WO2010059708A1 - Appareil buccal intégré pour un trouble respiratoire du sommeil - Google Patents

Appareil buccal intégré pour un trouble respiratoire du sommeil Download PDF

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Publication number
WO2010059708A1
WO2010059708A1 PCT/US2009/064966 US2009064966W WO2010059708A1 WO 2010059708 A1 WO2010059708 A1 WO 2010059708A1 US 2009064966 W US2009064966 W US 2009064966W WO 2010059708 A1 WO2010059708 A1 WO 2010059708A1
Authority
WO
WIPO (PCT)
Prior art keywords
oral appliance
tongue
restraint
tray
projections
Prior art date
Application number
PCT/US2009/064966
Other languages
English (en)
Inventor
Elijah Walker
Original Assignee
Elijah Walker
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 Elijah Walker filed Critical Elijah Walker
Priority to ES09828158T priority Critical patent/ES2776895T3/es
Priority to EP09828158.7A priority patent/EP2352468B1/fr
Publication of WO2010059708A1 publication Critical patent/WO2010059708A1/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 application pertains to oral (i.e. intraoral) appliances for treating sleep-related breathing disorders. More particularly, this invention application pertains to an oral appliance to enhance breathing during sleep by preventing and alleviating upper airway obstruction and restriction resulting from sleep-related breathing disorders such as snoring, obstructive sleep apnea, obstructive sleep hypopnea, or upper airway resistance.
  • Sleep is a fundamental need and appears to be required for human survival. However, for many people diagnosed with sleep apnea, going to sleep can be a dreaded experience due to the lack of restful sleep. Sleep apnea (apnea meaning a cessation of airflow) is a relatively common and potentially life-threatening sleep disorder that impacts millions of people in the United States and around the world.
  • Obstructive sleep apnea (OSA), obstructive sleep hypopnea, and upper airway resistance are characterized by upper airway abnormalities that result in airway collapse and complete or partial obstruction of airflow into the lungs.
  • Upper airway i.e.
  • upper respiratory tract, or airway abnormalities include: a smaller (than normal) airway cross- sectional area that subjects the pharynx to collapse; an enlarged tongue that can obstruct the airway by moving posteriorly (backward) into airway space during sleep; a retruding jaw that can increase tissue pressure surrounding the airway and subject it to collapse; an enlarged soft palate that can impinge on airway space when breathing; or compromised pharyngeal dilator muscles that fail to keep the airway open when inhaling, causing momentary obstruction of airflow. Fortunately, the brain usually detects this inability to breathe and briefly awakens the individual to reopen the airway.
  • Various apparatus-based approaches have been developed to treat snoring and/or sleep apnea which in general can be divided into two categories: 1. apparatus that require a power source and 2. apparatus that do not require a power source.
  • Apparatus that require power sources include medical devices, such as Continuous Positive Airway Pressure (CPAP) devices, and negative pressure apparatus.
  • CPAP devices have success rates of approximately 82.7% (Hoekema A, et al, Obstructive Sleep Apnea Therapy", J Dent Res. 2008 Sept.
  • Non-powered apparatus typically oral appliances
  • Oral appliances can generally be separated into two types: Mandibular Repositioning Appliances, (e.g. U.S. Pat. No. 6,729,335, Halstrom, 5/4/2004) and Tongue Retainer appliances.
  • Mandibular Repositioning Appliances (MRAs, sometimes known as mandibular advancement appliances) purport to reposition the mandible anteriorly to further open the airway to prevent its obstruction.
  • Tongue Retainer (TR) appliances are not used very often, and in general, they either use a medium such as a suction to hold/pull the tongue or they use a direct contact device to hold/restrain the tongue during sleep. Suction-type TRs may be recommended when users lack adequate teeth or when the lower jaw can't be advanced.
  • One vacuum-type TR (U.S. Pat. 4,676,240, Gardy, 6/30/1987) purports to provide a way to hold the tongue forward in a chamber that generates a vacuum when the tongue begins to fall and also purports to allow oral breathing.
  • TR a direct contact type of TR
  • U.S. Pat. Application Pub. 2008/0041396 A1 purports to restrain the tongue using a rigid flat tab at the back of the tongue and uses another rigid tab-like component in the area of the soft palate.
  • TR appliance e.g. U.S. Pat. 6,766,802, Keropian, 7/27/2004 purports to hold the tongue down using a rigid bar-like device.
  • thermoplastic (boil and bite) MRAs have been determined to be ineffective and "cannot be recommended as a therapeutic option nor can it be used as a screening tool to find good candidates for mandibular advancement therapy" (Vanderveken, OM, et al, "Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea.”, Am J Respir Crit Care Med 2008;178:197-202).
  • Vacuum-type TR devices that purport to hold the tongue suffer from low compliance rates, reported to be 25% in one study (e.g. 75% non-compliance) and low efficacy i.e. low treatment success, (Schonhofer, B et al, "Value of various intra- and extraoral therapeutic procedures for obstructive sleep apnea and snoring", Med Klin (Munich, 1997 Mar 15;92 (3) : 167-74 9173209).
