Safety, and Tolerability of the ZENS Device (PLUTO)

Study Overview
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Brief Summary
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The primary objective of the PLUTO study is to evaluate the safety and tolerability of the ZENS transcutaneous nerve stimulator device in primary snorers and those with mild obstructive sleep apnea. The study will assess the impact of ZENS on snoring frequency, duration, and other relevant sleep parameters. The intended purpose of the investigational device is to deliver a transcutaneous electrical stimulation signal to the hypoglossal nerve in the ON phase in order to alter the apnea hypopnea index (AHI), as well as mean snoring burden (intensity, duration), and to deliver no signal in the OFF phase of the study as a means for comparison. Subjects utilizing the ZENS Device will experience a reduction in snoring during the ON versus OFF phase, as quantified by a reduction in the percentage of time per hour of snoring (≥40 dB) in the active ZENS Device (ON phase) versus the inactive ZENS Device (OFF phase).

Detailed Description
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After indicating their consent to contact and signing an Informed Consent Form, potential participants will undergo a screening assessment that includes a review of their medical history, a focused physical exam, and a level 3 at-home sleep test (Sagatech SnoreSat Sleep Recorder, Philips Alice OneNight or equivalent), if not already available in the medical records). At the screening visit potential participants' eligibility for the study will be evaluated against the study inclusion and exclusion criteria. Following confirmation of eligibility, up to 45 (n=45) participants will be scheduled for their overnight in-laboratory PSG, which must occur no more than 12 weeks after screening has taken place. A final determination of eligibility and enrollment is completed when inclusion and exclusion criteria are verified on the day of the study visit. Those who do not meet inclusion and exclusion criteria on the day of the study will be deemed screening failures. Participants will wear the ZENS Device for the 8 to 12-hour overnight in-laboratory polysomnography assessment. Participants will be monitored for and asked about any adverse events and device effects that they experience during the overnight sleep study. Participants will be contacted by the site via telephone 24 to 96 hours after the overnight sleep study to determine if any adverse events and device effects were experienced late after the overnight polysomnography. After the telephone follow-up, participation in the study is complete.

Official Title
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An Initial Investigation of the Safety and Tolerability of Transcutaneous Stimulation of the Hypoglossal Nerve for the Treatment of Primary Snoring and Mild Sleep Apnea Using the ZENS Transcutaneous Nerve Stimulator (PLUTO)

Conditions
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Snoring, Obstructive Sleep Apnea

Intervention / Treatment
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* Device: ZENS


Participation Criteria
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Eligibility Criteria
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Inclusion: Adult (age of majority). Willing and able to provide written informed consent. BMI <35. Neck circumference <18 inches. History of disruptive snoring for most of the night, 12 or more of the last 14 nights. Level 3 at-home sleep test (Sagatech SnoreSat Sleep Recorder, Philips Alice OneNight or equivalent) recording from the past 12 months (prior to enrolment) with more than 4 hours of both oximetry and flow data for review; or willing to undergo a level 3 sleep test prior to overnight in-laboratory polysomnography assessment. The respiratory disturbance index (RDI) must be <15events/hour. Ability and willingness to shave significant facial hair (i.e. be clean shaven) for the overnight visit; and to cease wearing cosmetic products and/or moisturizing cream and/or remove excessive oil in the chin / jaw region (i.e. be clean skinned) for the overnight visit; and to wear clothing that covers the chest (e.g. a t-shirt) for the duration of the overnight visit. Willing to participate in overnight portion of study without use of another snoring/OSA treatment (CPAP, oral appliance) in the 72 hours prior to the overnight visit. Willing to refrain from use of alcohol, sedative hypnotics, or recreational drugs for 24 hours prior to and during the study. Exclusion: Prior diagnosis of moderate or severe OSA (AASM defines OSA severity as: Mild=AHI ≥5 and <15; Moderate=AHI ≥15 and <30; Severe = ≥30/hour). Known sleep disturbance other than snoring (insomnia, parasomnia, narcolepsy, restless legs syndrome, circadian rhythm disorder, or other disorder likely to interfere with the study). Fixed anatomical abnormality of the upper airway (e.g. history of head or neck trauma, head and neck malignancy, previous tracheotomy, subglottic stenosis, deformed uvula, aglossia) from trauma, malignancy, prior surgery, or congenital condition. Individuals with a history of severe nasal obstruction due to anatomical problems such as deviated septum, previously broken nose or non-anatomical factors such as chronic rhinitis or nasal polyposis. Enflamed/enlarged tonsils. Use of another snoring treatment (CPAP, medication or oral appliance) in the 72 hours prior to the overnight visit. Anatomic neck or skin abnormalities likely to interfere with fixation of the ZENS Device. Presence of an implantable medical device susceptible to electrical interference (e.g. pacemaker or defibrillator). History of epilepsy. Use of sedatives, hypnotics, recreational drug or alcohol in the 24 hours prior to the study. Known allergy to medical tape. Any severe skin condition affecting the head and neck likely to be aggravated by adhesives (e.g. psoriasis, eczema). Recent surgery to the face or neck (i.e. within the past 5 years). Inability to wear something on the neck or tolerate PSG procedure. Pregnancy. Any other criteria, which would make the participant unsuitable to participate in this study as determined by the site Principal Investigator (e.g. uncontrolled drug and/or alcohol addiction, extreme frailty, comorbidities, ongoing medication regimen, cognitive ability to follow instructions, etc.).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Interventional Model Description: Multi-center, open label randomized 2x2 cross-over sleep study of the ZENS transcutaneous hypoglossal nerve stimulator in the ON (active) versus OFF (passive) setting during a single over-night sleep study.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Sequence 1<br>Participants allocated to Sequence 1 will complete the overnight sleep study with the ZENS device ON for the first half and OFF for the second half. | Device: ZENS<br>* ZENS transcutaneous nerve stimulator (ZENS Device), a wearable and non-invasive device which stimulates nerves in the neck to reduce airway obstruction and maintain muscular tension while sleeping to reduce snoring severity.<br>|
| Experimental: Sequence 2<br>Participants allocated to Sequence 1 will complete the overnight sleep study with the ZENS device OFF for the first half and ON for the second half | Device: ZENS<br>* ZENS transcutaneous nerve stimulator (ZENS Device), a wearable and non-invasive device which stimulates nerves in the neck to reduce airway obstruction and maintain muscular tension while sleeping to reduce snoring severity.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percent change in loud snoring time | The percentage change in snoring time in the ON versus OFF period | up to 5 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in AHI | Change in AHI in the ON versus OFF period | up to 5 hours | 
| Percentage difference of time (minutes) per hour of sleep with loud snoring | Percentage difference of time (minutes) per hour of sleep with loud snoring (≥40) in the ON versus OFF phase | up to 5 hours | 
| Change in the number of arousals and awakenings in the ON versus OFF phase | Change in the number of arousals and awakenings in the ON versus OFF phase | up to 5 hours | 
| Difference in the mean oxygen saturation levels | Difference in the mean oxygen saturation levels in the ON versus OFF phase | up to 5 hours | 
| Number of patients with successful snoring reduction | ≥ 25% reduction in snoring intensity in the OFF versus the ON period. | up to 5 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Sleep Apnea, Snoring