Snoring is very common among mammals including humans. Snoring is a noise produced while breathing during sleep due to the vibration of the soft palate and uvula. Not all snoring is bad, except it bothers the bed partner or others near the person who is snoring. If the snoring gets worse over time and goes untreated, it could lead to apnea.
Those with apnea stop breathing in their sleep, often hundreds of times during the night. Usually apnea occurs when the throat muscles and tongue relax during sleep and partially block the opening of the airway. When the muscles of the soft palate at the base of the tongue and the uvula relax and sag, the airway becomes blocked, making breathing labored and noisy and even stopping it altogether. Sleep apnea also can occur in obese people when an excess amount of tissue in the airway causes it to be narrowed.
In a given night, the number of involuntary breathing pauses or “apneic events” may be as high as 20 to 60 or more per hour. These breathing pauses are almost always accompanied by snoring between apnea episodes. Sleep apnea can also be characterized by choking sensations.
Sleep apnea is diagnosed and treated by primary care physicians, pulmonologists, neurologists, or other physicians with specialty training in sleep disorders. Diagnosis of sleep apnea is not simple because there can be many different reasons for disturbed sleep.
The specific therapy for sleep apnea is tailored to the individual patient based on medical history, physical examination, and the results of polysomnography. Medications are generally not effective in the treatment of sleep apnea. Oxygen is sometimes used in patients with central apnea caused by heart failure. It is not used to treat obstructive sleep apnea.
Nasal continuous positive airway pressure (CPAP) is the most common treatment for sleep apnea. In this procedure, the patient wears a mask over the nose during sleep, and pressure from an air blower forces air through the nasal passages. The air pressure is adjusted so that it is just enough to prevent the throat from collapsing during sleep. The pressure is constant and continuous. Nasal CPAP prevents airway closure while in use, but apnea episodes return when CPAP is stopped or it is used improperly. Many variations of CPAP devices are available and all have the same side effects such as nasal irritation and drying, facial skin irritation, abdominal bloating, mask leaks, sore eyes, and headaches. Some versions of CPAP vary the pressure to coincide with the person's breathing pattern, and other CPAPs start with low pressure, slowly increasing it to allow the person to fall asleep before the full prescribed pressure is applied.
Dental appliances that reposition the lower jaw and the tongue have been helpful to some patients with mild to moderate sleep apnea or who snore but do not have apnea. A dentist or orthodontist is often the one to fit the patient with such a device.
Some patients with sleep apnea may need surgery. Although several surgical procedures are used to increase the size of the airway, none of them is completely successful or without risks. More than one procedure may need to be tried before the patient realizes any benefits. Some of the more common procedures include removal of adenoids and tonsils (especially in children), nasal polyps or other growths, or other tissue in the airway and correction of structural deformities. Younger patients seem to benefit from these surgical procedures more than older patients.
Uvulopalatopharyngoplasty (UPPP) is a procedure used to remove excess tissue at the back of the throat (tonsils, uvula, and part of the soft palate). The success of this technique may range from 30 to 60 percent. The long-term side effects and benefits are not known, and it is difficult to predict which patients will do well with this procedure.
Laser-assisted uvulopalatoplasty (LAUP) is done to eliminate snoring but has not been shown to be effective in treating sleep apnea. This procedure involves using a laser device to eliminate tissue in the back of the throat. Like UPPP, LAUP may decrease or eliminate snoring but not eliminate sleep apnea itself. Elimination of snoring, the primary symptom of sleep apnea, without influencing the condition may carry the risk of delaying the diagnosis and possible treatment of sleep apnea in patients who elect to have LAUP. To identify possible underlying sleep apnea, sleep studies are usually required before LAUP is performed.
Somnoplasty is a procedure that uses RF to reduce the size of some airway structures such as the uvula and the back of the tongue. This technique helps in reducing snoring and is being investigated as a treatment for apnea.
Tracheostomy is used in persons with severe, life-threatening sleep apnea. In this procedure, a small hole is made in the windpipe and a tube is inserted into the opening. This tube stays closed during waking hours and the person breathes and speaks normally. It is opened for sleep so that air flows directly into the lungs, bypassing any upper airway obstruction. Although this procedure is highly effective, it is an extreme measure that is rarely used.
Patients in whom sleep apnea is due to deformities of the lower jaw may benefit from surgical reconstruction. Surgical procedures to treat obesity are sometimes recommended for sleep apnea patients who are morbidly obese. Behavioral changes are an important part of the treatment program, and in mild cases behavioral therapy may be all that is needed. Overweight persons can benefit from losing weight. Even a 10 percent weight loss can reduce the number of apneic events for most patients. Individuals with apnea should avoid the use of alcohol and sleeping pills, which make the airway more likely to collapse during sleep and prolong the apneic periods. In some patients with mild sleep apnea, breathing pauses occur only when they sleep on their backs. In such cases, using pillows and other devices that help them sleep in a side position may be helpful.
Recently, Restore Medical, Inc., Saint Paul, Minn. has developed a new treatment for snoring and apnea, called the Pillar technique. Pillar System is a procedure where 2 or 3 small polyester rod devices are placed in the patient's soft palate. The Pillar System stiffens the palate, reduces vibration of the tissue, and prevents the possible airway collapse. Stiff implants in the soft palate, however, could hinder patient's normal functions like speech, ability to swallow, coughing and sneezing. Protrusion of the modified tissue into the airway is another long-term concern.
As the current treatments for snoring and/or apnea are not effective and have side-effects, there is a need for additional treatment options.
An inductive power transfer system associated with an airway implant device is disclosed. A non-implanted portion of the system comprises a mouthpiece or retainer. The mouthpiece includes a power transfer circuit and a power source. The power transfer circuit includes a receive circuit configured to receive a first inductive power transfer from a charging device and to deliver a charging current to the power source. The power transfer circuit also includes a transmit circuit coupled to the power source. The transmit circuit is configured to provide a second inductive power transfer from the mouthpiece to the airway implant. Some embodiments of the non-implanted portion include a charge controller and a lithium polymer battery. Some embodiments of the charging device include a microcontroller for controlling the operation of the charging device based on a proximity of the mouthpiece.
