WO2007014429A1 - Methode et systeme de traitement d'un patient souffrant d'apnee obstructive du sommeil - Google Patents

Methode et systeme de traitement d'un patient souffrant d'apnee obstructive du sommeil Download PDF

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Publication number
WO2007014429A1
WO2007014429A1 PCT/AU2006/001095 AU2006001095W WO2007014429A1 WO 2007014429 A1 WO2007014429 A1 WO 2007014429A1 AU 2006001095 W AU2006001095 W AU 2006001095W WO 2007014429 A1 WO2007014429 A1 WO 2007014429A1
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WO
WIPO (PCT)
Prior art keywords
patient
lower jaw
treatment period
apnea
ahi
Prior art date
Application number
PCT/AU2006/001095
Other languages
English (en)
Inventor
Klaus Henry Schindhelm
Original Assignee
Resmed Limited
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Resmed Limited filed Critical Resmed Limited
Publication of WO2007014429A1 publication Critical patent/WO2007014429A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS 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
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/56—Devices for preventing snoring
    • A61F5/566—Intra-oral devices

Definitions

  • the present invention relates to a method and system for treating a patient with obstructive sleep apnea.
  • Obstructive sleep apnea is a common sleep-related respiratory disorder, and many obstructive sleep apnea therapies have been developed to treat the disorder.
  • One such therapy is a mandibular advancement device that is used to adjust the position of the patient's lower jaw, e.g., bringing it forward, in an attempt to keep the patient's airway open.
  • U.S. Patent No. 6,604,527 discloses several embodiments of mandibular advancement devices, including fixed devices having a fixed magnitude of adjustment and adjustable devices having an adjustable magnitude of adjustment. The proper adjustment is found by trial and error by trying multiple fixed devices or by incrementally adjusting the adjustable device. This adjustment procedure makes it difficult to ensure clinical efficacy. Furthermore, an incorrect adjustment by the device may lead to stress in the temporo-mandibular joints of the patient.
  • One aspect of the present invention is directed towards an improved method and system for treating a patient with obstructive sleep apnea.
  • Another aspect of the invention relates to a method for treating a patient with obstructive sleep apnea.
  • the method includes measuring apnea severity of the patient during a treatment period, and selectively changing a position of the patient's lower jaw after the treatment period is complete based on the apnea severity measured during the treatment period.
  • Still another aspect of the invention relates to a system for treating obstructive sleep apnea.
  • the system includes an adjustable mandibular advancement device adapted to be fitted to the jaws of a patient for use during a treatment period to treat obstructive sleep apnea.
  • the adjustable mandibular advancement device is structured to advance the position of the patient's lower jaw.
  • a monitoring device monitors the patient during the treatment period to provide a measure of apnea severity displayed by the patient during the treatment period.
  • the adjustable mandibular advancement device is configured to selectively adjust the position of the patient's lower jaw after the treatment period is complete based on the measure of apnea severity provided by the monitoring device.
  • Yet another aspect of the invention relates to a system for treating obstructive sleep apnea.
  • the system includes a set of fixed mandibular advancement devices.
  • Each of the devices is adapted to be fitted to the jaws of a patient for use during a treatment period to treat obstructive sleep apnea.
  • Each of devices is structured to advance the position of the patient's lower jaw to a unique magnitude of advancement.
  • a monitoring device monitors the patient during the treatment period to provide a measure of apnea severity displayed by the patient during the treatment period.
  • One of the devices is selected for the next treatment period in accordance with the measure of apnea severity provided by the monitoring device.
  • FIG. 1 is a flow chart of a method for treating a patient with obstructive sleep apnea according to an embodiment of the present invention
  • Fig. 2 is a side view of a mandibular advancement device usable in the method of Fig. 1, the mandibular advancement device fitted to the jaws of a patient;
  • FIG. 3 is a perspective view of an embodiment of an upper member of the mandibular advancement device shown in Fig. 2;
  • FIG. 4 is a top view of an embodiment of an lower member of the mandibular advancement device shown in Fig. 2;
  • Fig. 5 is a side view of the lower member shown in Fig. 4, the adjustable lower flange of the lower member in a first predetermined setting;
  • Fig. 6 is a side view of the lower member shown in Fig. 4, the adjustable lower flange of the lower member in a fourth predetermined setting;
