Patent Document

BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention generally relates to treating sleep disorders, and more specifically relates to implant systems, devices and methods for treating patients suffering from obstructive sleep apnea. 
         [0003]    2. Description of the Related Art 
         [0004]    Obstructive sleep apnea (OSA) is caused by a blockage of the airway, which usually occurs when the soft tissue in the throat collapses and closes during sleep. The blockage can occur in a portion of the pharyngeal lumen and may include obstructions formed by the collapse of the tongue against the posterior wall of the pharynx, the collapse of the lateral pharyngeal walls, and the combined collapse of the tongue with impingement of the soft palate, particularly the posterior portion of the soft palate including the uvula. During each apnea event, the brain briefly arouses the sufferer in order to initiate the resumption of breathing. This type of sleep, however, is extremely fragmented and of poor quality. 
         [0005]    According to the National Institutes of Health, OSA affects more than twelve million Americans. When left untreated, OSA may result in high blood pressure, cardiovascular disease, weight gain, impotency, headaches, memory problems, job impairment, and/or motor vehicle crashes. Despite the seriousness of OSA, a general lack of awareness among the public and healthcare professionals results in the vast majority of OSA sufferers remaining undiagnosed and untreated. 
         [0006]    There have been a number of efforts directed to treating OSA. For example, devices for electrically stimulating the soft palate to treat snoring and obstructive sleep apnea are disclosed in U.S. Pat. Nos. 5,284,161 and 5,792,067. These devices have had mixed results because they require patient adherence to a strict regimen of use, subject the patient to discomfort during sleep, and result in repeated arousal of the patient. 
         [0007]    Another treatment, commonly referred to as continuous positive airway pressure (CPAP), delivers air into a patient&#39;s airway through a specially designed nasal mask or pillow. The flow of air creates positive pressure when the patient inhales to keep the airway open. CPAP is considered by many to be an effective non-surgical treatment for the alleviation of snoring and obstructive sleep apnea, however, patients complain about discomfort caused by the mask and hoses, including bloating, nasal drying, and dry eyes. As a result, patient compliance for CPAP is only about 40%. 
         [0008]    Surgical treatments have also been used to treat OSA. One such treatment is referred to as uvulopalatopharyngoplasty, which involves removing about 2 cm of the trailing edge of the soft palate to reduce the soft palate&#39;s ability to flutter between the tongue and the pharyngeal wall. Another procedure uses a surgical laser to create scar tissue on the surface of the soft palate, which reduces the flexibility of the soft palate for reducing snoring and/or closing of the air passage. Yet another procedure, commonly referred to as cautery-assisted palatal stiffening operation (CAPSO), is an office-based procedure performed under local anesthesia whereby a midline strip of soft palate mucosa is removed, and the wound is allowed to heal for stiffening the flaccid palate. 
         [0009]    Surgical procedures such as those mentioned above continue to have problems. Specifically, the area of tissue that is surgically treated (i.e., removal of palatal tissue or scarring of palatal tissue) is often larger than is necessary to treat the patient&#39;s condition. In addition, the above-mentioned surgical procedures are often painful with extended, uncomfortable healing periods. For example, scar tissue on the soft palate may present a continuing irritant to the patient. Furthermore, the above procedures are not reversible in the event of adverse side effects. 
         [0010]    Another surgical procedure for treating OSA uses several braided PET cylinders that are implanted in tissue to make the tissues of the tongue or uvula more rigid and less prone to deflection. The Pillar™ Palatal Implant System sold by Restore Medical of St. Paul, Minn. consists of cylindrical-shaped elements of braided polyester filaments that are implanted in the soft palate for reducing the incidence of airway obstructions in patients suffering from mild to moderate OSA. Use of the Pillar device may result in adverse side effects, including extrusion of the cylindrical-shaped elements, infection, and patient discomfort. 
         [0011]    Another implant system, sold under the trademark REPOSE™ by InfluENT of Concord, N.H., uses a titanium bone screw that is inserted into the posterior aspect of the mandible at the floor of the mouth. A loop of suture is passed through the tongue base and attached to the mandibular bone screw. The Repose™ procedure achieves a suspension or hammock of the tongue base making it less likely for the base of the tongue to prolapse during sleep. Due to the high activity of the tongue during wakefulness, however, the suture component of this device may act as a “cheese cutter” to the tongue, causing device failure and requiring subsequent removal. 
         [0012]    Another effort for treating OSA involves creating an auxiliary airway for bypassing the clogged portion of the main airway. In one embodiment of commonly assigned U.S. patent application Ser. No. 12/182,402, filed Jul. 30, 2008, the disclosure of which is hereby incorporated by reference herein, an auxiliary airway is formed by implanting an elongated conduit beneath a pharyngeal wall of the pharynx. The elongated conduit has a proximal end in communication with a first region of the pharynx, a distal end in communication with a second region of the pharynx, and an intermediate section extending beneath the pharyngeal wall for bypassing an oropharynx region of the pharynx. 