In one embodiment, the receive circuit comprises a pickup coil and the transmit circuit comprises a power transmission coil. The non-implanted portion may also include a timer coupled to the receive circuit and the transmit circuit and configured to activate the transmit circuit a predetermined time after the first inductive transfer is complete. In some embodiments, the timer comprises a resistor and a capacitor and a voltage associated with the capacitor is used to define the predetermined interval.
In one embodiment, the non-implanted portion comprises a charge controller coupled to the receive circuit and the battery. The charge controller is configured to deliver a charging current to the battery. The charge controller optionally has a first operating mode in which the charging current is delivered to the battery at a substantially constant level, and a second operating mode in which the charging current is delivered to the battery so as to maintain the battery at a substantially constant voltage.
In one embodiment, a charging device is disclosed. The charging device has a housing to receive a mouthpiece. The charging device also includes a power transfer circuit configured to source an inductive power transfer when the mouthpiece is received at the housing. The power transfer circuit includes a power transmission coil. A proximity detection circuit is also included. The proximity detection circuit is configured to detect a proximity of the mouthpiece to the power transmission coil and to generate an output signal based on the proximity. The charging device initiates the inductive power transfer when the output signal exceeds a predetermined threshold.
In one embodiment, a device for powering an airway implant is disclosed. The device includes a non-implanted portion adapted and configured to be worn in a patient's mouth. A power transfer circuit is attached to the non-implanted portion. The power transfer circuit comprises a receive circuit configured to receive a first inductive power transfer from a charging device and to charge a battery with a current induced in the receive circuit by the charging device. The power transfer circuit also includes a transmit circuit coupled to the battery and configured to provide a second inductive power transfer from the non-implanted portion to the airway implant. A first microprocessor is coupled to the power transfer circuit and configured to control the operation of the transmit and receive circuits.
In one embodiment, a method for powering an airway implant device is disclosed. The airway implant device includes a non-implanted portion and an implant portion. The method includes receiving a first inductive power transfer at the non-implanted portion and charging a power source of the non-implanted portion with a current derived from the first inductive power transfer. The method also includes performing a second inductive transfer from the non-implanted portion to the implant portion. The power source supplies energy for the second inductive power transfer.
In one embodiment, an inductive power transfer system is disclosed. The system includes a prosthesis and a receiver implanted in a body cavity. The receiver is coupled to the prosthesis. The system also includes a wearable transmitter comprising a power source and a timer. The power source is configured to supply a first inductive power transfer to the receiver for operating the prosthesis. The timer is coupled to the power source and configured to define an interval during which the first inductive power transfer is disabled.
A method of treating a patient suffering from sleep disordered breathing is disclosed. The method includes placing an implant device in the patient's upper airway passage and inductively powering the implant device with an implanted receiver. A wearable transmitter supplies a first inductive power transfer to the implanted receiver and the implanted receiver supplies a second inductive power transfer to the implant device.
A first aspect of the invention is a device for the treatment of disorders associated with improper airway patency, such as snoring or sleep apnea. The device comprises of an actuator element to adjust the opening of the airway. In a preferred embodiment, the actuator element comprises of an electroactive polymer (EAP) element. The electroactive polymer element in the device assists in maintaining appropriate airway opening to treat the disorders. Typically, the EAP element provides support for the walls of an airway, when the walls collapse, and thus, completely or partially opens the airway.
The device functions by maintaining energized and non-energized configurations of the EAP element. In preferred embodiments, during sleep, the EAP element is energized with electricity to change its shape and thus modify the opening of the airway. Typically, in the non-energized configuration the EAP element is soft and in the energized configuration is stiffer. The EAP element of the device can have a pre-set non-energized configuration wherein it is substantially similar to the geometry of the patient's airway where the device is implanted.
In some embodiments, the device, in addition to the EAP element, includes an implantable transducer in electrical communication with the EAP element. A conductive lead connects the EAP element and the implantable transducer to the each other. The device of the present invention typically includes a power source in electrical communication with the EAP element and/or the implantable transducer, such as a battery or a capacitor. The battery can be disposable or rechargeable.
Preferred embodiments of the invention include a non-implanted portion, such as a mouthpiece, to control the implanted EAP element. The mouthpiece is typically in conductive or inductive communication with an implantable transducer. In one embodiment, the mouthpiece is a dental retainer with an induction coil and a power source. The dental retainer can further comprise a pulse-width-modulation circuit. When a dental retainer is used it is preferably custom fit for the individual biological subject. If the implantable transducer is in inductive communication, it will typically include an inductive receiver, such as a coil. The implantable transducer can also include a conductive receiver, such as a dental filling, a dental implant, an implant in the oral cavity, an implant in the head or neck region. In one embodiment, the device includes a dermal patch with a coil, circuit and power source, in communication with the implantable transducer. The dermal patch can also include a pulse-width-modulation circuit.
Another aspect of the invention is a method to modulate air flow through airway passages. Such modulation is used in the treatment of diseases such as snoring and sleep apnea. One method of the invention is a method for modulating the airflow in airway passages by implanting in a patient a device comprising an actuator element and controlling the device by energizing the actuator element. The actuator element preferably comprises an electroactive polymer element. The actuator element can be controlled with a mouthpiece inserted into the mouth of the patient. The energizing is typically performed with the use of a power source in electrical communication, either inductive communication or conductive communication, with the actuator element. A transducer can be used to energize the actuator element by placing it in electrical communication with the power source. Depending on the condition being treated, the actuator element is placed in different locations such as soft palate, airway sidewall, uvula, pharynx wall, trachea wall, larynx wall, and/or nasal passage wall.
A preferred embodiment of the device of the present invention comprises an implantable actuator element; an implantable transducer; an implantable lead wire connecting the actuator element and the transducer; a removable transducer; and a removable power source; and wherein the actuator element comprises an electroactive polymer.
Electroactive polymer is a type of polymer that responds to electrical stimulation by physical deformation, change in tensile properties, and/or change in hardness. There are several types of electroactive polymers like dielectric electrostrictive polymer, ion exchange polymer and ion exchange polymer metal composite (IPMC). The particular type of EAP used in the making of the disclosed device can be any of the aforementioned electroactive polymers.