  • Saliva is continuously produced in the oral cavity at a rate of approximately 1.5 liters per day, which increases when foreign objects are added. Additionally, glycoproteins in saliva (which provide its lubhcative characteristic), increase the difficulty of holding the tongue.
  • a unique oral appliance integrates several novel features to treat sleep-related breathing disorders associated with upper airway abnormalities.
  • the appliance firmly grips the users' upper and lower dentition using custom fitted u-shaped trays (i.e. mouthpiece).
  • An adjustable bracket attached to the trays facilitates movement of the lower tray to advance the mandible to prevent airway closure.
  • the tongue-restraint-ac (TRAC) component containing a hollow middle, is attached to the bracket in a cantilevered fashion to apply a compressive spring- loaded force to the dorsal surface of the tongue.
  • Novel flexible bristles built into the bottom of the TRAC, (proven to be effective in a reduction to practice) engage the tongue to prevent it from obstructing the airway.
  • the hollow middle allows breathable air to flow (via the oral cavity) directly to the airway, bypassing nasal restrictions and/or airway obstructions.
  • Figure 1 is a left sectional view of an anatomical cross-section of a normal human upper airway including nasal cavity, oral cavity, and pharynx with arrows illustrating normal nasal airflow;
  • Figure 2 is a left sectional view of an anatomical cross-section illustrating occlusion of the pharynx that can occur during obstructive sleep apnea;
  • Figure 3 is a rear perspective view of an integrated oral appliance 26
  • Figure 4 is a left sectional view of an anatomical cross-section of a human upper airway (similar to Fig. 1 ), illustrating a cross-section of 26 positioned in the oral cavity, firmly gripping the upper and lower dentition, and interacting with the tongue to prevent it from obstructing the airway;
  • Figure 5 is a front exploded perspective view of an integrated oral appliance 26 illustrating all elements
  • Figure 6 is a left front perspective view of an integrated oral appliance 26 with an arrow illustrating advancement (repositioning) of the lower-tray 24 in an anterior direction;
  • Figure 7 is a left sectional view of an anatomical cross-section (similar to Fig. 4) illustrating anterior advancement of lower tray 24 to reposition the mandible from a neutral position, to further open the airway, and prevent occlusion within the pharynx;
  • Figure 8 is a top front perspective view of a tongue-restraint-ac 20;
  • Figure 9 is a front exploded perspective view of a tongue-restraint-ac 20 with heat-moisture-filter 28 removed;
  • Figure 10 is a front bottom perspective view of a tongue-restraint-ac 20.
  • the preferred embodiment of the present invention comprises several unique features designed to overcome upper airway abnormalities experienced by those who suffer from sleep-related breathing disorders such as obstructive sleep apnea and snoring.
  • the integrated oral appliance 26 treats obstructive sleep apnea and snoring by preventing or mitigating airway closures by advancing the mandible to further open the airway and by retaining the tongue using flexible bristles.
  • Fig. 1 is an anatomical cross-section of a normal human upper airway including nasal cavity, oral cavity, and pharynx with arrows illustrating nasal airflow.
  • Fig. 2 is a view similar to Fig. 1 , illustrating occlusion of the pharynx that can occur during obstructive sleep apnea.
  • Fig. 3 is a rear perspective view of an integrated oral appliance 26.
  • Fig. 4 is a left sectional view of an anatomical cross-section of a human upper airway (similar to fig. 1 ) illustrating a cross-section of integrated oral appliance 26 positioned in the oral cavity, firmly gripping the upper and lower dentition, and interacting with the tongue to prevent it from obstructing the airway.
  • Fig. 5 is a front exploded perspective view of (integrated oral appliance 26) illustrating all elements.
  • Fig. 6 is a left front perspective view of integrated oral appliance 26 with an arrow illustrating advancement (repositioning) of lower-tray 24 in an anterior direction.
  • Figure 7 is a left sectional view (similar to fig. 4) illustrating anterior advancement of lower-tray 24 to reposition the mandible from a neutral position, to further open the airway, and to prevent occlusion within the pharynx.
  • FIG. 8 is a top front perspective view of the tongue-restraint-ac 20.
  • Figure 9 is a front exploded perspective view of tongue-restraint-ac 20 with heat- moisture-filter 28 removed.
  • Figure 10 is a front bottom perspective view of a tongue-restraint-ac 20.
  • an appropriate medical professional e.g. physician, dentist, etc.
  • an appropriate medical professional initially fits and adjusts integrated oral appliance 26 after the u-shaped upper-tray 12 and the u-shaped lower-tray 24 have been custom molded and fitted to conform to the users' dentition.
  • Initial adjustment includes mandible repositioning and tongue-restraint- ac 20 adjusted to fit the users' tongue.
  • the user positions the integrated oral appliance 26 inside their oral cavity so that the u-shaped upper-tray 12 and lower-tray 24 firmly grips both upper and lower dentition.
  • Both u- shaped trays are made from a biocompatible resilient material (e.g.
  • both u-shaped trays may also have sides to direct the flow of air to the center of both trays. This prevents air from entering the oral cavity from the sides of both trays and restricts the air to flow through the open channel within the tongue-restraint-ac 20.
