (semi-permeable). Generally, the more the permeable the body portion 32 and the perimeter seal 34 are, and/or the more leaky the perimeter seal 34 is, the greater the evacuation flow rate required to compensate for leakage in order to maintain the desired level of negative pressure.
  • [0030]
    A negative pressure control unit 20 is coupled to the neck appliance 30 via a fluid line or tube 25 connected to port 38 on the neck appliance 30 and port 28 on the control unit 20.
  • [0031]
    The control unit 20 may generally include a negative pressure source 22 (e.g., vacuum pump), which may be electrically powered by a power source 24 (e.g., DC battery or 120V AC line power). The negative pressure source 22 may be connected to an adjustable regulator 26 to titrate the amount of negative pressure applied to the neck appliance 30. The regulator 26 may include a vent (not shown) which enables it to function as a pressure regulator. Alternatively, the regulator 26 may function as a flow regulator and a negative pressure relief valve may be incorporated into the neck appliance 30 and/or line 25 to maintain the desired level of negative pressure. Those skilled in the art will recognize that a variety of devices (valves, regulators, etc.) may be plumbed into the system to achieve and maintain the desired level of negative pressure. Further, the control unit may be configured to deliver constant, intermittent or feedback controlled negative pressure. Feedback parameters include, for example, oxygen saturation, plural cavity pressure, inhalation/exhalation flow, snore volume, etc., and suitable sensors may be employed accordingly.
  • [0032]
    With reference to FIGS. 3A-3D, the neck appliance 30 is shown in more detail. FIG. 3A is a side view, FIG. 3B is a front view, and FIGS. 3C and 3D are cross-sectional views taken along lines C-C and D-D in FIG. 3A. From these views, it may be appreciated that the body portion 32 may have concave interior shape to accommodate expansion of tissue upon application of negative pressure. Alternatively, as shown in FIGS. 4A-4C, the body portion 32 may have a shape that generally follows the contour of the user's neck with a stand-off sufficient to accommodate expansion of tissue in the negative pressure zone.
  • [0033]
    With continued reference to FIGS. 3A-3D, an optional diffuser 33 such as an open-cell foam may be placed on the inside of the shell 32 over the port 38 to prevent skin from occluding the port if the suction displaces the skin sufficiently to otherwise come into contact with the shell 32. Also optionally, small vent holes 39 may be proved to permit limited infusion of air to provide a cooling effect to the skin in the negative pressure zone. Vent holes 39 may have a diameter of approximately 0.010 inches, for example, to provide the venting function without compromising the ability to draw sufficient vacuum in the negative pressure zone. Alternatively, the shell 32 and/or the perimeter seal 34 may be semi-permeable or otherwise provide for controlled leakage to provide the same venting and cooling function.
  • [0034]
    With reference to FIGS. 4A-4C, alternative neck appliances 40 and 40′ are shown schematically. In the embodiments illustrated in FIGS. 4A and 4C, the body portion 32 is shown as a bellows structure, whereas in the embodiment illustrated in FIGS. 2A-2B and 3A-3D, the body portion 32 is shown as a shell. The neck appliance 40 shown in FIGS. 4A and 4B extends around the anterior and lateral aspects of the neck, and the neck appliance 40′ shown in FIG. 4C further extends around the posterior aspect of the neck, thus encircling the neck. The upper portions of the perimeter of neck appliances 40 and 40′ generally follow the contour of the mandible. At least a portion of the upper perimeter of the neck appliances 30, 40 and 40′ may extend under at least a portion of the mandible such the chin to apply upward forces against the mandible to bias the jaw to the closed position. To bias the jaw to the closed position, neck appliances 40 and 40′ may engage the sternum and/or clavicle as best seen in FIG. 4B.
  • [0035]
    With continued reference to FIG. 4A-4C, the bellows structure 32 may comprise a flexible membrane 42 covering or encasing a plurality of wire or polymeric semi-circular struts 44 that have sufficient hoop strength to resist collapse under negative pressure but permit relative articulation of the user's head and neck. To counteract the tendency of negative pressure to cause the head and neck to nod forward, one or more biasing members 46 such as springs my be incorporated between the upper and lower perimeter portions.