Suitable materials for the electroactive polymer element include, but are not limited to, an ion exchange polymer, an ion exchange polymer metal composite, an ionomer base material. In some embodiments, the electroactive polymer is perfluorinated polymer such as polytetrafluoroethylene, polyfluorosulfonic acid, perfluorosulfonate, and polyvinylidene fluoride. Other suitable polymers include polyethylene, polypropylene, polystyrene, polyaniline, polyacrylonitrile, cellophane, cellulose, regenerated cellulose, cellulose acetate, polysulfone, polyurethane, polyvinyl alcohol, polyvinyl acetate, polyvinyl pyrrolidone. Typically, the electroactive polymer element includes a biocompatible conductive material such as platinum, gold, silver, palladium, copper, and/or carbon.
Suitable shapes of the electroactive polymer element include three dimensional shape, substantially rectangular, substantially triangular, substantially round, substantially trapezoidal, a flat strip, a rod, a cylindrical tube, an arch with uniform thickness or varying thickness, a shape with slots that are perpendicular to the axis, slots that are parallel to the longitudinal axis, a coil, perforations, and/or slots.
IPMC is a polymer and metal composite that uses an ionomer as the base material. Ionomers are types of polymers that allow for ion movement through the membrane. There are several ionomers available in the market and some of the suited ionomers for this application are polyethylene, polystyrene, polytetrafluoroethylene, polyvinylidene fluoride, polyfluorosulfonic acid based membranes like NAFION® (from E. I. Du Pont de Nemours and Company, Wilmington, Del.), polyaniline, polyacrylonitrile, cellulose, cellulose acetates, regenerated cellulose, polysulfone, polyurethane, or combinations thereof. A conductive metal, for example gold, silver, platinum, palladium, copper, carbon, or combinations thereof, can be deposited on the ionomer to make the IPMC. The IPMC element can be formed into many shapes, for example, a strip, rod, cylindrical tube, rectangular piece, triangular piece, trapezoidal shape, arch shapes, coil shapes, or combinations thereof. The IPMC element can have perforations or slots cut in them to allow tissue in growth.
The electroactive polymer element has, in some embodiments, multiple layers of the electroactive polymer with or without an insulation layer separating the layers of the electroactive polymer. Suitable insulation layers include, but are not limited to, silicone, polyurethane, polyimide, nylon, polyester, polymethylmethacrylate, polyethylmethacrylate, neoprene, styrene butadiene styrene, or polyvinyl acetate.
In some embodiments, the actuator element, the entire device, or portions of the airway implant have a coating. The coating isolates the coated device from the body fluids and/or tissue either physically or electrically. The device can be coated to minimize tissue growth or promote tissue growth. Suitable coatings include poly-L-lysine, poly-D-lysine, polyethylene glycol, polypropylene, polyvinyl alcohol, polyvinylidene fluoride, polyvinyl acetate, hyaluronic acid, and/or methylmethacrylate.
Instead of or in addition to wire lead 14, the connecting element may be an inductive energy transfer system, a conductive energy transfer system, a chemical energy transfer system, an acoustic or otherwise vibratory energy transfer system, a nerve or nerve pathway, other biological tissue, or combinations thereof. The connecting element is made from one or more conductive materials, such as copper. The connecting element is completely or partially insulated and/or protected by an insulator, for example polytetrafluoroethylene (PTFE). The insulator can be biocompatible. The power source 4 is typically in electrical communication with the actuator element 8 through the connecting element. The connecting element is attached to an anode 10 and a cathode 12 on the power source 4. The connecting elements can be made from one or more sub-elements.
The actuator element 8 is preferably made from an electroactive polymer. Most preferably, the electroactive polymer is an ion exchange polymer metal composite (IPMC). The IPMC has a base polymer embedded, or otherwise appropriately mixed, with a metal. The IPMC base polymer is preferably perfluoronated polymer, polytetrafluoroethylene, polyfluorosulfonic acid, perfluorosulfonate, polyvinylidene fluoride, hydrophilic polyvinylidene fluoride, polyethylene, polypropylene, polystyrene, polyaniline, polyacrylonitrile, cellophane, cellulose, regenerated cellulose, cellulose acetate, polysulfone, polyurethane, polyvinyl alcohol, polyvinyl acetate and polyvinyl pyrrolidone, or combinations thereof. The IPMC metal can be platinum, gold, silver, palladium, copper, carbon, or combinations thereof.
Preferably, the airway implant device 2 discussed herein is used in combination with an inductive coupling system 900 such as depicted in
Two preferred embodiments of the airway implant device are shown in
A preferred embodiment of the device of the present invention comprises an implanted portion 20 comprising an implantable actuator element 8, a housing 112, a first inductor 18, and connecting elements 14 connecting the actuator element 8 to the first inductor 18 within the housing 112; and a non-implanted portion 22 comprising a power source 4 and a second inductor 16 capable of transferring energy to the first inductor 18, wherein the energy of the first inductor 18 energizes the actuator element 8 wherein the actuator element 8 comprises an electroactive polymer element. In a preferred embodiment, the actuator element 8 of the device is implanted in the soft palate 84. The housing 112 of the preferred embodiment is implanted inferior to the hard palate 74. In a preferred embodiment of the device, the housing 112 comprises at least one of acrylic, polytetrafluoroethylene (PTFE), polymethylmethacrylate (PMMA), Acrylonitrile Butadiene Styrene (ABS), polyurethane, polycarbonate, cellulose acetate, nylon, and a thermoplastic or thermosetting material.
In a preferred embodiment, the non-implanted portion 22 is in the form of a mouth guard or dental retainer 66. In a preferred embodiment, the non-implanted portion comprises a non-implantable wearable element. In some embodiments, the superior side of the housing 112 comports to the shape of a hard palate 74. In some embodiments, the housing 112 is cast from an impression of a hard palate 74. In still other embodiments, the housing 112 is concave on its superior side. In some embodiments, the housing 112 is convex on its superior side. In some embodiments, the housing 112 comprises bumps 114 on its superior side lateral to a central axis extending from the housing's 112 anterior to its posterior end. In some embodiments, the housing 112 configuration has a substantially smooth rounded superior side. Other configurations for the housing 112 may be contemplated by one having skill in the art without departing from the invention.