  • tongue-restraint-ac 20 may not include an open channel and air flow is provided through the trays or other restraint support.
  • attachment means to the upper or lower dentition can be provided such as orthodontic materials including stainless steel, nickel titanium, or polymers.
  • other support apparatuses can support the tongue-restraint-ac 20 or like restraint component, within the oral cavity our outside the oral cavity.
  • the" lower-tray 24 can also be fixed relative to the upper-tray 12.
  • the upper-tray 12 contains a guide-bracket 10 built into the back of the tray and attached to the inner surfaces of the left and right sides of the tray so as to form a bridge between the sides.
  • the guide-bracket 10 supports and guides the flex-bracket 16 along an anterior-posterior path.
  • the guide-bracket 10 is made from a material that is biocompatible, rigid, and shaped to fit comfortably inside the oral cavity. The material can be polymeric, stainless steel, or any appropriate material that will functionally perform and will not rust or degrade when exposed to the environment inside the oral cavity.
  • the guide-bracket 10 contains an opening in the middle to allow fastener-g 14 to connect the guide-bracket 10 to the flex-bracket 16 and fastener-fb 18.
  • the flex-bracket 16 is permanently attached to the rear of lower-tray 24, or in an alternate embodiment it can be removably attached.
  • a medical professional adjusts lower-tray 24 (guided by the flex-bracket 16) in an anterior direction, to a position that is sufficient to prevent airway collapse without causing adverse effects.
  • the flex-bracket 16 serves three functions. One function is to enable the attached lower-tray 24 to move the mandible to increase airway size. A second function is to provide a surface capable of generating a spring-loaded, compressive force when flexed. This surface also serves as the point of attachment (third function) for the tongue-restraint-ac 20.
  • the tongue-restraint-ac 20 is attached to the flex-bracket 16 in a cantilevered fashion at its mid-section that contains a slot for adjustment.
  • the tongue-restraint-ac 20 contains flexible bristles built into (e.g. molded, implanted) its bottom rear surface to engage the dorsal surface of the tongue.
  • the bristles maintain contact with the tongue under a compressive force that is sufficient to keep the bristles engaged with the tongue to properly restrain it, but not excessive to cause pain or injury.
  • the bristles can be made from a polymeric material or another biocompatible appropriate material.
  • the bristles can also be made using hollow fibers to allow time-released treatment solutions to flow into the dorsal surface of the tongue or oral cavity to treat other medical or nutritional conditions.
  • other materials can be used to engage the tongue that are configured to provide comfort and avoid pain or injury.
  • other projections and/or textures may be provided in addition or as an alternative to bristles, including raised non-slip elements, bumps, protrusions, ridges and the like.
  • the flex-bracket 16 is made from a material that is biocompatible, lightweight, strong enough to perform said function, and able to endure multiple flexures over the lifetime of integrated oral appliance 26.
  • the material can be polymeric, stainless steel or any appropriate matehal(s) that will not rust or degrade when exposed to the environment inside the oral cavity.
  • the spring-force range exerted by the flex-bracket 16 can be fixed or adjustable in an alternate embodiment.
  • the present invention can comprise a variety of spring types to exert the required force including leaf springs, torsion springs, etc.
  • the alternate embodiments in the tongue restraint component can provide the spring-force with or without the flex bracket.
  • the flex-bracket 16 contains an appropriately sized opening (e.g. slot) in the middle of the top surface to allow anterior-posterior adjustment and allow fastener-g 14 and fastener-fb 18 to connect the guide-bracket 10 to the flex-bracket 16.
  • the flex- bracket 16 is appropriately shaped to enable it to be moved within the guide-bracket 10 in order to move the mandible.
  • the tongue-restraint-ac 20 comprises front, middle, and rear sections that are inter-connected to form an internal open conduit to allow passage of breathable air to bypass potential nasal restrictions and or airway obstructions.
  • the air conduit extends from the front section of the tongue-restraint-ac 20 to the rear section.
  • the tongue-restraint component can be positioned to contact the tongue in a variety of locations including the tongue base, or proximal to the soft palate, or any appropriate location to restrain the tongue.
  • the user telescopically advances the front section to position it slightly beyond the front of the u- shaped trays so that the user's lips can surround it. Airflow within the air conduit occurs naturally as the user inhales and exhales.
  • the air conduit can be made in different forms and shapes including round tubes, or, or in another embodiment the air conduit can be eliminated if not required, or in another embodiment air can also flow via other channels.
  • the rear section of the tongue-restraint-ac 20 also has an opening in its top surface to allow a heat-moisture-filter 28 to be inserted into the air conduit to provide heat and moisture to inspired air.