         [0013]    Magnets have also been used for treating OSA. For example, in one embodiment of commonly assigned U.S. patent application Ser. No. 12/183,955, filed Jul. 31, 2008, the disclosure of which is hereby incorporated by reference herein, a magnetic implant includes a bone anchor, a first magnet coupled to the bone anchor, a tongue anchor, a second magnet coupled to the tongue anchor, and a support for aligning the first and second magnets so that a repelling force is generated between the magnets for urging the second magnet away from the first magnet and toward the bone anchor. The support maintains the first magnet at a fixed distance from the bone anchor, aligns the first magnet with the second magnet, and guides movement of the first and second magnets. The magnetic implant disclosed in one or more embodiments of the &#39;955 application does not have a hard stop so as to avoid the “cheese-cutter” effect observed when using implants having a hard stop. 
         [0014]    In spite of the above advances, there remains a need for additional systems, devices and methods for treating OSA through minimally invasive approaches that provide long term results, that encourage patient compliance, and that minimize patient discomfort. 
       SUMMARY OF THE INVENTION 
       [0015]    In one embodiment, the present invention provides a medical implant for the treatment of obstructive sleep apnea including an implant device, such as an elastic extension member, affixed to the distal end of the hard palate and extending into the uvula. The implant device is adapted to provide a degree of support that is sufficient to resist distal movement of the tongue when the tongue is relaxed and the patient is in a supine position, but not so great as to impair the soft palate and the uvula from sealing the nasal cavity during the act of swallowing. In one embodiment, two or more implant devices are implanted in the soft palate, and the proximal ends of at least two of the devices are connected with the hard palate. 
         [0016]    In one embodiment, a system for treating obstructive sleep apnea includes a body implantable in a soft palate, and a fastening element at a proximal end of the body for connecting the body with a hard palate. In one embodiment, the body is curved and has a convex top surface and a concave bottom surface. The radius of the curve and the size of the body may vary depending upon the needs of the patient. When implanted, the convex top surface of the body preferably faces toward an upper end of a patient and the concave bottom surface of the body preferably faces toward the lower end of the patient. In one embodiment, the implant extends to the uvula for changing the shape of the uvula and/or providing support for the uvula. 
         [0017]    In one embodiment, the fastening element at the proximal end of the body is engageable with the hard palate for securing the body to the hard palate. In one embodiment, the fastening element desirably includes at least one barb adapted to engage the hard palate for anchoring the body to the hard palate. In one embodiment, the fastening element includes at least one tab projecting from the proximal end of the body and at least one barb projecting from the at least one tab. In one embodiment, an implantable body includes an upper tab, and a pair of opposing lower tabs that are normally biased toward one another. The opposing tabs preferably include inwardly projecting barbs that oppose one another. Upon implantation, the upper tab preferably overlies a top surface of the hard palate and the pair of lower tabs preferably underlie a bottom surface of the hard palate. The tabs bias toward one another so that the barbs on the respective tabs bite into the bone of the hard palate for securing the implant to the hard palate. 
         [0018]    In one embodiment, the body has a surface adapted to promote tissue in-growth. The tissue in-growth promoting surface is desirably selected from a group of outer surfaces including a textured surface, a porous surface, a braided surface, a mesh surface, a fleece surface, and a coating for inducing bone or tissue in-growth. In one embodiment, the body is made of materials such as nitinol, stainless steel, biocompatible polymers, temperature-sensitive materials, and/or shape memory materials. 
         [0019]    In one embodiment, an implant for supporting a uvula for treating obstructive sleep apnea includes a body implantable in a soft palate, the body having a distal end and a proximal end, and a fastening element adjacent the proximal end of the body for fastening the body to a hard palate. In one embodiment, the fastening element desirably includes at least one anchoring tab adapted to overlie the surface of a hard palate, the at least one anchoring tab having at least one barb. In one embodiment, the fastening element may include fasteners such as barbs, bone anchors, screws, tacks, pins, wire, sutures, staples, rods, and/or adhesive. 
         [0020]    In one embodiment, a method of treating obstructive sleep apnea includes forming a surgical opening in a soft palate, inserting an implant device through the surgical opening and into the soft palate, and securing the implant device to a hard palate. A distal end of the implanted device desirably engages the uvula for supporting and/or changing the shape of the uvula. In one embodiment, the shape of the soft palate is changed by the implant as the implant device is inserted into the soft palate. The method may include using a fastening element for securing the implant to the hard palate. The implant may include a body, and the fastening element for securing the body to the hard palate. The body may be curved, and the soft palate may be curved by the curved body during the inserting step. The fastening element preferably includes opposing tabs projecting from the proximal end thereof, whereby the opposing tabs are normally biased toward one another. In one embodiment, the opposing tabs include tissue engaging barbs. In one embodiment, the implant device may be implanted directly within the oral cavity of a patient. In one embodiment, the implant device may be implanted through the nasal passageway. 
