LinguaFlex Tongue Retractor (LTR) for the Treatment of OSA and Snoring in Adults

Obstructive Sleep Apnea Clinical Trial

Official title:

Non-Randomized, Multi-Site, Single-Arm Study of the LinguaFlex™ Tongue Retractor (LTR) for the Treatment of Moderate to Severe Obstructive Sleep Apnea and Snoring in Adult Subjects

Clinical Trial Details — Status: Enrolling by invitation

Administrative data

• NCT number: NCT04129229
• Other study ID #: LTR-006-V02.0-US-CTP
• Status: Enrolling by invitation
• Phase: N/A
• Start date: January 10, 2020
• Est. completion date: April 2025

Study information

• Verified date: November 2022
• Source: Linguaflex, Inc.
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The LinguaFlex™ Tongue Retractor (LTR) is an investigational medical device that is inserted into the tongue to lessen its backward movement during sleep. This helps to keep the airway open during sleep so that the tongue doesn't block the airway causing obstructive apnea or narrow it enough to cause snoring. This study will monitor the effectiveness of the LTR device in the reduction of Obstructive Sleep Apnea and snoring over the course of a one-year treatment period.

Description:

The study design is a multi-site, prospective, open-label, non-randomized, single-arm clinical study to test the efficacy of the LinguaFlex Tongue Retractor for the treatment of moderate to severe Obstructive Sleep Apnea (OSA) (AHI ≥15 at baseline) in adult subjects in twelve (12) months of continuous use. The study will include three (3) investigational sites that will implant a maximum of eighty (80) subjects with the LTR. No single site is to perform more than 35 implants. After informed consent is obtained, eligible subjects (adults who have moderate to severe OSA) will be screened for study inclusion. The screening will consist of a Home Sleep Test (HST) completed within four (4) months of inclusion in the study to confirm the diagnosis of moderate to severe OSA, an Epworth Sleepiness Scale (ESS) assessment, Snoring Self-Assessment (SOS) with bed partner input (SBPS), assessment of pain, speech and swallowing, and a physical examination. The screening data will be reviewed by the Sponsor's designated study monitor to confirm and approve that inclusion criteria are fully met. Failure to meet all inclusion criteria will be designated as a screen failure and the subject's enrollment will be terminated. Participation in the study is voluntary. Subjects may withdraw at any time during the study. Reasons for the withdrawal will be recorded and entered into the clinical study report. Any subject who withdraws from the study for any reason will have the device removed and will undergo a Post Device Removal Follow-Up within 30 days (-7/+ 15) of device removal.

Recruitment information / eligibility

• Status: Enrolling by invitation
• Enrollment: 80
• Est. completion date: April 2025
• Est. primary completion date: December 2024
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Subjects able to read, understand and sign consent

• Subjects 18 years or older with:

1. Moderate to severe OSA (AHI of = 15 to = 50 as determined by a Diagnostic PSG recording within 2 months of inclusion)

2. Subject agrees not to use any type of additional OSA therapy including PAP therapy throughout the course of the study

Exclusion Criteria:

Subjects who meet any of the following criteria will be excluded from participation in the clinical trial:

• < 18 years of age

• AHI < 15(mild OSA)

• AHI > 50

• Subjects with > 20% of AHI score accounted for from central apnea

• More than 10% of Total Sleep Time (TST) with blood O2 saturation (SaO2) below 70%

• Subjects successfully treated with prescribed PAP therapy

• Tonsillar hypertrophy =3

• Subjects with significant active comorbid respiratory or cardiac disease (such as COPD or Heart Failure)

• Subjects requiring regular use of supplemental oxygen

• Nasal airway obstruction as seen on examination

• Congenital malformations of the upper airway, larynx, pharynx, oral cavity or tongue

• Narrowing of hypopharynx airspace more than velopharyngeal airspace as seen on examination (suspected epiglottic obstruction)

• History of radiation therapy to the neck or upper respiratory tract

• Subjects with bleeding disorders, unresolved impaired immunity for any reason, or heart attack within the last six months

