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

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details. Identifier: NCT04129229
Recruitment Status : Enrolling by invitation
First Posted : October 16, 2019
Last Update Posted : March 9, 2022
Information provided by (Responsible Party):
Linguaflex, Inc.

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

Condition or disease Intervention/treatment Phase
Obstructive Sleep Apnea Snoring Device: LinguaFlex Tongue Retractor (LTR) Not Applicable

Detailed 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.

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Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 80 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Masking: None (Open Label)
Primary Purpose: Treatment
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
Actual Study Start Date : January 10, 2020
Estimated Primary Completion Date : December 2022
Estimated Study Completion Date : April 2023

Resource links provided by the National Library of Medicine

MedlinePlus related topics: Sleep Apnea Snoring

Arm Intervention/treatment
Experimental: LTR Treatment
Eligible subjects will undergo insertion of the LTR device in their tongue. Initiation of treatment will occur 7 days post insertion procedure and will be monitored over the course of 1 year.
Device: LinguaFlex Tongue Retractor (LTR)
The LinguaFlex Tongue Retractor (LTR) is a small, flexible, implanted tongue retaining device that prevents 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.

Primary Outcome Measures :
  1. Responder to Therapy [ Time Frame: One Year ]
    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.

Secondary Outcome Measures :
  1. Change in Epworth Sleepiness Scale (ESS) [ Time Frame: One Year ]
    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.)

  2. Oxygen Desaturation Index (ODI) Responder [ Time Frame: One Year ]
    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.

Other Outcome Measures:
  1. Quality of Life Metric - Pain [ Time Frame: At each follow-up visit over the course of 1 year ]
    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.

  2. Quality of Life Metric - Speech and Swallowing [ Time Frame: At each follow-up visit over the course of 1 year. ]
    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.

  3. Quality of Life Metric - Snoring [ Time Frame: At each follow-up visit over the course of 1 year. ]
    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.

Information from the National Library of Medicine

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. For general information, Learn About Clinical Studies.

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Ages Eligible for Study:   18 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

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

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its identifier (NCT number): NCT04129229

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United States, Massachusetts
St. Elizabeth's Medical Center
Brighton, Massachusetts, United States, 02135
United States, West Virginia
WVU Medicine / J. W. Ruby Memorial Hospitl
Morgantown, West Virginia, United States, 26505
United States, Wisconsin
Medical College of Wisconsin
Milwaukee, Wisconsin, United States, 53226
Sponsors and Collaborators
Linguaflex, Inc.
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Principal Investigator: Peter Catalano, MD Saint Elizabeth's Medical Center
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Responsible Party: Linguaflex, Inc. Identifier: NCT04129229    
Other Study ID Numbers: LTR-006-V01.0-US-CTP
First Posted: October 16, 2019    Key Record Dates
Last Update Posted: March 9, 2022
Last Verified: February 2022
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No
Plan Description: No data will be shared with other researchers.

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: Yes
Device Product Not Approved or Cleared by U.S. FDA: Yes
Additional relevant MeSH terms:
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Sleep Apnea Syndromes
Sleep Apnea, Obstructive
Respiration Disorders
Respiratory Tract Diseases
Signs and Symptoms, Respiratory
Sleep Disorders, Intrinsic
Sleep Wake Disorders
Nervous System Diseases
Respiratory Sounds