         [0021]    In one embodiment, the implant devices disclosed herein may be used to re-shape the soft palate for minimizing the likelihood of obstructive sleep apnea episodes associated with long, flat soft palates and/or L-shaped soft palates. In one embodiment, when a long, flat soft palate is causing OSA, an implant having a curved body may be implanted into the soft palate for increasing the curve of the soft palate. In another embodiment, when an L-shaped soft palate is causing OSA, an implant may be inserted for reducing the curve or angle of the soft palate. Thus, in one embodiment, a plurality of implants having varying radii may be provided, whereby an implant having a desired amount of curve may be utilized for increasing or reducing the curve of the soft palate (i.e. changing the shape of the soft palate). In one embodiment, a plurality of implants having varying sizes may be provided so as to enable medical personnel to select an implant having a desired size. 
         [0022]    In one embodiment, the implant device is made of a shape changeable material such as nitinol. The nitinol may have a super elastic property and/or a shape memory property. In the one embodiment whereby the nitinol has a shape memory property, the nitinol material has a first transition temperature set just above body temperature, whereby the nitinol transitions into a pre-determined elastic configuration to support the uvula and thereby keep the airway open. In this state, the implant may be useful during sleep. The implant desirably includes a second lower transition temperature set somewhat below body temperature, whereby the implant transitions into a ductile state allowing the uvula move in a posterior direction. This state or condition may be suitable for when the patient is awake, whereupon there is no need for the implant to urge the uvula into a more anterior position. An implant having shape memory properties may be used in other areas of the airway. In one embodiment, a transition into the ductile state may be initiated by gargling with cold water. In one embodiment, a transition into a pre-determined elastic state may be achieved by drinking warm or hot fluid. 
         [0023]    In one embodiment, an implant device made of a shape memory material, such as nitinol, may be implanted when at a temperature that is below body temperature. When below the normal body temperature, the material is easily shapeable. After implantation, the material may be elevated to body temperature, whereby the implant assumes its pre-determined shape to support the uvula. In certain preferred embodiments, the implant device is made of stainless steel, such as 300 and 400 series stainless steel. The implant device may also be made of a biocompatible polymer. 
         [0024]    In one embodiment, the degree of support provided by the implant may be customized by adjusting the length of the implant, such as by trimming the implant. The cross-sectional geometry of the implant may also be changed to reduce or increase the section modulus. 
         [0025]    The outer surface of the implant device may be modified to encourage tissue in-growth so as to stabilize the implant within tissue and minimize opportunity for tissue erosion. Modification of the outer surface to promote tissue in-growth may be achieved by texturizing the outer surface, making the implant porous through the addition of openings or apertures, encapsulating the implant with a braided structure, surgical mesh, or fleece type material, and/or at least partially coating the implant with bone growth stimulating agents such as hydroxyapatite. 
         [0026]    Although the present is not limited by any particular theory of operation, it is believed that providing an implant device that supports the uvula and that is connected to the distal end of the hard palate provides more positive positioning of the uvula and enables the uvula to provide greater resistance to distal tongue movement than implants that are not supported by the hard palate. The implant also provides a balanced level of uvula support which provides tongue support when needed, but does not inhibit swallowing. The shape changing feature preferably allows greater uvula support (and thereby tongue support) during times of rest, and less support during waking hours. The modification of the outer surface of the implant preferably reduces the chance of tissue erosion and provides greater lateral stability to the implant. The ability to implant the device through the nasal passageway results in an implant being more cranial and thereby minimizing the tongue&#39;s sensitivity to the implants&#39; presence. Furthermore, the implant device disclosed herein provides a medical procedure that does not damage the musculature within the soft palate and maintains all mucosal surfaces, which enables the natural musculature to continue providing support in addition to that provided by the implant. 
         [0027]    These and other preferred embodiments of the present invention will be described in more detail below. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         [0028]      FIG. 1  shows a cross-sectional view of a human head including a nasal cavity and a pharynx. 
           [0029]      FIG. 2  shows a cross-sectional view of the nasal cavity and the pharynx of a human during normal breathing. 
           [0030]      FIG. 3  shows a cross-sectional view of the nasal cavity and the pharynx of a human during an obstructive sleep apnea episode. 
           [0031]      FIG. 4  shows another cross-sectional view of the nasal cavity and the pharynx of a human during an obstructive sleep apnea episode. 
           [0032]      FIGS. 5A-5E  show a perspective view of an implant used for treating obstructive sleep apnea, in accordance with one embodiment of the present invention. 
           [0033]      FIG. 6  shows a distal end of an insertion tool for inserting the implant shown in  FIGS. 5A-5E , in accordance with one embodiment of the present invention. 
           [0034]      FIGS. 7A-7D  show the implant of  FIGS. 5A-5E  secured to the distal end of the insertion tool of  FIG. 6 , in accordance with one embodiment of the present invention. 
           [0035]      FIG. 8A  shows a cross-sectional view of the implant insertion tool of  FIGS. 7A-7D  with the insertion tool in a first position, in accordance with on embodiment of the present invention. 
           [0036]      FIG. 8B  shows a cross-sectional view of the implant insertion tool of  FIGS. 7A-7D  with the insertion tool in a second position, in accordance with one embodiment of the present invention. 