  • [0036]
    In the embodiments that utilize negative pressure, the zone of reduced pressure may act directly on the skin and indirectly on the subcutaneous tissues, glossal muscles, suprahyoid muscles, infrahyoid muscles and adjacent pharyngeal tissues defining the pharynx (e.g., oropharynx and/or hypopharynx) to indirectly increase the size of the airway. The negative pressure zone may indirectly act on the anterior, inferior and/or lateral aspects of the pharyngeal tissues to increase the size of the airway defined thereby. Thus, the negative pressure zone may apply forces in the anterior, inferior and/or lateral directions. These “pulling” forces may act to increase the luminal size of the upper airway or otherwise open the airway to mitigate against or reverse a compromise of airflow such as a hypopnea event, an apnea event, a snoring event, etc.
  • [0037]
    Explained differently, by application of negative pressure to tissues outside the upper airway, the magnitude of the pressure gradient between the atmosphere and the airway that normally occurs during inhalation is reduced. Thus, just as positive internal airway pressure (e.g., CPAP) “pushes” pharyngeal tissues outward to open the upper airway, negative external airway pressure “pulls” pharyngeal tissues outward to have the same or similar net effect.
  • [0038]
    In order to apply “pull” forces in the anterior, lateral and/or inferior directions to tissues adjacent the upper airway, opposing “push” forces must be supported by some anatomical structure or offset by an equal and opposite pull force. For example, the embodiments illustrated in FIGS. 2A-2B and 4A-4B pull pharyngeal tissues anteriorly and inferiorly (forward and down), as well as laterally. The anterior and inferior pull forces may be supported anatomically by pushing on the mandible (e.g., lower jaw and/or chin) and on the sternal head of the sternocleidomastoid muscle and/or thyroid cartilage. Alternatively, as shown in FIGS. 4A and 4B, the anterior and inferior pull forces may be supported anatomically by pushing on the mandible and the sternum and/or bilaterally to the clavicle. The lateral pull forces are offset (in part) by equal and opposite pull forces acting on the right and left sides of the neck, and supported anatomically (in part) by pushing on the mandible and lateral neck muscles (e.g., sternocleidomastoid, scalene, and/or trapezius muscles). Although not illustrated, the neck appliance may extend around the entire circumference of the neck such that the anterior pull force is offset by an equal and opposite force pulling posteriorly on the back of the neck. Generally, the anatomical structures supporting the opposing push forces should exclude the anatomical structures that influence airflow in the upper airway, such as the hyoid bone, the glossal, suprahyoid and infrahyoid muscles, and the adjacent pharyngeal tissues.
  • [0039]
    With reference to FIGS. 5A-5C, an inflatable adhesive traction device 50 is shown schematically. Traction device 50 includes a body portion 52 comprising a rigid or semi-rigid shell, for example, having a geometry that generally follows the contours of the user's neck and underside of the mandible. The body portion 52 may extend from the mandible superiorly, to the sternum/clavicle inferiorly. A releasable adhesive layer 54 is bonded or otherwise connected to the inside surface of the shell 52 and is configured to adhesively connect to the user's skin. A single or series of inflatable perimeter balloons 56 is connected to the perimeter of the shell 52. The balloon(s) 56 are inflatable between a collapsed state as shown in FIG. 5B and an expanded state as shown in FIG. 5C.
  • [0040]
    Upon inflation of the balloon(s) 56, the balloon(s) 56 push on the user's mandible, lateral neck muscles, and sternum/clavicle regions, causing the shell 52 to be displaced in an anterior and inferior direction, thus applying traction to tissues in contact with the adhesive layer 54 in the same direction. Thus, by virtue of the adhesive connection between the shell 52 and the skin of the neck, inflation of the balloon(s) 56 causes traction to be applied to the neck in inferior and anterior directions similar to the forces applied by the negative pressure embodiments described previously, and with similar effect. Applying traction to the skin transfers forces to the underlying platysma muscle which acts to apply negative pressure to the underlying musculature and laryngeal tissues thus opening the airway.