In some embodiments, the actuator element 8 is at least partially within the housing 112. In other embodiments, the actuator element 8 is outside the housing 112. The housing 112 is capable of housing and protecting the first inductor 18 and connecting elements 14 between the first inductor 18 and the actuator element 8. In some embodiments, the housing 112 has a roughened surface to increase friction on the housing 112. In some embodiments, the roughened surface is created during casting of the housing 112. In some embodiments, the roughened surface induces fibrosis.
In some embodiments of the airway implant device having attachment elements 120, the attachment element 120 is a bioabsorbable material. Examples of bioabsorbable materials include, but are not limited to, polylactic acid, polyglycolic acid, poly(dioxanone), Poly(lactide-co-glycolide), polyhydroxybutyrate, polyester, poly(amino acid), poly(trimethylene carbonate) copolymer, poly (ε-caprolactone) homopolymer, poly (ε-caprolactone) copolymer, polyanhydride, polyorthoester, polyphosphazene, and any bioabsorbable polymer.
In another embodiment, the airway implant device comprises an attachment element 120, as shown in
In some embodiments, the implant may be secured in place, with or without use of an attachment element 120, using an adhesive suitable for tissue, such as cyanoacrylates, and including, but not limited to, 2-octylcyanoacrylate, and N-butyl-2-cyanoacrylate.
In some embodiments, the non-implanted portion 22 does not include ball clamps 128 for recharging the power source 4. In some embodiments, the power source 4 is a rechargeable battery. In some embodiments, the power source 4 is one of a lithium-ion battery, lithium-ion polymer battery, a silver-iodide battery, lead acid battery, a high energy density, or a combination thereof In some embodiments, the power source 4 is removable from the non-implanted portion 22. In some embodiments, the power source 4 is replaceable. In some embodiments, the power source is designed to be replaced or recharged per a specified time interval. In some embodiments, replacing or recharging the power source 4 is necessary no more frequently than once per year. In other embodiments, replacing or recharging the power source 4 is necessary no more frequently than once every six months. In yet other embodiments, replacing or recharging the power source 4 is necessary no more frequently than once or every three months. In yet another embodiment, daily replacing or recharging of the power source is required.
In some embodiments, the power source 4 and second inductor 16 are sealed within the non-implanted portion and the sealing is liquidproof
One embodiment of the invention is an airway implant device with a sensor for monitoring a condition prior to and/or during the occurrence of an apneic event. Preferably, the sensor monitors for blockage of an airway. The sensor senses the possible occurrence of an apneic event. This sensing of a possible apneic event is typically by sensing a decrease in the airway gap, a change in air pressure in the airway, or a change in air flow in the airway. A progressive decrease in the airway gap triggers the occurrence of an apneic event. Most preferably the sensor senses one or more events prior to the occurrence an apneic event and activates the airway implant to prevent the apneic event. In some embodiments, the airway implant device and the sensor are in the same unit. In other embodiments, the actuator element of the airway implant device is the sensor. In these embodiments, the actuator element acts as both a sensor and actuator. In yet other embodiments, the airway implant device and the sensor are in two or more separate units.
One aspect of the invention is an airway implant device with a sensor for sensing the occurrence of apneic events and actuating the device. The invention also includes methods of use of such device.
One embodiment of an airway implant device with sensor is depicted in
In one embodiment, the operation of the device is as follows:
Typically, an algorithm in the micro-controller controls the actuation of the actuator. An example of the algorithm is—
Complex algorithms, such as adaptive algorithms, can also be used. The objective of the adaptive algorithm can be to selectively control the stiffness of the soft palate by varying the power applied to the airway implant actuator.
Another example of an algorithm to selectively control the stiffness of the soft palate is:
An example of a controller to maintain a predetermined reference gap is shown is
In alternative embodiments, the sensor can be a wall tension sensor, an air pressure sensor, or an air flow monitoring sensor. In another embodiment, instead of fully turning the airway implant actuator on or off, the actual value of the airway gap can be used to selectively apply varying voltage to the airway implant actuator, hence selectively varying the stiffness of the soft palate. In yet another embodiment, if the airway implant actuator exhibits a lack of force retention over an extended period of time under DC voltage, a feedback control algorithm may be implemented in the microcontroller, which uses the sensory information provided by the sensors to control the stiffness of the soft palate by maintaining the force developed by the airway implant actuator.
Another embodiment of the invention is depicted in
Some of the advantages of the use of an airway sensor with an airway implant device include: optimization of the power consumed by the airway implant device and hence extension of the life of the device; assistance in predicting the occurrence of apneic event, and hence selective activation of the device in order to minimize any patient discomfort; flexibility to use a feedback control system if required to compensate for any actuator irregularities; and possible configuration of the system to interact with an online data management system which will store different parameters related to apneic events for a patient. This system can be accessed by the doctor, other health care providers, and the insurance agency which will help them provide better diagnosis and understanding of the patient's condition.
In preferred embodiments, the airway gap is individually calculated and calibrated for each patient. This information can be stored in the microcontroller. The sensors are described herein mainly in the context of airway implant devices comprising of electroactive polymer actuators. The sensors can also be used with airway implant devices comprising other active actuators, i.e., actuators that can be turned on, off, or otherwise be controlled, such as magnets. The sensors can be used to activate, in-activate, and/or modulate magnets used in airway implant devices. Preferably, the sensors are in the form of a strip, but can be any other suitable shape for implantation. They are typically deployed with a needle with the help of a syringe. The sensor can be made with any suitable material. In preferred embodiments, the sensor is a smart material, such as an IPMC. The sensor is typically in connection with a microcontroller, which is preferably located in the retainer. This connection can be either physical or wireless.