           [0037]      FIG. 9A  shows a method of inserting the implant of  FIGS. 5A-5D  in a patient using the insertion tool shown in FIGS.  6  and  7 A- 7 D, in accordance with one embodiment of the present invention. 
           [0038]      FIG. 9B  shows a magnified view of the implant and the distal end of the insertion tool shown in  FIG. 9A . 
           [0039]      FIGS. 10A-10C  show a method of inserting an implant device in a patient using an insertion tool, in accordance with one embodiment of the present invention. 
           [0040]      FIGS. 10A-1 ,  10 B- 1  and  10 C- 1  show a magnified view of the insertion method shown in  FIGS. 10A-10C . 
           [0041]      FIGS. 11A and 11B  show a method of treating obstructive sleep apnea, in accordance with one embodiment of the invention. 
           [0042]      FIG. 12  shows an implant for treating obstructive sleep apnea, in accordance with one embodiment of the present invention. 
           [0043]      FIG. 13  shows an implant for treating obstructive sleep apnea, in accordance with one embodiment of the present invention. 
           [0044]      FIG. 14  shows a system for treating obstructive sleep apnea, in accordance with one embodiment of the present invention. 
           [0045]      FIG. 15  shows a system for treating obstructive sleep apnea, in accordance with one embodiment of the present invention. 
       
    
    
     DETAILED DESCRIPTION 
       [0046]      FIG. 1  shows a cross-section of a human head with anatomical structures including the nasal cavity N, bone B of the hard palate HP, the soft palate SP including the uvula UV at the posterior end thereof, the mouth M, the tongue T, the trachea TR, the epiglottis EP, the esophagus ES, and the posterior pharyngeal wall PPW. 
         [0047]    In a human body, an air filled space between the nasal cavity N and the larynx LX is referred to as the upper airway. The most critical part of the upper airway associated with sleep disorders is the pharynx PX. Referring to  FIG. 2 , the pharynx has three different anatomical levels. The nasopharynx NP is the upper portion of the pharynx located in the back of the nasal cavity N. The oropharynx OP is the intermediate portion of the pharynx containing the soft palate SP, the epiglottis EP, and the curve at the back of the tongue T. The hypopharynx HP is the lower portion of the pharynx located below the soft tissue of the oropharynx OP. The oropharynx OP is the section of the pharynx that is most likely to collapse due to the high prevalence of soft tissue structure, which leaves less space for airflow. The hypopharynx HP lies below the aperture of the larynx and behind the larynx, and extends to the esophagus. 
         [0048]    As is well known to those skilled in the art, the soft palate and the tongue are both flexible structures. The soft palate SP provides a barrier between the nasal cavity N and the mouth M. In many instances, the soft palate SP is longer than is necessary and extends a significant distance between the back of the tongue T and the posterior pharyngeal wall PPW. The midline posterior end of the soft palate is referred to as the uvula, which is the soft tissue that extends downward from the soft palate over the back of the tongue. 
         [0049]    Although the muscles relax throughout the body during sleep, most of the muscles of the respiratory system remain active. During inhalation, the diaphragm contracts and causes negative pressure to draw air A into the nasal cavity N and the mouth M. The air then flows past the pharynx PX, through the trachea TR and into the lungs. The negative pressure causes the tissue of the upper airway to deform slightly, which narrows the airway passage. In apneic patients, the soft palate SP, the tongue T, and/or the epiglottis EP collapse against the posterior pharyngeal wall PPW to block airflow into the trachea. As the airway narrows, airflow through the pharynx becomes turbulent, which causes the soft palate SP to vibrate, generating a sound commonly known as snoring. 
         [0050]    During sleep, humans typically experience brief obstructions of airflow and/or small decreases in the amount of airflow into the trachea and lungs. An obstruction of airflow for more than ten seconds is referred to as apnea. A decrease in airflow by more than fifty percent is referred to as hypopnea. The severity of sleep disorders is measured by the number of apneas and hypopneas that occur during every hour of sleep. 
         [0051]    If apnea or hypopnea occurs more than five times per hour, most medical personnel diagnose the individual as having an upper airway resistance problem. Many of these patients often exhibit symptoms related to sleep disorders including sleepiness during the day, depression, and difficulty concentrating. 
         [0052]    Individuals having ten or more episodes of apnea or hypopnea during every hour of sleep are officially classified as having obstructive sleep apnea syndrome. As the airway is obstructed, the individual makes repeated attempts to force inhalation. Many of these episodes are silent and are characterized by movements of the abdomen and chest wall as the individual strains to draw air into the lungs. Typically, episodes of apnea may last a minute or more. During this time, oxygen levels in the blood will decrease. Ultimately, the obstruction may be overcome by the individual generating a loud snore or awakening with a choking feeling. 
         [0053]    Referring to  FIG. 2 , when an individual is awake, the back of the tongue T and the soft palate SP maintain their shape and tone due to their respective internal muscles. As a result, the airway A through the pharynx remains open and unobstructed. During sleep, however, the muscle tone decreases and the posterior surface of the tongue and the soft palate become more flexible and distensible. 