  • [0041]
    With reference to FIG. 5D, an alternative adhesive traction device 50′ is shown schematically. Traction device 50′ is similar to device in form and function to device 50 except that forces are applied by a posterior portion 58 rather than balloons 56 as shown previously. Accordingly, device 50′ includes a shell 52 and an adhesive layer 54, but may exclude balloon 56. Posterior portion 58 includes a releasable adhesive layer 54′ is bonded or otherwise connected to the inside surface of the shell 52′ and is configured to adhesively connect to the user's skin on the back of the neck. A traction mechanism 57 such as a turnbuckle interconnects the device 50′ to the posterior portion 58. Adjusting the traction mechanism 57 causes the shell 52 to be displaced in an anterior and inferior direction, thus applying traction to tissues in contact with the adhesive layer 54 to have a similar effect as device 50.
  • [0042]
    With reference to FIGS. 6A-6D, a resilient traction device 60 is shown schematically. The resilient traction device 60 includes a flexible and resilient strip 62 formed of sheet metal, for example, which may have a resting profile as schematically shown in FIG. 6C. The device 60 also includes a releasable adhesive layer 64 that is bonded or otherwise connected to the inside surface of the resilient strip 62 and is configured to adhesively connect to the user's skin. Upon application to the neck of the user under the mandible, the resilient strip 62 elastically deforms to conform to the contours of the neck with an applied profile as schematically shown in FIG. 6D. By virtue of the adhesive connection between the strip 62 and the skin of the neck, the elastic bias of the flexible strip 62 causes traction to be applied to the neck by pushing under the mandible in an inferior direction similar to the inferior forces applied by the negative pressure embodiments described previously, and with similar effect. Applying traction to the skin transfers inferior forces to the underlying musculature which acts to apply negative pressure to the underlying laryngeal tissues thus opening the airway.
  • [0043]
    With reference to FIGS. 7A-7D, an alternative resilient traction device 70 is shown schematically. The resilient traction device 70 includes a flexible and resilient strip 72 formed of sheet metal, for example, which may have a resting profile as schematically shown in FIG. 7C. The device 70 also includes a releasable adhesive layer 74 that is bonded or otherwise connected to the inside surface of the resilient strip 72 and is configured to adhesively connect to the user's skin. Upon application around the neck of a user, the resilient strip 72 elastically deforms to conform to the contours of the neck with an applied profile as schematically shown in FIG. 7D. By virtue of the adhesive connection between the strip 72 and the skin of the neck, the elastic bias of the flexible strip 72 causes traction to be applied to the neck by pushing on the thyroid cartilage and applying lateral and anterior pulling forces similar to the lateral and anterior forces applied by the negative pressure embodiments described previously, and with similar effect. Applying traction to the skin transfers inferior forces to the underlying musculature which acts to apply negative pressure to the underlying laryngeal tissues thus opening the airway. Resilient traction devices 60 and 70 may be used alone or in combination to have the desired net effect.
  • [0044]
    With reference to FIGS. 8A and 8B, force vectors (F) acting on the hyoid bone (H) are schematically illustrated relative to other anatomical features including the mandible (M) and chin (CH) portion thereof, thyroid cartilage (TH), cricoid cartilage (CC), trachea (T), clavicle (CL), sternum (S), and first rib (R1). By pulling the body of the hyoid bone in the anterior and/or inferior directions as shown in FIG. 8A, the luminal size of the airway may be increased or otherwise dilated in the anterior direction. In addition or alternatively, by pulling the greater horns of the hyoid bone in the lateral directions as shown in FIG. 8B, the luminal size of the airway may be increased or otherwise dilated in the lateral directions.
  • [0045]
    These force vectors acting in the hyoid bone may be implemented in a number of different ways, including, for example, utilizing the tension members described with reference to FIGS. 8C-8N and FIGS. 9A-9E, or utilizing the magnetic devices described with reference to FIGS. 10A-10D.
  • [0046]
    Various combinations of tension member arrangements are illustrated in FIGS. 8C-8N. These arrangements are provided by way of example, not necessarily limitation, and these arrangements may be taken alone or in combination. Further, for each illustrated tension member, one or more members may be utilized to provide a composite effect.
  • [0047]
    With reference to FIGS. 8C and 8D, a first unilateral tension member 80 is anchored to the middle of the body of the hyoid bone and to the middle of the chin, and a second unilateral tension member 84 is anchored to the middle of the body of the hyoid bone and to the middle of the sternum. Tension members 80 and 84 provide the net force vector illustrated in FIG. 8A.