• Subjects with an existing tongue stud/piercing

• Females who are pregnant (anesthesia risk)

• Allergy to LTR materials (Silicone, PEEK, Polyurethane)

• Subjects who have in the surgeon's judgment unusual anatomy that would interfere with treatment or increase the risk for the procedure

• Unable and/or unwilling to comply with study requirements

Related Conditions & MeSH terms

• Obstructive Sleep Apnea
• Sleep Apnea Syndromes
• Sleep Apnea, Obstructive
• Snoring

Intervention

Device:
• LinguaFlex Tongue Retractor (LTR)
The LinguaFlex Tongue Retractor (LTR) is a small, flexible, implanted tongue retaining device that lessens the backward movement of the tongue during sleep. The LTR's flexible shaft and a nubbed tether passes through the center of the tongue beneath the tongue blade (frenulum area) and connects to a disc (head) that rests on the external surface of the tongue base mucosa. Underneath the tongue, on the external surface of the frenulum, a small anchor secures the shaft that can be adjusted to tension the LTR to maximize therapeutic effect and maintain comfort.

Locations

Country	Name	City	State
United States	St. Elizabeth's Medical Center	Brighton	Massachusetts
United States	Medical College of Wisconsin	Milwaukee	Wisconsin
United States	WVU Medicine / J. W. Ruby Memorial Hospital	Morgantown	West Virginia

Sponsors (1)

Lead Sponsor	Collaborator
Linguaflex, Inc.

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Quality of Life Metric - Pain	Examine the tolerance and comfort of the implanted LTR. Pain will be assessed at each follow-up visit using a 10 point Visual Analog Scale (0 no pain - 10 worst pain) and will be compared to the baseline measurement.	At each follow-up visit over the course of 1 year
Other	Quality of Life Metric - Speech and Swallowing	Examine the tolerance and comfort of the implanted LTR. Comfort with speech and swallowing will be assessed using the Performance Status Scale for Head and Neck Cancer Patients (PSS-HN). This scale consists of three individual scores for Normalcy of Diet, Eating in Public and Understanding of Speech. In each case a score of 100 indicates normal function and 0 indicates the most limited function.	At each follow-up visit over the course of 1 year.
Other	Quality of Life Metric - Snoring	Examine the change in snoring from the baseline control measurement. Snoring will be assessed using the Snore Outcome Survey (SOS) and the Spouse/Bed Partner Survey (SBPS). The SOS is a series of 8 questions with a score range of 0 - 100; with 0 representing the worst possible snoring and 100 representing no snoring. The Spouse Bed Partner Survey is a series of 3 questions with a score range of 0 - 100; with a score of 0 representing the worst possible snoring and 100 representing no snoring.	At each follow-up visit over the course of 1 year.
Primary	Responder to Therapy	Determine the responder rate to therapy. A responder is defined as a subject who experiences a = 50% reduction in AHI from baseline and has an AHI < 20 at the 12-month follow-up visit. Subjects with an AHI = 20 at baseline will be considered a responder if a 50% reduction in AHI is achieved from baseline.	One Year
Secondary	Change in Epworth Sleepiness Scale (ESS)	Determine the change in Epworth Sleepiness Scale (ESS) from the baseline control measurement and determine the proportion of study subjects that achieve an ESS value of = 10 at the twelve-month follow-up. ((ESS is a validated instrument that rates a subject's daytime sleepiness and is commonly used in clinical evaluation and management of OSA as a quality of life measurement. Scores range from 0 to 24, with lower scores indicating greater functioning. An ESS < 10 is considered normal subjective sleepiness.)	One Year
Secondary	Oxygen Desaturation Index (ODI) Responder	Determine the Oxygen Desaturation Index (ODI) responder rate at the twelve-month follow-up visit. An ODI responder is defined as a subject which demonstrates at least a 25% reduction in ODI from the baseline control measurement at the 12-month follow-up visit. Change in ODI will be reported as a percentage change from baseline for each subject as well as the mean percentage change for the entire cohort.	One Year