         [0054]    Referring to  FIG. 3 , without normal muscle tone to keep their shape and to keep them in place either alone or as a group, the posterior surface of the tongue T, the epiglottis EP, and the soft palate SP tend to easily collapse to block the airway A. 
         [0055]    Referring to  FIG. 4 , during sleep, the proximal end of the tongue T may block the airway A between the nasal passages N and the upper end of the trachea TR. The soft palate SP may also relax and have the uvula UV slide between the back of the tongue T and the posterior pharyngeal wall PPW. In one embodiment, the present invention provides an implant that changes the shape of the soft palate so that it does not move into the position shown in  FIG. 4 . The implant also desirably provides support to the tongue T so that it does not sag in a posterior direction against the posterior pharyngeal wall, as shown in  FIG. 4 . 
         [0056]    Referring to  FIGS. 5A-5E , in one embodiment, an implant  100 , such as a soft palate implant, includes a main body  102  that is implantable in a soft palate. The main body  102  has a posterior or distal end  104 , and an anterior or proximal end  106  that is adapted to be coupled and/or secured to a hard palate of a patient. The main body  106  of the implant  102  preferably includes a top surface  108  and a bottom surface  110 . The main body  102  of the implant  100  preferably has a length L and a width W that may vary depending upon patient anatomy. The main body  102  and the top and bottom surfaces  108 ,  110  may be curved. The curvature of the main body  102  may vary depending upon patient anatomy, the specific problem affecting the patient and/or surgical requirements. In one embodiment, the curvature of the main body  102  may be varied as required to prevent the back of a patient&#39;s tongue from pressing against the posterior pharyngeal wall. 
         [0057]    Referring to  FIGS. 5A-5E , in one embodiment, the proximal end  106  of the soft palate implant  102  includes a securing element  112  for securing the implant to a hard palate of a patient. In one embodiment, the securing element includes an upper anchoring tab  114  adapted to engage an upper surface of a hard palate, and a pair of lower anchoring tabs  116 ,  118  adapted to engage a lower surface of a hard palate. 
         [0058]    Referring to  FIGS. 5A and 5E , in one embodiment, the upper anchoring tab  114  desirably includes a leading end  120  and trailing end  122  that is connected to the main body  102  via a flexible connection  124 . The upper anchoring tab  114  includes an outer face  126  and an inner face  128  having anchoring barbs  130 . The anchoring barbs  130  are adapted to bite into an upper surface of a hard palate for anchoring the proximal end  106  of the soft palate implant  100  to the hard palate. The flexible connection  124  normally biases the upper anchoring tab  114  toward the opposing lower anchoring tabs  116 , 118  in a downward direction designated D 1 . 
         [0059]    The lower anchoring tabs include the first lower tab  116  having a leading end  132  and a trailing end  134  that is connected with the main body  102  via a flexible connection  136 . The flexible connection  136  normally biases the first lower tab  116  toward the upper tab  114  in an upward direction designated D 2 . The first lower tab  116  includes an outer surface  138  and an inner surface  140  having anchoring barbs  142  projecting therefrom. In one embodiment, the anchoring barbs  142  are adapted to bite into an underside surface of a hard palate. The first lower tab  116  also desirably includes through holes  144  that extend from the inner surface  140  toward the outer surface  138 . In one embodiment, the through holes  144  extend completely between the inner and outer surfaces  140 ,  138 . In one embodiment, the through holes  144  are blind detents that extend only part of the way between the inner surface and the outer surface. 
         [0060]    The second lower tab  118  preferably includes a leading end  146  and a trailing end  148  that is coupled with a proximal end of the main body via a flexible connection  150 . The flexible connection  150  normally biases the second lower tab  118  toward the upper anchoring tab  114  in an upward direction designated D 2 . The second lower anchoring tab  118  includes an outer surface  152  and an inner surface  154  having bone anchoring barbs  156  projecting therefrom. The bone anchoring barbs  156  are preferably adapted to bite into an underside surface of a hard palate. The second lower anchoring tab  118  also includes through holes  158  adapted to receive posts at a distal end of an insertion tool as will be described in more detail below. 
         [0061]    Referring to  FIG. 6 , in one embodiment, an insertion tool  200  for implanting the implant  100  shown in  FIGS. 5A-5E  includes a shaft  202  having a distal end  204  that secures and deploys the implant. The distal end  204  of the insertion tool  200  desirably includes an upper blade  210  having a leading end  212  and a trailing end  214 . The upper blade  210  includes a pair of aligned slits  216 A,  216 B that extend from the leading end  212  toward the trailing end  214 . The upper blade  210  includes a first set of through holes  218 A,  218 B adjacent the first slot  216 A, and a second set of through holes  220 A,  220 B adjacent the second slot  216 B. 
         [0062]    Referring to  FIG. 6 , in one embodiment, the insertion tool  200  also preferably includes a lower blade  222  having a leading end  224  and a trailing end  226 . The lower blade  222  includes an inner surface  228  having a first set of lower anchoring tab securing posts  230  aligned with one another and extending along a first lateral edge  232  of the lower blade  222  and a second set of lower anchoring tab securing posts  234  aligned with one another and extending along a second lateral edge  236  of the lower blade  222 . In one embodiment, the aligned securing posts  230 ,  234  on the lower blade  222  may be aligned with the through holes  218 ,  220  extending through the upper blade  212 . 