  • FIG. 7 is a schematic view of an embodiment of a monitoring device usable in the method of Fig. 1;
  • FIG. 8 is a schematic view of another embodiment of a monitoring device usable in the method of Fig. 1;
  • Figs. 9 A and 9B are tables illustrating embodiments of the relation between an AHI Value and its related mandibular advancement device setting;
  • FIG. 10 is a schematic view of a system for treating a patient with obstructive sleep apnea according to another embodiment of the present invention.
  • Fig. 1 illustrates a method for treating a patient with obstructive sleep apnea according to an embodiment of the present invention.
  • the method relates to the way in which a mandibular advancement device used in the treatment of obstructive sleep apnea is changed, e.g., adjusted, hi general, the mandibular advancement device is used in conjunction with a monitoring device that monitors the patient during a treatment period to provide a measure of apnea severity which the patient displayed during the treatment period.
  • the mandibular advancement device can be selectively or incrementally changed after the treatment period is complete for the next treatment period based on the measure of apnea severity provided by the monitoring device. This can be an iterative procedure over a number of treatment periods, e.g., nights, to determine the optimal device setting.
  • the mandibular advancement device may have any suitable structure as is known in the art to advance the position of the patient's lower jaw.
  • the mandibular advancement device may be adjustable wherein the magnitude of advancement provided by the device may be adjusted.
  • the mandibular advancement device may be fixed wherein the magnitude of advancement provided by the device is fixed.
  • the mandibular advancement device forms part of a system for treating obstructive sleep apnea constructed according to an embodiment of the present invention.
  • the mandibular advancement device is a device disclosed in U.S. Patent No. 6,604,527, the entirety incorporated herein by reference. It is to be understood that the device is merely exemplary, and any suitable mandibular advancement device may form a part of the system.
  • the mandibular advancement device 10 includes an upper member 12 that is adapted to be releasably fitted to the patient's upper jaw 14 and a lower member 16 adapted to be releasably fitted to the patient's lower jaw 18.
  • the upper member 12 includes an upper flange 20 and the lower member 16 includes a lower flange 22.
  • the upper and lower flanges 20, 22 engage one another to advance the position of the patient's lower jaw 18 to a set magnitude of advancement.
  • the mandibular advancement device 10 is maintained in its set magnitude of advancement which attempts to keep the patient's airway open to treat obstructive sleep apnea.
  • the mandibular advancement device 10 may be adjustable or fixed.
  • Figs. 3-6 illustrate an embodiment of an adjustable mandibular advancement device 10.
  • the upper member 12 includes a fixed upper flange 20.
  • the lower flange 22 is movably mounted to the lower member 16 to allow adjustment of the lower flange 22 with respect to the lower member 16.
  • This arrangement allows the patient to manually adjust the magnitude of advancement provided by the device 10 by adjusting the position of the lower flange 22.
  • a turnbuckle mechanism 24 is provided between the lower flange 22 and the lower member 16, and the patient may manually advance and retract the lower flange 22 by adjusting the turnbuckle mechanism 24 with a turnbuckle key.
  • any suitable adjustment mechanism may be provided to adjust the position of the lower flange 22 with respect to the lower member 16.
  • the adjustable mandibular advancement device 10 provides a range of settings that provides a range of set magnitudes of advancement to treat obstructive sleep apnea.
  • the range of settings may be discrete so that the patient can selectively adjust the device 10 from one predetermined setting to another predetermined setting.
  • the lower member 16 includes markings adjacent the movable lower flange 22 that each represent a predetermined setting, e.g., settings 1-4.
  • the leading edge 26 of the movable lower flange 22 may be selectively aligned with a marking to set the device 10. For example, Fig.
  • Fig. 5 illustrates the lower flange 22 in a first predetermined setting ("1") that represents the smallest magnitude of advancement provided by the device 10
  • Fig. 6 illustrates the lower flange 22 in a fourth predetermined setting ("4") that represents the greatest magnitude of advancement provided by the device 10.
  • any suitable number of predetermined settings may be provided, and the settings may be offset from one another by any suitable amount.
  • the range of settings may not be discrete and adjustment may include infinite settings.
  • a maximum setting may be incorporated to prevent overextension or damage to the temporo-mandibular joints.