Suitable sensors include, but are not limited to, an electroactive polymer like ionic polymer metal composite (IPMC). Suitable materials for IPMC include perfluorinated polymer such as polytetrafluoroethylene, polyfluorosulfonic acid, perfluorosulfonate, and polyvinylidene fluoride. Other suitable polymers include polyethylene, polypropylene, polystyrene, polyaniline, polyacrylonitrile, cellophane, cellulose, regenerated cellulose, cellulose acetate, polysulfone, polyurethane, polyvinyl acetate. Typically, the electroactive polymer element includes a biocompatible conductive material such as platinum, gold, silver, palladium, copper, and/or carbon. Commercially available materials suitable for use as a sensor include Nafion® (made by DuPont), Flemion® (made by Asahi Glass), Neosepta® (made by Astom Corporation), Ionac® (made by Sybron Chemicals Inc),Excellion™ (made by Electropure). Other materials suitable for use as a sensor include materials with piezoelectric properties like piezoceramics, electrostrictive polymers, conducting polymers, materials which change their resistance in response to applied strain or force (strain gauges) and elastomers.
The airway implant devices of the present invention, with or without the sensor, can be used to treat snoring. For snoring, the sensor can be adapted and configured to monitor air passageways so as to detect the possible occurrence of snoring or to detect the possible worsening of ongoing snoring. Preferably the sensors are capable of detecting relaxation of tissues in the throat, which can cause them to vibrate and obstruct the airway. Other tissues that can be monitored by the sensor include the mouth, the soft palate, the uvula, tonsils, and the tongue.
Another disease that can be treated with the devices of the present invention includes apnea. The sensor preferably monitors the throat tissue for sagging and/or relaxation to prevent the occurrence of an apneic event. Other tissues that can be monitored by the sensor include the mouth, the soft palate, the uvula, tonsils, and the tongue.
Another aspect of the invention is directed to a wireless power transfer system in which the non-implanted portion receives electrical power from a charging device.
Non-implanted portion 22 includes a receive (RX) circuit 5308, a transmit circuit 5312, and a power source 5310. Receive circuit 5308 includes a second transducer configured to couple with the electromagnetic field from charging device 5302 and to produce a current for powering the operations of non-implanted portion 22. For example, current induced in receive circuit 5308 as part of the inductive transfer can be used to charge power source 5310. Transmit circuit 5312 provides an inductive power transfer to implant 20 as is generally described in connection with
Advantageously, power source 5310 can be repeatedly charged by receive circuit 5308 and discharged by transmit circuit 5312 in connection with the use of implant 20. Wires and other mechanical connections between non-implanted portion 20 and implant 20 are thereby avoided. In addition, because non-implanted portion 22 has both receive and transmit capabilities, it can communicate with and respond to commands from charging device 5302. In one embodiment, charging device 5302 can collect operating information from non-implanted portion 22 and maintains a log reflecting its usage and condition. Charging device 5302 can, for example, retrieve information about power source 5310 and issue commands to place non-implanted portion 22 into a long-term storage mode in which portions of its transmit and receive circuits 5308, 5310 are deactivated. In some embodiments, charging device 5302 includes a data interface such as a USB connection or serial port through which usage log data is exported for analysis.
Charging device 5400 also includes status indicators 5406. Status indicators 5406 can be light emitting diodes (LEDs), a liquid crystal display, bar graph elements, icons, or the like, which provide operating information to a user. In this exemplary embodiment, three colored LEDs are used to monitor a power transfer from charging device 5302 to the mouthpiece or retainer such as when charging a battery or other power source. A yellow LED, for example, indicates that power is being transferred from charging device 5400 to the retainer, a green LED signifies that the power transfer is complete, and a red LED alerts the user that a fault condition has been detected.
A timer can be used to control the charging duration and to allow for a cooling period when charging is complete. For example, charging device 5400 may be programmed to transfer power to the retainer for approximately eleven hours and to allow approximately one-half hour for cooling. When the cooling period has expired, the green LED may be illuminated to indicate that the retainer is ready for use. Connector 5410 is also shown on the back side of charging device 5400. Connector 5410 supports communication with electronics disposed within housing 5402 and can be used for calibration and/or to access usage data.
Microcontroller 5604 is the nerve center of the charging device and is configured to control its operations. Microcontroller 5604 supplies drive signals to resonator circuit 5606. In one embodiment, charging device 5302 includes an oscillator (not shown) which produces the drive signals. The oscillator may be calibrated before initial use to produce drive signals at the desired frequency. For example, a frequency of the drive signals can be matched to a resonant frequency of the resonator circuit 5606. The drive signals are applied, under control of the microcontroller 5604, to resonator circuit 5606 to start or stop an inductive power transfer. Alternatively, the oscillator can be embedded within microcontroller 5604 such that its frequency is adjusted internally by microcontroller 5604.
Resonator circuit 5606 receives drive signals from microcontroller 5604 and produces a changing electromagnetic field suitable for inductive power transfer. In one embodiment, resonator circuit 5606 includes an inductor 5612 (also “power transmission coil”), a capacitor 5614, and a pair of H-bridge drivers 5610a, 5610b. Current flowing through the inductor 5612 sets up a magnetic field. As the magnetic field collapses, it charges capacitor 5614. Capacitor 5614 stores the energy in an electric field between its plates. Under the influence of H-bridge drivers 5610, current flows back and forth through inductor 5612 and capacitor 5614 generating an expanding and collapsing electromagnetic field. The electromagnetic field, in turn, supports an inductive power transfer from the charging device to the non-implanted portion of the airway implant system. Although one specific resonator circuit 5606 has been described, many alternatives are possible within the scope of the present invention.
Microcontroller 5604 is also configured to detect a proximity of the non-implanted portion to the charging device. In one embodiment, a current monitor 5616 is coupled to resonator circuit 5606. The current monitor 5616 detects a current level of the resonator circuit 5606 and can include, for example, a resistor shunt amplifier. In operation, as the non-implanted portion 22 is placed near to power transmission coil 5612, it affects the coil's magnetic field and current flow in the power transmission coil changes. Current monitor 5616 detects changes in the current flowing through resonator and provides a signal to microcontroller 5604.
Based on the signal from current monitor 5616, microcontroller 5604 determines the proximity of the non-implanted portion 22 to the charging device. For example, if the signal exceeds a first threshold, microcontroller 5604 determines that the mouthpiece or retainer is present and can be charged. Similarly, if the signal drops below a second threshold, microcontroller 5604 determines that the mouthpiece or retainer has been removed and is no longer charging. This information can be communicated to status indicator 5608 and used to signal an operating state of the charging device. For example, if the current flow exceeds the first threshold, microcontroller 5604 can illuminate a yellow or green LED of status indicator 5608, whereas the LEDs may be extinguished if the current flow is below the second threshold. Microcontroller 5604 also includes a communications interface 5618 and a programming interface 5620.