  • [0048]
    With reference to FIGS. 8E and 8F, a unilateral tension member 80 is anchored to the middle of the body of the hyoid bone and to the middle of the chin, and bilateral tension members 84 and 86 are anchored to the lateral aspects of body of the hyoid bone near the lesser horns and to the right and left clavicles. Tension members 80, 84 and 86 provide the net force vector illustrated in FIG. 8A. In addition, the lateral placement of tension members 84 and 86 provide the force vectors illustrated in FIG. 8B.
  • [0049]
    With reference to FIGS. 8G and 811, bilateral tension members 80 and 82 are anchored to the lateral aspects of the body of the hyoid bone near the lesser horns and to the lateral aspects of the chin, and a unilateral tension member 84 is anchored to the middle of the body of the hyoid bone and to the sternum. Tension members 80, 82 and 84 provide the net force vector illustrated in FIG. 8A. In addition, the lateral placement of tension members 80 and 82 provide the force vectors illustrated in FIG. 8B.
  • [0050]
    With reference to FIGS. 8I and 8J, bilateral tension members 80 and 82 are anchored to the lateral aspects of body of the hyoid bone near the lesser horns and to the lateral aspects of the chin, and bilateral tension members 84 and 86 are anchored to the lateral aspects of body of the hyoid bone near the lesser horns and to the right and left clavicles. Tension members 80, 82, 84 and 86 provide the net force vector illustrated in FIG. 8A. In addition, the lateral placement of tension members 80, 82, 84 and 86 provide the force vectors illustrated in FIG. 8B.
  • [0051]
    With reference to FIGS. 8K and 8L, bilateral tension members 80 and 82 are anchored near the greater horns of the hyoid bone lateral aspects of the mandible, and a unilateral tension member 84 is anchored to the middle of the body of the hyoid bone and to the middle of the sternum. Tension members 80, 82, and 84 provide the net force vector illustrated in FIG. 8A. In addition, the lateral placement of tension members 80 and 82 provide the force vectors illustrated in FIG. 8B.
  • [0052]
    With reference to FIGS. 8M and 8N, a unilateral tension member 80 is anchored to the middle of the body of the hyoid bone and to the middle of the chin, and bilateral tension members 84 and 86 are anchored to the lateral aspects of body of the hyoid bone near the lesser horns and to the lateral aspects of the thyroid cartilage. Tension members 80, 84 and 86 provide the net force vector illustrated in FIG. 8A. In addition, the lateral placement of tension members 84 and 86 provide the force vectors illustrated in FIG. 8B.
  • [0053]
    With reference to FIGS. 9A-9E, various embodiments of tension members 90 are shown schematically. The tension members 90 may be arranged according to the examples provided in FIGS. 8C-8N. The tension members 90 may be placed surgically by minimal incisions at the attachment or anchor points and tunneling therebetween under the platysma muscle, for example. The tension members 90 may tensioned by adjusting the final implanted length. Tension may be set such that the hyoid is under constant tension or may be set such that the hyoid is under tension only when displaced sufficiently to be concomitant with an apnea or hypoxia event.
  • [0054]
    In the embodiment illustrated in FIG. 9A, tension member 90A includes a cable 92 that is flexible but relatively inelastic in elongation, such as a polymeric multifilament cable. For example, the cable may comprise a multifilar braided polymeric construction, with filaments of ultra high molecular weight polyethylene (e.g., Spectra™), polyester (e.g. Dacron™), liquid crystal polymers (e.g., Vectran™), or other like polymer, used to form the braided cable. The cable 92 may be covered with an expanded PTFE sheath or other material to facilitate in-growth of tissue. The cable 92 may be connected to the desired anatomical anchor points using screws 94 or other anchor mechanisms conventionally used to anchor to bone and/or cartilage.
  • [0055]
    In the embodiment illustrated in FIG. 9B, the tension member 90B includes an elastic member 91 connected in-line with the cable 92 that increases the tension as the length of the tension member 90B increases. Elastic member 91 may comprise an elastic cable material or a spring, for example.