  • the lower flange 22 may be fixed to the lower member 16 to provide a fixed mandibular advancement device 10.
  • the magnitude of advancement provided by the device 10 is fixed and cannot be adjusted by the patient. Therefore, in order to selectively change the magnitude of advancement, the patient may be supplied with a set of devices each being preset to a different position. That is, each of the devices in the set is structured to advance the position of the patient's lower jaw to a unique magnitude of advancement that is different than the magnitude of advancement provided by the remainder of the devices in the set. For example, four such devices may be provided in a set to allow for four different settings.
  • the monitoring device may have any suitable structure as is known in the art to monitor a patient during a sleeping period to provide a measure of apnea severity which the patient displayed during the sleeping period.
  • the monitoring device may monitor any suitable patient parameter indicative of apnea, and the measure of apnea severity may be expressed in any suitable manner.
  • the monitoring device includes a pocket- sized recording device adapted to receive information from one or more patient monitors monitoring one or more patient parameters, e.g., breathing effort, patient's heart rate. It is to be understood that the device is merely exemplary, and any suitable monitoring device may form a part of the system.
  • the monitoring device may be a device such as the
  • Fig. 7 illustrates an embodiment of the MAP MicroMESAM® monitoring device 40.
  • the device 40 includes a recording device 42 and nasal cannula 44.
  • the recording device 42 may be worn by the patient during use, e.g., by an adjustable abdominal strap 46.
  • the nasal cannula 44 are adapted to be inserted into nasal passages of the patient and coupled to a pressure sensor provided by the recording device 42.
  • the recording device 42 monitors the patient's airflow to detect at least one of apneas, hypopneas, flow limitations, and snoring.
  • the recording device 42 includes a control panel 48 that provides one or more control features.
  • the control features may be selected to adjust operating parameters of the recording device 42.
  • the recording device 42 may provide a log of the patient's use for tracking purposes.
  • the patient programs the recording device 42 to monitor selected patient parameters, e.g., apneas and hypopneas, during a testing period, e.g., overnight. Based on information received from the monitored parameters during the testing period, the recording device 42 provides a measure that is indicative of the degree and/or severity of obstructive sleep apnea which the patient exhibited during the testing period.
  • selected patient parameters e.g., apneas and hypopneas
  • the measure may be an index, such as the Apnea-
  • the monitor may include one or more indicator lights to indicate the severity of obstructive sleep apnea.
  • the device may include a red light that indicates that the patient exhibits symptoms of obstructive sleep apnea, and a green light that indicates that the patient does not exhibit symptoms of obstructive sleep apnea.
  • the AHI value and indicator lights provide positive feedback regarding the patient's degree of obstructive sleep apnea.
  • Fig. 8 illustrates an embodiment of the Medcare Embletta® monitoring device 60.
  • the device 60 includes a recording device 62 and multiple monitors 64, 66, 68, 70 (e.g., nasal cannula, heart-rate monitor, position and activity, etc.) coupled to the recording device 62.
  • the recording device 62 may be worn by the patient during use, e.g., by an adjustable abdominal strap 72.
  • the recording device 62 Based on information received from the monitors 64, 66, 68, 70 during the testing period, the recording device 62 provides a measure that is indicative of the degree and/or severity of obstructive sleep apnea which the patient exhibited during the testing period.
  • the measure may be an AHI value and/or indicator lights.
  • obstructive sleep apnea is treated by selectively changing the mandibular advancement device 10 after a treatment period is complete based on the measure of apnea severity provided by a monitoring device, such as monitoring devices 40 and 60.
  • the patient may be supplied with either an adjustable mandibular advancement device or a set of fixed mandibular advancement devices.
  • the patient adjusts the adjustable device to set the magnitude of advancement or selects a pre-set device from the set of fixed devices.
  • the patient should initially select a magnitude of adjustment that is relatively small, and then change the device as needed.
  • the patient can set the adjustable device to the first setting ("1 ") which provides minimal displacement of the jaw for the first treatment.
  • a clinician may recommend an initial setting based on an examination of the patient.
  • the device is releasably fitted to the patient's jaws for use during a treatment period, e.g., overnight.