         [0063]    In one embodiment, the lower blade  222  is adapted to be wedged away from the upper blade  210  for releasing the uvula implant from the distal end  204  of the insertion tool. In one embodiment, the insertion tool  200  includes a push bar  240  that is coupled with an actuator (not shown) located at a proximal end of the insertion tool. Upon activation of the actuator (not shown), the push bar  240  preferably moves in a distal direction designated D 3  for wedging the leading end  224  of the lower blade  222  away from the upper blade  210 . In one embodiment, the push bar may wedge the upper blade away from the lower blade. 
         [0064]    Referring to  FIGS. 7A-7D , in one embodiment, the soft palate implant  100  is preferably securable to the distal end  204  of the insertion tool  200 . Referring to  FIGS. 7A-7D , in one embodiment, the insertion tool  200  includes an elongated shaft  202  having a distal end  204  and a proximal end  206  coupled with a housing  207  having an actuator or trigger  209 . Referring to  FIGS. 7C and 7D , in one embodiment, the lower anchoring tabs  116 ,  118  are held between the upper blade  210  and the lower blade  222 , with the barbs  142  projecting from the inner surfaces of the lower tabs  116 ,  118  passing through the slots  216  adjacent the lateral edges of the upper blade  210 . In one embodiment, the upper and lower blades  220 ,  222  pinch towards one another for holding the lower anchoring tabs  116 ,  118  therebetween. The securing posts  234  on the lower blade  222  preferably pass through the through holes  144 ,  158  of the lower anchoring tabs  116 ,  118  for more securely holding the implant to the distal end  204  of the insertion tool  200 . 
         [0065]    Referring to  FIGS. 7C and 7D , in one embodiment, when the lower anchoring tabs  116 ,  118  are held between the upper and lower blades  210 ,  224 , the upper anchoring tab  114  preferably lies above the upper blade  210 . In one embodiment, during an insertion operation, the insertion tool  200  secures the implant  100  so that the distal end  104  of the implant  100  may be guided into a surgical opening, such as an incision formed in the soft palate of a patient. In one embodiment, the push bar  240  is actuated so that it moves in the direction D 3  toward the distal end of the insertion tool  200 . As the push bar  240  moves toward the distal end, the upper and lower blades  210 ,  222  are wedged away from one another for releasing the lower anchoring tabs  116 ,  118  from the insertion tool. In one embodiment, the respective upper and lower anchoring tabs will preferably bias toward one another, whereby the barbs on the inner surfaces of the tabs bite into the respective upper and lower faces of the hard palate for anchoring the implant  100  to the hard palate. 
         [0066]    Referring to  FIGS. 8A and 8B , in one embodiment, the distal end of the insertion tool  200  is adapted to secure a proximal end of the implant device  100 . The distal end of the insertion tool preferably releases the implant device after the device has been implanted in tissue. In one preferred embodiment, the insertion tool is used to implant the implant device in the soft palate of a patient and anchor a proximal end of the implant device to the patient&#39;s hard palate. 
         [0067]    Referring to  FIG. 8A , in one embodiment, the upper and lower blades pinch the pair of lower tabs  116 ,  118  therebetween, and the push bar  240  is in a retracted position. In  FIG. 8B , the push bar  240  is advanced in a distal direction designated D 3  for wedging the lower blade  222  away from the upper blade  210  so as to release the pair of lower tabs  116 ,  118  from the distal end of the insertion tool  200 . The insertion tool may then be retracted in the direction designated D 4  so as to release the implant device  100  and leave the proximal end of the implant device anchored to a structure, such as the hard palate of a patient. 
         [0068]    Referring to  FIG. 9A , in one embodiment, a surgical opening SO is formed in the soft palate SP and an implant device  100  is inserted into the surgical opening for supporting the soft palate SP and the uvula UV. In one embodiment, the implant  100  is preferably held by the upper and lower blades at the distal end  204  of the insertion tool  200 .  FIG. 9B  shows a magnified view of the distal end  204  of the insertion tool  200  with the implant  100  inserted into the surgical opening SO in the soft palate SP. In one embodiment, the shaft  202  of the insertion tool  200  is moved in the direction A 1  for inserting the implant  100  into the surgical opening SO. The shaft  202  of the insertion tool  200  is then retracted in the direction A 2  so that the upper tab  114  overlies the top surface of the hard palate HP and the lower tabs  116 ,  118  underlie the bottom surface of the hard palate. The push bar is then advanced to open the upper and lower blades of the tool for releasing the implant  100  from the distal end of the insertion tool. 