Memory 5712 can include read-only memory (ROM) and random-access memory (RAM). In one embodiment, memory 5712 stores programming instructions as well as calibration and usage data. Programming instructions can be loaded through programming interface 5620 and typically include software for controlling operation of the charging device and for communicating with other devices. For example, programming instructions can provide a command interface for sending usage data and for receiving calibration data through communication port 5618. Also, programming instructions can support a user interface provided by status indicators 5608.
When the non-implanted portion (mouthpiece) is detected, processor 5710 transitions to state S1. This can occur, for example, when inductive power transfer begins and may be detected by a change in current through the power transmission coil. In response, processor 5710 starts a charging timer and illuminates a yellow LED to indicate that the charging device is supplying power to the mouthpiece. In an exemplary embodiment, the timer expires after approximately 11 hours and 20 minutes. Generally speaking, the timer interval corresponds to the charge rate and can vary based upon operational requirements. For example, relatively low charging rates may be preferred to reduce heat and to facilitate the use of low power components in the non-implanted portion, whereas higher charging rates can be utilized if more frequent use of the non-implanted portion is desired.
Upon expiration of the charging timer, processor 5710 transitions to state S2 in which the resonator circuit enters an idle state. During the idle state, for example, processor 5710 periodically activates the resonator circuit to detect the proximity of the mouthpiece. In some embodiments, this periodic checking also serves to reset a timer in the mouthpiece which controls power transfer to the implant. For example, periodic proximity detection by the charging device can reset the timer of a fully-charged mouthpiece such that the mouthpiece does not begin sourcing an inductive power transfer before it is removed from the charger. In state S2, processor 5710 also activates a cooling timer to permit the mouthpiece to cool for a predetermined interval (such as 20 minutes) following charging. The yellow LED remains illuminated during the cooling interval.
When the cooling timer expires, processor 5710 transitions to state S3 which signifies that charging (and cooling) is complete. At this point, the green LED is illuminated and the resonator circuit remains in the idle state. If the mouthpiece is removed at any point during states S1-S3, processor 5710 reverts to state S0 until the mouthpiece is again detected. Also, processor 5710 transitions to state S4 in response to external commands. For example, if the command ‘m’ is received through communications interface 5618, processor 5710 enters a calibration mode. In calibration mode, operational settings such as the drive signal frequency, threshold values for proximity detection, and current date/time information may be entered and stored in memory 5712. If at any point during operation, excessive current levels or bad calibration data is detected, processor 5710 transitions to state S5. In state S5, a fault is indicated by illuminating the red LED and the resonator circuit is disabled.
At step 5904, an entry is added to the event log. In some embodiments, event data is stored in a memory or non-volatile storage device from which it can later be retrieved for analysis. For example, the frequency with which the non-implanted portion 22 is used can be estimated based on the number and frequency of charging events. Similarly, the duration of each use can be estimated based upon the duration of each charging event. Typically, events stored in the event log are time stamped such as with the output of a real-time clock. Thus, when the presence of the mouthpiece is detected, an arrival event stamped with the current time is added to the event log.
After logging the arrival event, the charging device queries the mouthpiece or retainer 5906 for status information. In one embodiment, the charging device communicates with the retainer or mouthpiece using a type of on-off keying. For example, when processor 5710 detects that the mouthpiece is near to the power transmission coil, it toggles the resonator circuit on and off at predetermined intervals representing a status-query command. The processor 5710 then waits for a response to the query and, at step 5908, records status information received from the mouthpiece portion in the event log. By way of illustration, the mouthpiece may transmit a voltage level of its internal battery to the charging device. The voltage level can be compared to the rate at which a mouthpiece battery is discharged during normal operation and can thus provide a usage estimate. Similarly, abnormal voltage levels can provide an alert that the mouthpiece may need service.
When communication with the mouthpiece is complete, at step 5910, inductive power transfer begins. At step 5912, removal of the mouthpiece from the charging device is detected. This can occur, for example, when processor 5710 transitions from state S2 to state S3 or when the mouthpiece is removed before charging is complete. In one embodiment, the charging device periodically queries the mouthpiece for status information and stops charging when it is determined that the mouthpiece battery is fully charged. At step 5914, an entry in the event log is added when charging is complete or the mouthpiece has been removed. Final status information, if available, may also be added to the event log.
In an alternative embodiment, the separate RX and TX coils shown in
RX circuit 6202 is coupled to charge controller 6204 and microprocessor 6206. Charge controller 6204 receives the DC voltage from RX circuit 6202 and delivers a charging current to battery 6208. Charge controller 6204 also monitors the health of battery 6208 and provides status information to microprocessor 6206. For example, charge controller 6204 can protect battery 6208 from over-voltage conditions by limiting the voltage at its output to a predetermined level. Charge controller 6204 can also protect against battery failure or low-voltage conditions by providing a trickle-charge in which current flow is greatly reduced. Additionally, charge controller 6204 can monitor and report the temperature of battery 6208 to microprocessor 6206.
In one embodiment, charge controller 6204 is configured to provide a constant-current (CC), constant-voltage (CV) charge to battery 6208. For example, battery 6208 can be a lithium polymer cell with an operational range of about 3.0-4.2 volts. During a constant-current portion of the charge cycle, current is delivered to battery 6208 at a more or less constant rate thereby increasing the voltage across its terminals. CC charging is shown in
Microprocessor 6206 controls the operation of the non-implanted portion and can included embedded peripherals similar to those discussed with microcontroller 5604. When charging battery 6208, microprocessor 6206 can monitor the status information received from charger controller 6204 and can deactivate parts of the non-implanted portion if problems are detected. For example, microprocessor 6206 can monitor current levels through a pickup coil in RX circuit 6202 and can decouple charge controller 6204 from the RX circuit 6202 if an excessive current is detected. Also, microprocessor 6206 can halt charging based upon a voltage level or temperature of battery 6208 and can deenergize TX circuit 6212 if it is determined that battery 6208 can no longer support a minimum transmit power.