  • the heat-moisture-filter 28 is also made to be changed on a daily basis.
  • the heat-moisture-filter 28 can also be replaced by a solid filter to block airflow.
  • the tongue-restraint-ac 20 can be provided without the heat-moisture-filter 28.
  • the middle section of the tongue-restraint-ac 20 is made of a rigid material (e.g. polymer) and includes a slot in the middle (referred to above) that is open at the top and bottom.
  • An appropriate fastener-trac 22 is used to connect the tongue-restraint-ac 20 to the flex-bracket 16.
  • the slot enables the tongue-restraint-ac 20 to be adjusted for proper positioning on the dorsal surface of the tongue.
  • the heat-moisture-filter 28 contains an outer shell made from a rigid material (e.g. biocompatible polymer) and an inner corrugated paper rolled to fit within the outer shell.
  • the paper is made of a material suitable to absorb heat and moisture from expired air and release heat and moisture into inspired air.
  • the paper can be made from a cellulose-based material or another appropriate material with heat/moisture characteristics.
  • a solid material can be substituted for the corrugated material to prevent airflow.
  • a treatment can also be added to the enclosed filter material to provide for other medical or nutritional needs, etc.
  • moisture absorbent and moisture release material can be placed at any location in an oral device of the invention or otherwise within the oral cavity.
  • the front section of the tongue-restraint-ac 20 provides an entrance to allow air to enter and leave the tongue-restraint-ac 20 during inspiration and expiration.
  • This section is made using a sufficiently flexible material to allow the tongue-restraint-ac 20 to flex within the confines of the upper-tray 12 and lower-tray 24 in concert with superior-inferior tongue movement.
  • key elements of the integrated oral appliance 26 interact with upper airway tissue to treat upper airway abnormalities that cause obstructions during sleep.
  • the integrated oral appliance 26 When positioned in a user's mouth (oral cavity), the integrated oral appliance 26 restrains the tongue, preventing the tongue from moving into airway space; moves the mandible in an anterior (forward) direction to open the airway; and reduces tissue pressure to improve airflow.
  • the present invention also provides an air conduit that's built into the tongue-restraint-ac 20 to bypass nasal restrictions and or airway obstructions if they occur.
  • the tongue-restraint-ac 20 contains a heat- moisture-filter 28 that captures the heat and moisture from the expired air and releases heat and moisture to the drier inspired air.
  • the user removes the integrated oral appliance 26 from the oral cavity. Appropriate means are also used to clean the integrated oral appliance 26.
  • a tongue restraint may be a singular element applying restraining force, such as spring force, without separate brackets or force-applying elements.
  • a force applying coupling can be fabricated as an integral part of a tray or as part of another non-tray restraint support element that may engage a portion of the dentition or differently secure attachment from in or out of the oral cavity.
  • tongue restraint can be accomplished with attachment to upper dentition or lower dentition using either the upper-tray 12 alone or the lower-tray 24 alone. Tongue restraint can also be accomplished without an internal air conduit if an alternate breathing passage is not required.
  • adjustable features such as adjustable spring force or the type of spring used.
  • the bristle element can be replaceable to accommodate wear or made out of a different material that also has non-slip properties.
  • Coupling elements to support the tongue restraint may include one supports or attachments for placement in one or both of inside and outside the oral cavity.
  • Coupling elements for positioning the tongue restraint in some embodiments may include wires (including but not limited to engaging a portion of dentition), straps, bracings, grips, and the like. It will be appreciated that in such alternative embodiments the supports external or internal of the oral cavity are generally provided for comfortable fitting to the user.
  • a tongue restraint of the present invention can comprise alternatives or additions to projections or bristles to engage the tongue.
  • Such other tongue restraint and engagement elements may include holes, openings, a grid or mesh pattern with openings, cavities, a porous matrix, pores, perforations, reliefs, grating, non-slip substances, and the like.
  • the tongue restraint is not limited to a particular shape and can be a variety of shapes and textures including but not limited to flat, curved, ovular, rippled, circular, triangular, polygonal, honeycomb, custom-fitted and the like.
  • a tongue restraint of the present invention may comprise a variety of materials including but not limited to polymeric, elastomehc, composite materials, metals, material blends, and the like.
  • a tongue restraint is not limited to a passive restraint.
  • active restraints to the tongue may include electronic, electro-mechanical, and fluidic restraint portions that contact or engage the tongue.
  • active restraints may be integral of a tongue restraint or operatively coupled to a mechanical restraint to engage a tongue.