  • [0056]
    In the embodiment illustrated in FIG. 9C, the tension member 90C includes a magnetic mechanism 93 connected in-line with the cable 92 that increases the tension as the length of the tension member 90C decreases. Magnetic mechanism 93 may comprise two magnets arranged to attract each other and movably disposed in a housing.
  • [0057]
    In the embodiment illustrated in FIG. 9D, the tension member 90D includes a pneumatic or hydraulic actuation (e.g., piston and chamber) 95 connected in-line with the cable 92. The actuator 95 may be connected to a subcutaneous injection port 96 or subcutaneous pump 98 via a fluid line 97 to increase or decrease the volume of fluid and pressure in the actuator. The actuator 95 permits adjustment of the length and/or dynamic characteristics of the tension member 90D from outside the body without the need for surgical access.
  • [0058]
    In the embodiment illustrated in FIG. 9E, the tension member 90E includes alternative anchoring mechanisms 94′ and 94″ for attachment to the hyoid bone. Anchor mechanism 94′ comprises a loop or band that may encircle a portion of the hyoid bone, thereby negating the need to mechanically disrupt the bone as with a screw. Anchor mechanism 94″ comprises an expandable anchor wherein the expandable portion engages more surface area than otherwise provided by the threads on a bone screw.
  • [0059]
    With reference to FIGS. 10A-10D, various embodiments of magnetic devices acting on the hyoid bone are schematically illustrated. The illustrated embodiments generally utilize a magnet implanted and attached to the hyoid bone, together with an external magnet which either attracts or repels the implanted magnet. For example, an implanted magnet may be placed on the middle portion of the body of the hyoid bone with external magnets placed on either the front or back of the user's neck as shown to achieve anterior forces acting thereon. Alternatively, the implanted and external magnets may be placed more laterally to achieve lateral forces acting thereon. For example, implanted magnets may be placed on the greater horns of the hyoid bone with external magnets placed on the left and right sides of the user's neck. The external magnet is relatively fixed such that the magnetic fields apply forces to the hyoid bone and cause displacement thereof to increase the size of the airway as described previously.
  • [0060]
    With specific reference to FIGS. 10A and 10B, an implanted magnet 100 is schematically shown anchored to the body of the hyoid bone. Implanted magnet 100 may comprise a rare earth magnetic material such as Neodymium (Nd2Fe14B or NIB) or Samarium-Cobalt (SmCo5) encapsulated by a non-magnetic biocompatible material and secured to the hyoid bone with a screw, looped band or expandable anchor, for example. An external magnet 102 may be secured to the front of the neck as shown in FIG. 10A to attract the implanted magnet 100, or to the back of the neck as shown in FIG. 10B to repel the implanted magnet 100, both resulting in anterior forces being applied to the hyoid bone. The external magnet 102 may comprise a rare earth magnet as described above, or an electromagnet connected to a suitable power supply (not shown). The external magnet 102 may be surrounded by padding and may be held in position by and oral brace 104 as shown in FIG. 10A or a neck band 106 as shown in FIG. 10B.
  • [0061]
    With reference to FIGS. 10C and 10D, the implanted magnet 100 is indirectly connected to the hyoid bone by tension member 90. Utilizing tension member 90 permits the implanted magnet 100 to be positioned more proximate the external magnet 102 independent of hyoid bone position and independent of skin thickness. In the embodiment shown in FIG. 10C, the implanted magnet 100 is positioned proximate the chin inside the mandible and indirectly connected to the hyoid bone via tension member 90. The external magnet 102 is positioned on the chin and held in place with strap 106. In the embodiment shown in FIG. 10D, the implanted magnet 100 is positioned in subcutaneous fat proximate the dermis and indirectly connected to the hyoid bone via tension member 90. The external magnet 102 is positioned under the chin and held in place with oral brace 104.
  • [0062]
    With reference to FIGS. 11A and 11B, an example of a magnetic arrangement for use in the embodiments shown in FIGS. 10A-10D is schematically illustrated. In the illustrated arrangement, two groups of magnets are shown, one comprising magnet 114 and another comprising magnetic pair 110/112. Magnet 114 may correspond to the implanted magnet 100 described previously, with the magnet pair 110/112 corresponding to the external magnet 102 described previously, or vice-versa. The pair of magnets 110 and 112 are physically connected (e.g., adhesively bonded) together, each with either the south or north poles facing each other. Having the same poles facing each other provides a unique magnetic field, but causes the magnets 110 and 112 to repel each other, hence the need for a sufficiently strong physical connection therebetween. Generally speaking, the magnetic field of magnet 110 provides a greater magnetic force than magnet 112.