Microprocessor 6206 also controls TX circuit 6212 and can communicate status information. Status information, for example, can include data such as a charging voltage or current levels in addition to a voltage of battery 6208 and current transmit power settings of the non-implanted portion. In one embodiment, microcontroller 6206 detects a command from an external device (such as charging device 5302) and responds by transmitting one or more pieces of status information. Commands from the external device can also be used to place the non-implanted portion into a long-term storage mode.
Commands from the external device and responses to such commands may be communicated via TX circuit 6212 using frequency modulation, amplitude modulation, on-off keying, and other techniques as known in the relevant art. In this way, battery 6208 is wirelessly charged and the non-implanted portion provides status information which can be logged and analyzed as described herein. Microprocessor 6206 can also provide a timer function as discussed in connection with
Power adjustment block 6210 cooperates with microprocessor 6206 to control power transferred to the implant. In one embodiment, power adjustment block 6210 includes an RDAC (digital potentiometer) the setting of which is varied by microprocessor 6206 to maintain a steady voltage at the implant device. For example, an offset can exist between the mouthpiece or retainer and the implant. During calibration, an initial RDAC value can be established so that, for example, sufficient power is transferred from TX circuit 6212 to support operation of the implant. In one exemplary embodiment, calibration is based upon a separation distance of approximately 2 mm and the RDAC setting is chosen to support a target voltage of about 1.9V at the implant.
The offset can vary somewhat relative to the value establishing during calibration. In particular, the distance between a power transmission coil of TX circuit 6212 and a pickup coil of the implant may differ from calibration estimates. To compensate for such differences, microprocessor 6206 measures a current flow in TX circuit 6212 and delivers a control signal to power adjustment block 6210. The measured current, for example, provides an indication of the power supplied to the implant.
In one embodiment, power adjustment block 6210 includes a monitor circuit such as current monitor 5616 and operates to maintain a steady voltage at the implant independent of the battery 6208 voltage. In a manner similar to that described in
TX circuit 6212 receives power from battery 6208 and provides an inductive power transfer to the implant. In one embodiment, TX circuit 6212 includes a resonator circuit similar to resonator 5606. Specifically, transmit circuit 6212 can include a pair of H-bridge drivers, a power transmission coil, and a capacitor configured to resonate and to support an inductive coupling with the implant. Microprocessor 6206 activates and deactivates TX circuit 6212 and controls its output via power adjustment block 6210. Although described separately, it will be recognized that the functions of TX circuit 6212 and power adjustment block 6210 may be combined and that both may be supported by peripherals such as an oscillator, analog-to-digital converter, and current sensor, either embedded in or separate from microprocessor 6206.
The implants described herein are preferably implanted with a deployment tool. Typically, the implantation involves an incision, surgical cavitation, and/or affixing the implant.
In some embodiments, the EAP element is an IPMC strip which is made from a base material of an ionomer sheet, film or membrane. The ionomer sheet is formed using ionomer dispersion.
IPMC is made from the base ionomer of, for example, polyethylene, polystyrene, polytetrafluoroethylene, polyvinylidene fluoride (PVDF) (e.g., KYNAR® and KYNAR Flex®, from ATOFINA, Paris, France, and SOLEF®, from Solvay Solexis S. A., Brussels, Belgium), hydrophilic-PVDF (h-PVDF), polyfluorosulfonic acid based membranes like NAFION® (from E.I. Du Point de Nemours and Company, Wilmington, Del.), polyaniline, polyacrylonitrile, cellulose, cellulose acetates, regenerated cellulose, polysulfone, polyurethane, and combinations thereof. The conductive material that is deposited on the ionomer can be gold, platinum, silver, palladium, copper, graphite, conductive carbon, or combinations thereof. Conductive material is deposited on the ionomer either by electrolysis process, vapor deposition, sputtering, electroplating, or combination of processes.
The IPMC is cut into the desired implant shape for the EAP element. The electrical contact (e.g., anode and cathode wires for EAP element) is connected to the IPMC surfaces by, for example, soldering, welding, brazing, potting using conductive adhesives, or combinations thereof. The EAP element is configured, if necessary, into specific curved shapes using mold and heat setting processes.
In some embodiments, the EAP element is insulated with electrical insulation coatings. Also, the EAP element can be insulated with coatings that promote cell growth and minimize fibrosis, stop cell growth, or kill nearby cells. The insulation can be a biocompatible material. The EAP element is coated with polymers such as polypropylene, poly-L-lysine, poly-D-lysine, polyethylene glycol, polyvinyl alcohol, polyvinyl acetate, polymethyl methacrylate, or combinations thereof. The EAP element can also be coated with hyaluronic acid. The coating is applied to the device by standard coating techniques like spraying, electrostatic spraying, brushing, vapor deposition, dipping, etc.
In one example, a perfluorosulfonate ionomer, PVDF or h-PVDF sheet is prepared for manufacturing the EAP element. In an optional step, the sheet is roughened on both sides using, for example, about 320 grit sand paper and then about 600 grit sand paper; then rinsed with deionized water; then submerged in isopropyl alcohol (IPA); subjected to an ultrasonic bath for about 10 minutes; and then the sheet is rinsed with deionized water. The sheet is boiled for about 30 minutes in hydrochloric acid (HCL). The sheet is rinsed and then boiled in deionized water for about 30 minutes. The sheet is then subject to ion-exchange (i.e., absorption). The sheet is submerged into, or otherwise exposed to, a metal salt solution at room temperature for more than about three hours. Examples of the metal salt solution are tetraammineplatinum chloride solution, silver chloride solution, hydrogen tetrachloroaurate, tetraamminepalladium chloride monohydrate or other platinum, gold, silver, carbon, copper, or palladium salts in solution. The metal salt solution typically has a concentration of greater than or equal to about 200 mg/100 ml water. 5% ammonium hydroxide solution is added at a ratio of 2.5 ml/100 ml to the tetraammineplatinum chloride solution to neutralize the solution. The sheet is then rinsed with deionized water. Primary plating is then applied to the sheet. The sheet is submerged in water at about 40° C. 5% solution by weight of sodium borohydride and deionized water is added to the water submerging the sheet at 2 ml/180 ml of water. The solution is stirred for 30 minutes at 40° C. The sodium borohydride solution is then added to the water at 2 ml/180 ml of water and the solution is stirred for 30 minutes at 40° C. This sodium borohydride adding and solution stirring is performed six times total. The water temperature is then gradually raised to 60° C. 20 ml of the sodium borohydride solution is then added to the water. The solution is stirred for about 90 minutes. The sheet is then rinsed with deionized water, submerged into 0.1N HCl for an hour, and then rinsed with deionized water.