         [0069]      FIGS. 10A-10C  and  10 A- 1  through  10 C- 1  show a simplified view of how the insertion tool is used for implanting the implant device in the soft palate. Referring to  FIG. 10A , after the soft palate implant  100  has been inserted into the surgical opening in the soft palate and while the upper and lower blades  210 ,  222  hold the implant  100 , the insertion tool  200  is moved in a the direction A 2  so that the upper anchoring tab  114  overlies the top surface of the hard palate HP and the lower anchoring tabs  116 ,  118  are positioned under the bottom surface of the hard palate HP. 
         [0070]      FIG. 10A-1  shows a magnified cross-sectional view of the soft palate implant  100  and the insertion tool  200  shown in  FIG. 10A . The implant  100  includes the upper anchoring tab  114  overlying a top surface of the hard palate HP and the lower anchoring tabs  116 ,  118  underlying the bottom surface of the hard palate HP. Initially, the lower anchoring tabs  116 ,  118  remain secured between the upper blade  210  and the lower blade  222  of the insertion tool. The upper and lower blades  210 ,  222  desirably pinch the lower anchoring tabs  116 ,  118  therebetween for securing the lower tabs to the distal end of the insertion tool. The push bar  240 , which is later used for wedging the lower blade  222  away from the upper blade  210 , is preferably in the fully retracted position. 
         [0071]    Referring to  FIG. 10B , in one embodiment, an actuator at the proximal end of the insertion tool  200  is engaged for moving the push bar  240  in a distal direction designated D 3 . As the push bar  240  moves in the distal direction, the lower blade  224  is wedged away from the upper blade  210  so that the securing posts  234  on the lower blade  222  are retracted from the through holes extending through the lower anchoring tabs  116 ,  118 . 
         [0072]      FIG. 10B-1  shows an expanded view of  FIG. 10B , whereby the lower blade  222  of the insertion tool  200  is wedged away from the upper blade  210  by the push bar  240 . The posts  234  on the lower blade  222  are retracted from the through holes in the lower anchoring tabs  116 ,  118  of the implant  100 . The barbs on the pair of lower anchoring tabs  116 ,  118  preferably pass through the slots in the upper blade for engaging the underside of the hard palate HP. After the upper and lower blades  210 ,  222  have been wedged away from one another for releasing the implant  100 , the insertion tool  200  may be retracted in the direction designated A 2 . After being released from the distal end of the insertion tool, the upper and lowers tabs of the implant  100  preferably bias toward one another for pinching the hard palate HP therebetween. The barbs  130 ,  142  on the inner surfaces of the opposing upper and lower anchoring tabs  114 ,  116 ,  118  preferably bite into the bone of the hard palate HP for anchoring the implant  100  to the hard palate HP. 
         [0073]    FIGS.  10 C and  10 C- 1  show the implant  100  after it has been anchored to the hard palate HP. The implant  100  includes the upper tab  114  anchored to the top surface of the hard palate HP, and the lower tabs  116 ,  118  anchored to the underside surface of the hard palate HP. As shown in  FIG. 10C-1 , the barbs  124  on the upper anchoring tab  114  bite into the upper surface of the hard palate HP, while the barbs  142  on the lower anchoring tabs  116 ,  118  bite into the underside surface of the hard palate HP. Although barbs are shown for securing the implant to the hard palate, in other embodiments other fastening elements such as screws, pins, tacks, adhesives, wire, and sutures may be used for securing the implant to the hard palate. 
         [0074]    Referring to  FIG. 11A , some patients have a condition whereby the soft palate SP has a horizontal component H and a vertical component V that is angled relative to the horizontal component. In some instances, the vertical component V may be at an angle that approaches 90° or more relative to the horizontal component H. As is known to those skilled in the art, the existence of the vertical component reduces the size of the opening in the posterior portion of the nasopharynx, which may cause OSA symptoms. In order to change the shape of the soft palate SP and/or provide a soft palate SP having a more continuous arc, an implant as disclosed herein may be implanted into the soft palate of a patient.  FIG. 11B  shows the soft palate SP of the  FIG. 11A  after the implant  100  has been implanted therein. The implant  100  includes a proximal end anchored to the hard palate HP of the patient and a distal end that extends to the uvula UV. The implant  100  preferably changes the shape of the soft palate so that it has a more preferred, continuous arc between the hard palate HP and uvula UV. The more continuous arc shape of the soft palate shown in  FIG. 11B  opens the posterior portion of the nasopharynx and provides more space between the soft palate SP and the posterior pharyngeal wall PPW. During sleep, the implanted device  100  may provide indirect support to the tongue T in an anterior direction for further opening in the posterior portion of the nasopharynx. 
         [0075]    Referring to  FIG. 12 , in one embodiment, an implant  300  for supporting and/or changing the shape of the uvula includes a main body  302  and a fastening element provided at a proximal end of the main body. The main body includes a plurality of openings  305  extending therethrough that provide for bone or tissue in-growth.  FIG. 13  shows another embodiment of an implant  400  for supporting a uvula including a main body  402  having an outer mesh surface  405  for promoting bone and/or tissue in-growth. 