Abstract

La présente invention concerne un appareil buccal intégré, personnalisé, dimensionné et adapté, destiné à traiter une obstruction et une restriction de la respiration dans la voie aérienne supérieure pendant le sommeil. Plusieurs nouvelles caractéristiques sont intégrées dans un dispositif unique, lesquelles comprennent un repositionnement de la mandibule pour ouvrir la voie aérienne, et une retenue de la langue pour prévenir une obstruction de la voie aérienne. Ce dispositif est constitué d’un conduit d’air incorporé pour éviter une restriction et une obstruction de la voie aérienne. Lorsqu’il fonctionne, l’appareil est positionné dans la cavité buccale de façon à maintenir fermement les dents supérieures et inférieures à l'aide de plateaux personnalisés en forme de U. Le positionnement de l’appareil fait avancer la mandibule jusqu’à une position prédéterminée réglable et retient simultanément la langue à l'aide de soies souples fixées à un élément de retenue de la langue (TRAC, de « tongue-restraint-ac ») à ressort. Un conduit d’air creux, élaboré dans le TRAC, enjambe la surface comprise entre les lèvres de l’utilisateur et le voile du palais. Il facilite le flux direct d’air auto-chauffé et humidifié vers et en provenance de l’oropharynx afin d’éviter les obstructions de la voie aérienne et/ou les restrictions nasales.
PCT/US2009/064966 2008-11-18 2009-11-18 Appareil buccal intégré pour un trouble respiratoire du sommeil WO2010059708A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
ES09828158T ES2776895T3 (es) 2008-11-18 2009-11-18 Aparato oral integrado para la respiración con trastorno del sueño
EP09828158.7A EP2352468B1 (fr) 2008-11-18 2009-11-18 Appareil buccal intégré pour un trouble respiratoire du sommeil

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US12/273,534 US8127769B2 (en) 2007-11-18 2008-11-18 Integrated oral appliance for sleep-disordered breathing
US12/273,534 2008-11-18

Publications (1)

Publication Number Publication Date
WO2010059708A1 true WO2010059708A1 (fr) 2010-05-27

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Country Status (4)

Country Link
US (1) US8127769B2 (fr)
EP (1) EP2352468B1 (fr)
ES (1) ES2776895T3 (fr)
WO (1) WO2010059708A1 (fr)

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US20090241969A1 (en) 2009-10-01
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EP2352468A1 (fr) 2011-08-10
EP2352468A4 (fr) 2014-10-29
US8127769B2 (en) 2012-03-06

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