In some embodiments, the sheet receives second plating. The sheet is submerged or otherwise exposed to a tetraammineplatinum chloride solution at a concentration of about 50 mg/100 ml deionized water. 5% ammonium hydroxide solution is added at a rate of 2 ml/100 ml of tetrammineplatinum chloride solution. 5% by volume solution of hydroxylamine hydrochloride in deionized water is added to the tetraammineplantium chloride solution at a ratio of 0.1 of the volume of the tetraammineplatinum chloride solution. 20% by volume solution of hydrazine monohydrate in deionized water is added to the tetraammineplatinum chloride solution at a ratio of 0.05 of the volume of the tetraammineplantinum chloride solution. The temperature is then set to about 40° C. and the solution is stirred.
A 5% solution of hydroxylamine hydrochloride is then added at a ratio of 2.5 ml/100 ml of tetraammineplatinum chloride solution. A 20% solution of hydrazine monohydrate solution is then added at a ratio of 1.25 ml/100 ml tetraammineplatinum chloride solution. The solution is stirred for 30 minutes and the temperature set to 60° C. The above steps in this paragraph can be repeated three additional times. The sheet is then rinsed with deionized water, boiled in HCl for 10 minutes, rinsed with deionized water and dried.
In some embodiments, the polymer base is dissolved in solvents, for example dimethyl acetamide, acetone, methylethyle ketone, toluene, dimethyl carbonate, diethyl carbonate, and combinations thereof. The solvent is then allowed to dry, producing a thin film. While the solution is wet, a low friction, (e.g., glass, Teflon) plate is dipped into the solution and removed. The coating on the plate dries, creating a think film. The plate is repeatedly dipped into the solution to increase the thickness of the film.
Polyvinyl alcohol, polyvinyl pyrrolidone, polyinyl acetate or combinations thereof can be added to a PVDF solution before drying, thus contributing hydrophilic properties to PVDF and can improve ion migration through the polymer film during manufacture. Dye or other color pigments can be added to the polymer solution.
During sleep, the muscles in the roof of the mouth (soft palate), tongue and throat relax. If the tissues in the throat relax enough, they vibrate and may partially obstruct the airway. The more narrowed the airway, the more forceful the airflow becomes. Tissue vibration increases, and snoring grows louder. Having a low, thick soft palate or enlarged tonsils or tissues in the back of the throat (adenoids) can narrow the airway. Likewise, if the triangular piece of tissue hanging from the soft palate (uvula) is elongated, airflow can be obstructed and vibration increased. Being overweight contributes to narrowing of throat tissues. Chronic nasal congestion or a crooked partition between the nostrils (deviated nasal septum) may be to blame.
Snoring may also be associated with sleep apnea. In this serious condition, excessive sagging of throat tissues causes your airway to collapse, preventing breathing. Sleep apnea generally breaks up loud snoring with 10 seconds or more of silence. Eventually, the lack of oxygen and an increase in carbon dioxide signal causes the person to wake up, forcing the airway open with a loud snort.
Obstructive sleep apnea occurs when the muscles in the back of the throat relax. These muscles support the soft palate, uvula, tonsils and tongue. When the muscles relax, the airway is narrowed or closed during breathing in, and breathing is momentarily cut off. This lowers the level of oxygen in the blood. The brain senses this decrease and briefly rouses the person from sleep so that the airway can be reopened. Typically, this awakening is so brief that it cannot be remembered. Central sleep apnea, which is far less common, occurs when the brain fails to transmit signals to the breathing muscles.
Thus, it can be seen that airway disorders, such as sleep apnea and snoring, are caused by improper opening of the airway passageways. The devices and methods described herein are suitable for the treatment of disorders caused by the improper opening of the air passageways. The devices can be implanted in any suitable location such as to open up the airways. The opening of the passageways need not be a complete opening and in some conditions a partial opening is sufficient to treat the disorder.
In addition to air passageway disorders, the implants disclosed herein are suitable for use in other disorders. The disorders treated with the devices include those that are caused by improper opening and/or closing of passageways in the body, such as various locations of the gastro-intestinal tract or blood vessels. The implantation of the devices are suitable for supporting walls of passageways The devices can be implanted in the walls of the gastro-intestinal tract, such as the esophagus to treat acid reflux. The gastro-intestinal tract or blood vessel devices can be used in combination with the sensors described above. Also, the implants and/or sphincters can be used for disorders of fecal and urinary sphincters. Further, the implants of said invention can be tailored for specific patient needs.
It is apparent to one skilled in the art that various changes and modifications can be made to this disclosure, and equivalents employed, without departing from the spirit and scope of the invention. Elements shown with any embodiment are exemplary for the specific embodiment and can be used on other embodiments within this disclosure.
This application is a continuation in part of U.S. patent application Ser. No. 11/613,027 (atty. docket no. 026705-000312) filed Dec. 19, 2006 which is a continuation in part of U.S. patent application Ser. Nos. 10/946,435, filed Sep. 21, 2004, 11/233,493 filed Sep. 21, 2005, and 11/355,927 filed Feb. 15, 2006, all of which are incorporated herein by reference in their entirety.
Number | Date | Country | |
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Parent | 11613027 | Dec 2006 | US |
Child | 12192924 | US | |
Parent | 11355927 | Feb 2006 | US |
Child | 11613027 | US | |
Parent | 11233493 | Sep 2005 | US |
Child | 11355927 | US | |
Parent | 10946435 | Sep 2004 | US |
Child | 11233493 | US |