         [0076]    Although the present invention is not limited by any particular theory of operation, it is contemplated that two or more implant devices may be implanted in a soft palate of a patient for supporting and/or changing the shape of the uvula of the patient for treating obstructive sleep apnea. Referring to  FIG. 14 , in one embodiment, a system for treating obstructive sleep apnea may include a pair of implant devices  500 A and  500 B implanted in a soft palate SP, whereby each of the implants have distal ends supporting a uvula and proximal ends anchored to a hard palate. Referring to  FIG. 15 , in one embodiment, a system for treating obstructive sleep apnea may include a plurality of implant devices  600 A,  600 B,  600 C (e.g. three implant devices) that are implanted in a soft palate SP, whereby each of the implants have distal ends supporting a uvula and proximal ends anchored to a hard palate HP. The implants extending through the soft palate may be parallel to one another or may be angled relative to one another. The lengths and/or sizes of the implants may vary. In one embodiment, a first implant may have a first length, and a second adjacent implant may have a second length that is different than the first length. 
         [0077]    In other embodiments, fastening elements other than barbs may be used for securing the proximal end of the implant to the hard palate. In one embodiment, one or more screws may be used for securing the implant to a hard palate. In another embodiment, surgical tacks may be used for securing the implant to the hard palate. In yet another embodiment, surgical wire or sutures may be used to securing the implant to the hard palate. Bone needles may also be used for securing the implant to the hard palate. 
         [0078]    In one embodiment, the implant may have an outer surface that encourages tissue in-growth so as to stabilize the implant within the tissue and so as to minimize the opportunity for tissue erosion. The outer surface modification may be achieved by texturizing the outer surface, making the implant porous through the addition of holes (e.g. drilled or pierced holes), encapsulating the implant with a braided, surgical mesh, or fleece type material, and/or coating the implant with bone growth stimulating agents such as hydroxyapatite. 
         [0079]    Although the present invention is not limited by any particular theory of operation, it is believed that providing a soft tissue implant supported by the distal end of the hard palate provides more positive positioning of the uvula and enables the uvula to provide greater resistance to distal tongue movement than when using implants that are not supported by the hard palate. The soft palate implant of the present invention preferably provides a balanced level of support for the uvula, providing tongue support when needed, but not inhibiting swallowing. The shape changing feature of the implant allows greater uvula support (and thereby tongue support) during times of rest and less support during waking hours. Providing an outer surface on the implant having tissue in-growth capabilities reduces the chance of tissue erosion and provides greater lateral stability to the implant. In one embodiment, the ability to implant the device through the nasal passageways results in the implant location being more cranial, thereby minimizing tongue sensitivity to the presence of the implant. In one embodiment, the implant procedure does not damage the musculature within the soft palate and maintains mucosal surfaces, thereby enabling the natural musculature to continue to provide support in addition to that provided by the implant. 
         [0080]    In one embodiment, the soft palate implant may be formed from absorbable materials, non-absorbable materials, or a combination of absorbable and non-absorbable materials. The non-absorbable materials may include polymeric materials such as non-resorbable polymers, silicone, polyethylene terephalate, polytetrafluoroethylene, polyurethane and polypropylene, nitninol, stainless steel, and/or composite materials. Suitable resorbable polymers may include polylactide, polyglycolide copolymers, polycaprolactone, and/or collagen. The implant may also include a biocompatible metal or alloy. 
         [0081]    The present invention provides a number of advantages over prior art methods and devices used for treating obstructive sleep apnea syndrome and hypopnea. First, the methods, systems and devices disclosed herein provide for simple surgical procedures that are minimally invasive. Typically, the methods, systems and devices disclosed herein may be utilized during an outpatient procedure. In addition, the methods, systems and devices disclosed herein provide both immediate and long term results for treating obstructive sleep apnea syndrome and hypopnea. Moreover, the methods, systems and devices disclosed herein do not require a significant level of patient compliance. 
         [0082]    In addition, the present invention does not anchor the tongue to a fixed hard structure, such as the mandible. Thus, the present invention is significantly less likely to affect swallowing or speech, thereby providing a great improvement over prior art devices, systems and methods. The present invention also preferably uses materials having long-term biocompatibility. 
         [0083]    Although various embodiments disclosed herein relate to use in humans, it is contemplated that the present invention may be used in all mammals, and in all animals having air passages. Moreover, the methods, systems and devices disclosed herein may incorporate any materials that are biocompatible, as well as any solutions or components that minimize rejection, enhance tissue ingrowth, enhance the formation of mucosal layers, and improve acceptance of the device by a body after the device has been implanted. 
         [0084]    The headings used herein are for organizational purposes only and are not meant to be used to limit the scope of the description or the claims. As used throughout this application, the word “may” is used in a permissive sense (i.e., meaning having the potential to), rather than the mandatory sense (i.e., meaning must). Similarly, the words “include”, “including”, and “includes” mean including but not limited to. To facilitate understanding, like reference numerals have been used, where possible, to designate like elements common to the figures. 
         [0085]    While the foregoing is directed to embodiments of the present invention, other and further embodiments of the invention may be devised without departing from the basic scope thereof. As such, the scope of the present invention is to be limited only as set forth in the appended claims.

Technology Category: 1