  • a treatment period e.g., overnight.
  • the mandibular advancement device is maintained in its set magnitude of advancement to treat obstructive sleep apnea.
  • the patient is monitored by the monitoring device during the treatment period.
  • the monitoring device provides a measure of apnea severity that was displayed by the patient during the treatment period, e.g., an AHI value or indicator lights. This measure is used by the patient to determine the adequacy of treatment of the mandibular advancement device, and whether the mandibular advancement device should be changed or tailored for the next treatment period.
  • the patient can maintain the same setting of the device or selectively change the setting to one that provides less advancement (if available) for the next treatment period.
  • the measure indicates that the patient's apnea is relatively severe and treatment was inadequate, e.g., AHI greater than 15, the patient can manually adjust the adjustable device to a setting that increases advancement or selectively replace the device with another device in the set to increase advancement for the next treatment period. For example, as shown in Fig.
  • the setting of the adjustable device may correspond with a specific AHI value, e.g., AHI between 20-25 indicates that adjustable device should be set to setting "3".
  • the setting may be selectively or incrementally changed based on the AHI value. This process of selectively changing the device based on the measure of apnea severity provided by the monitoring device may be repeated (e.g., an inventive process) until the patient finds that they are being adequately treated. The process may continue from night to night, and adjustment may or may not occur from night to night based on the measure of apnea detected.
  • the treatment period occurs while the patient is asleep, which generally lasts on average 4-10 hours. However, depending on the patient, the treatment period may be less than 4 hours or more than 10 hours. Regardless of the length of the treatment period, adjustment and/or change of the device occurs when the treatment period is complete.
  • the treatment period is complete, e.g., when the patient awakes and/or the patient's normal breathing cycle resumes.
  • the patient By adjusting and/or changing the device after the treatment period, before the next treatment period, or between treatment periods, e.g., not sleeping, the patient is not awaken by movement of the device that may be necessary to treat the obstructive sleep apnea. Moreover, adjustment of the device to ensure clinical efficacy is relatively simple, thereby suitable for patients to use in their home.
  • a controller 90 may be provided to control adjustment of the adjustable device and/or to control selection of one of the fixed devices from a set. As illustrated, the controller 90 is communicated with the monitoring device 40 or 50 and controls the adjustment and/or selection of the device 10 after a treatment period is complete based on the apnea severity measured during the treatment period. For example, the controller 90 may suggest a specific setting of the device based on the apnea severity measured during the treatment period. Based on the recommended setting, the patient can adjust the adjustable device or select the fixed device for the next treatment period. Moreover, the controller 90 may simply perform a monitoring and/or diagnostic function rather than a control function per se.
  • the controller 90 may automatically adjust the adjustable device after the treatment period is complete based on the measure of apnea severity. That is, the controller 90 may automatically adjust the adjustable device for the next treatment period based on the measure of apnea severity measured during the last treatment period.
  • the controller 90 may determine when the treatment period is complete in any suitable manner, e.g., controller stops receiving signals from the monitoring device for an extended period of time. The process may continue until symptoms have disappeared. This is analogous to a titration method for delivering treatment pressure in a CPAP device. In an embodiment, adjustment may occur during the treatment period rather than after the treatment period until symptoms have disappeared.
  • the monitoring device 40 or 60 may include an AHI detector. If the AHI value detected by the AHI detector is greater than a predetermined value, e.g., AHI greater than 15, for an extended period of time, e.g., 30 hours, then the controller 90 may automatically adjust the adjustable device after a treatment period is complete based on the measure of apnea severity.
  • the controller may adjust the setting of the device via a servo controlled screw extension. The suggested setting may be provided from the monitoring device to the controller via a radio link. For safety, a maximum extension may be set by the clinician based on clinical exam to prevent overextension or damage to the patient's temporo-mandibular joints.