  • [0063]
    As magnet 114 is moved toward magnet pair 110/112, the attractive force between magnet 114 and magnet 110 is stronger than the repulsive force between magnet 114 and magnet 112, thus creating a net attractive force as shown in FIG. 11A. As magnet 114 approaches magnet pair 110/112, the attractive force between magnet 110 and 114 is counterbalanced by the repulsive force between magnet 112 and 114, thus creating a zone of zero net force as shown in FIG. 11B. As magnet 114 moves closer to magnet pair 110/112, the repulsive force between magnet 112 and magnet 114 becomes greater than the attractive force between magnet 110 and magnet 114. This arrangement allows attraction between two groups of magnets that decreases to zero as the magnets approach, which may be useful in the embodiments described with reference to FIGS. 10A, 10C, and 10D because it allows for attractive forces to be applied to the hyoid bone without the risk of pinching tissue (e.g., skin) as the magnets come into close proximity.
  • [0064]
    With reference to FIGS. 12A-12D, various embodiments of intra-oral devices that provide an alternative airway passage are shown schematically. With specific reference to FIG. 12A, intra-oral device 120 is shown disposed in a user's mouth. Device 120 includes a body portion 122 having a geometry that follows the contours of the roof of the mouth (hard and soft palates) and a retainer portion 124 that partially surrounds one or more teeth to hold the device 120 in place as shown. One or more holes 125, inferior channels 127 or superior channels 129 as seen in FIGS. 12C, 12D and 12E, respectively, extend through the body portion 122 of the device 120 to define a path extending from approximately the retainer portion 124 adjacent the teeth to approximately the distal aspect of the body portion 122 beyond where the tongue naturally rests against the soft palate. The more holes 125, inferior channels 127 or superior channels 129 provide a passage for air to pass through the oral cavity and into the oropharynx despite the tongue pressing against the soft palate and despite the soft palate occluding the nasopharynx.
  • [0065]
    With reference to FIGS. 13A and 13B, an implantable device 130 is shown schematically. Implantable device 130 may comprise a stent-like structure that defines an alternative air passageway. The stent-like device 130 may comprise a stainless steel or nickel titanium alloy wire or cut tube structure (e.g., self-expanding stent or balloon expandable stent design), and may be covered with a graft material such as expanded PTFE or polyester fabric.
  • [0066]
    The stent-like device 130 may be disposed submucosally in the buccopharyngeal space and extend from the nasopharyngeal level through oropharyngeal level superior to the esophagus as shown. To position the device 130 as such, a submucosal lumen may be formed by surgically or endoscopically tunneling by blunt dissection. The stent-like device 130 may then be deployed in the dissected lumen, such as by catheterization, for example. Once in place, the device 130 maintains patency of a lumen to provide an alternative air passageway that is useful in the event of occlusion of the natural upper airway.
  • [0067]
    From the foregoing, it will be apparent to those skilled in the art that the present invention provides, in exemplary non-limiting embodiments, devices and methods for treating OSA and other sleep disorders. Further, those skilled in the art will recognize that the present invention may be manifested in a variety of forms other than the specific embodiments described and contemplated herein. Accordingly, departures in form and detail may be made without departing from the scope and spirit of the present invention as described in the appended claims.

Claims (2)

  1. 1. A device for maintaining an open airway comprising:
    a body portion configured for application along a front portion of a patient's neck, the body portion having a perimeter, an outside surface, and an inside surface;
    an adhesive provided along the inside surface such that the body portion is configured for adhesive engagement with the front portion of the patient's neck; and
    a traction application mechanism configured to apply traction in one or both of inferior and anterior directions to tissues in contact with the adhesive layer.
  2. 2-40. (canceled)
US12625255 2005-05-27 2009-11-24 Devices and methods for treating sleep disorders Abandoned US20100139667A1 (en)

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