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  • Health & Medical Sciences (AREA)
  • Otolaryngology (AREA)
  • Pulmonology (AREA)
  • Nursing (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Measurement Of The Respiration, Hearing Ability, Form, And Blood Characteristics Of Living Organisms (AREA)
  • Orthopedics, Nursing, And Contraception (AREA)

Abstract

L'invention concerne une méthode de traitement d'un patient souffrant d'apnée obstructive du sommeil. Cette méthode consiste : à mesurer la gravité de l'apnée du patient pendant une période de traitement ; et à modifier sélectivement une position de la mâchoire inférieure du patient après la période de traitement en fonction de la gravité de l'apnée mesurée pendant ladite période de traitement.
PCT/AU2006/001095 2005-08-02 2006-08-02 Methode et systeme de traitement d'un patient souffrant d'apnee obstructive du sommeil WO2007014429A1 (fr)

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US70444705P 2005-08-02 2005-08-02
US60/704,447 2005-08-02

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Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2009143102A1 (fr) * 2008-05-22 2009-11-26 Pavad Medical, Inc. Système de repositionnement mandibulaire intelligent
WO2010033926A1 (fr) * 2008-09-22 2010-03-25 Pavad Medical, Inc. Systèmes et procédés de détection et de traitement d'apnée obstructive du sommeil
DE102011051443A1 (de) * 2011-06-29 2013-01-03 Kai Beermann Schnarch-Therapiegerät
US8757157B2 (en) 2007-08-02 2014-06-24 Resmed Limited Mask for delivery of respiratory therapy to a patient
US8770196B2 (en) 2007-01-19 2014-07-08 Resmed Limited System and method for treating patient with obstructive sleep apnea
WO2015187949A1 (fr) 2014-06-04 2015-12-10 Giridharagopalan Subhalakshmi Systeme et méthode pour appareil buccal intelligent entraîné par un capteur
US10010313B2 (en) 2015-05-18 2018-07-03 Richard L. Arden Mandibular subluxation device and method
US10258319B2 (en) 2015-05-18 2019-04-16 Richard L. Arden Airway assist device and method
US10342526B2 (en) 2015-07-01 2019-07-09 Richard L. Arden Airway assist device and method
US10517701B2 (en) 2015-01-13 2019-12-31 Align Technology, Inc. Mandibular advancement and retraction via bone anchoring devices
US10537463B2 (en) 2015-01-13 2020-01-21 Align Technology, Inc. Systems and methods for positioning a patient's mandible in response to sleep apnea status
US10588776B2 (en) 2015-01-13 2020-03-17 Align Technology, Inc. Systems, methods, and devices for applying distributed forces for mandibular advancement
US11045348B2 (en) 2018-05-08 2021-06-29 Archis Health Investments LLC Apparatus for mandibular advancement of an oral appliance

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WO1995019746A1 (fr) * 1994-01-19 1995-07-27 The University Of British Columbia Appareil de repositionnement des mandibules pour la prevention du ronflement
US5921942A (en) * 1995-11-01 1999-07-13 University Technologies International, Inc. Adaptively controlled mandibular positioning device and method of using the device
AU7244000A (en) * 1999-12-20 2001-06-21 David Rodwell Anti-snoring appliance
AU2775302A (en) * 2001-10-12 2003-04-17 Angove, John Guy A dental appliance for reducing snoring and/or obstructive sleep apnea
US6604527B1 (en) * 1998-07-06 2003-08-12 Richard George Palmisano Mandibular advancement device
US6619290B1 (en) * 2002-11-07 2003-09-16 Christopher B. Zacco Mouthpiece for reducing snoring
US6845774B2 (en) * 2000-04-07 2005-01-25 Mdsa Pty Ltd. Dental device
US20050016547A1 (en) * 2001-10-26 2005-01-27 Philippe Mousselon Intraoral orthosis for preventing snoring

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Publication number Priority date Publication date Assignee Title
WO1995019746A1 (fr) * 1994-01-19 1995-07-27 The University Of British Columbia Appareil de repositionnement des mandibules pour la prevention du ronflement
US5921942A (en) * 1995-11-01 1999-07-13 University Technologies International, Inc. Adaptively controlled mandibular positioning device and method of using the device
US6273859B1 (en) * 1995-11-01 2001-08-14 University Technologies International, Inc. Adaptively controlled mandibular positioning device and method of using the device
US6604527B1 (en) * 1998-07-06 2003-08-12 Richard George Palmisano Mandibular advancement device
AU7244000A (en) * 1999-12-20 2001-06-21 David Rodwell Anti-snoring appliance
US6845774B2 (en) * 2000-04-07 2005-01-25 Mdsa Pty Ltd. Dental device
AU2775302A (en) * 2001-10-12 2003-04-17 Angove, John Guy A dental appliance for reducing snoring and/or obstructive sleep apnea
US20050016547A1 (en) * 2001-10-26 2005-01-27 Philippe Mousselon Intraoral orthosis for preventing snoring
US6619290B1 (en) * 2002-11-07 2003-09-16 Christopher B. Zacco Mouthpiece for reducing snoring

Cited By (20)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8770196B2 (en) 2007-01-19 2014-07-08 Resmed Limited System and method for treating patient with obstructive sleep apnea
US9566405B2 (en) 2007-08-02 2017-02-14 Resmed Limited Mask for delivery of respiratory therapy to a patient and a lotion dispenser therefor
US8757157B2 (en) 2007-08-02 2014-06-24 Resmed Limited Mask for delivery of respiratory therapy to a patient
WO2009143102A1 (fr) * 2008-05-22 2009-11-26 Pavad Medical, Inc. Système de repositionnement mandibulaire intelligent
WO2010033926A1 (fr) * 2008-09-22 2010-03-25 Pavad Medical, Inc. Systèmes et procédés de détection et de traitement d'apnée obstructive du sommeil
DE102011051443A1 (de) * 2011-06-29 2013-01-03 Kai Beermann Schnarch-Therapiegerät
DE102011051443B4 (de) * 2011-06-29 2014-01-09 Kai Beermann Schnarch-Therapiegerät
EP3151792A4 (fr) * 2014-06-04 2017-12-13 Giridharagopalan, Subhalakshmi Systeme et méthode pour appareil buccal intelligent entraîné par un capteur
WO2015187949A1 (fr) 2014-06-04 2015-12-10 Giridharagopalan Subhalakshmi Systeme et méthode pour appareil buccal intelligent entraîné par un capteur
US11246743B2 (en) 2014-06-04 2022-02-15 Archis Health Investments System and method for sensor driven intelligent oral appliance
US11207208B2 (en) 2015-01-13 2021-12-28 Align Technology, Inc. Systems and methods for positioning a patient's mandible in response to sleep apnea status
US11376153B2 (en) 2015-01-13 2022-07-05 Align Technology, Inc. Systems, methods, and devices for applying distributed forces for mandibular advancement
US11259901B2 (en) 2015-01-13 2022-03-01 Align Technology, Inc. Mandibular advancement and retraction via bone anchoring devices
US10517701B2 (en) 2015-01-13 2019-12-31 Align Technology, Inc. Mandibular advancement and retraction via bone anchoring devices
US10537463B2 (en) 2015-01-13 2020-01-21 Align Technology, Inc. Systems and methods for positioning a patient's mandible in response to sleep apnea status
US10588776B2 (en) 2015-01-13 2020-03-17 Align Technology, Inc. Systems, methods, and devices for applying distributed forces for mandibular advancement
US10258319B2 (en) 2015-05-18 2019-04-16 Richard L. Arden Airway assist device and method
US10010313B2 (en) 2015-05-18 2018-07-03 Richard L. Arden Mandibular subluxation device and method
US10342526B2 (en) 2015-07-01 2019-07-09 Richard L. Arden Airway assist device and method
US11045348B2 (en) 2018-05-08 2021-06-29 Archis Health Investments LLC Apparatus for mandibular advancement of an oral appliance

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