None.
Obstructive sleep apnea is characterized by episodes of partial or complete nasopharyngeal obstruction during sleep. The term apnea is defined as the cessation of air flow for a minimum of 10 seconds. These periods of apnea are frequently associated with sleep fragmentation and a drop in oxygen saturation. The term hypopnea is defined as a 30 to 50% reduction in airflow for a minimum of 10 seconds. Both apnea and hypopnea cause respiratory effort-related arousals and disordered sleep. When these apneras and hpopneas are combined with symptoms such as daytime somnolence, the terms obstructive sleep apnea-hypopnea syndrome or obstructive sleep apnea are utilized. These episodes of apnea and hypopnea lead to daytime sleepiness and other pathological manifestations including stroke, cardiac arrhythmias, hypertension, sudden death, psychological syndromes, depression, hyperactivity, and others.
The upper airway resistance syndrome is a breathing disorder during sleep in which there is increased breathing effort during periods of increased upper airway resistance not resulting in apneas or hypopnic episodes. These patients however experience daytime somnolence as well.
Epidemiologically, it has been estimated that 5% of the adult population under 60 years old meet the criteria of obstructive sleep apnea syndrome. It is even more common in the elderly, and with the “graying of America,” the incidence is certainly going to increase. Snoring is a sleep related breathing disorder estimated to affect 10-86% of the population and can be related to OSA syndrome. More commonly, it causes nighttime awakenings and daytime somnolence in the sleep partner. Increased incidence of automobile accidents has been found in sleep partners of snorers, as well as diminished job productivity. It has been estimated that up to 30 million individuals in the U.S. suffer from some form of OSA syndrome, upper airway resistance syndrome, problematic snoring, and other sleep related breathing disorders.
Treatment of these disorders has been varied, mainly due to either the lack of success and the lack of compliance. An effective treatment is continuous positive airway pressure (“CPAP”), which is administered by means of nasal mask. Room air is pressurized by a mechanical device and forced into the nasal passageway. This distends the tissues in the upper airway and overcomes the obstruction, providing for patency. While advancements have been made to improve the comfort and sealing of the device, poor acceptance and compliance have limited its utility.
Surgical techniques have been utilized, but are invasive and are effective in a minority of patients. Oral appliances and retention devices have also been utilized, but with very limited success. Insertion of nasophanyngeal tubes has resulted in effective treatment of the OSA episodes and diminished daytime somnolence. They are impractical as they are rigid, uncomfortable, and need to be inserted by a medical professional, not the patient. Zammit, in U.S. Pat. No. 6,328,753, describes a novel nasopharyngeal tube which is collapsible for insertion, and subsequently expanded. While an improvement, it too has limitations, as it eliminates the moistening effect on inhaled air normally provided by the nasal mucosa. The contact of the plastic with large areas of mucosa may cause irritation, inflammation, and further mucosal edema limiting long-term compliance. It also suffers from the lack of a small delivery device.
The present invention relates to medical devices and their methods of use. More specifically, one aspect of the present invention relates to devices which are particularly useful for repairing and/or serving as a conduit for body passageways requiring reinforcement, dilatation, disease prevention or the like. The present invention may provide temporary patency of the upper airway for breathing disorders, sleep apnea, and other obstructions of the nasoppharyneal region. Another aspect of the invention relates to the delivery of a therapy, that therapy being from a family of devices, drugs, or any of a variety of other elements, to a specific location within the body. More specifically, the therapy may be directed to systemic uptake through the nasal mucosa or along a path extending from the nasal cavity to the lungs. A further aspect of the invention may be used as a nasal filter to remove pollen, or other unwanted particulate matter, and non-particulate substances, such as noxious or unhealthy chemical compounds, bacteria and viruses, from the inhaled air.
A first aspect of the invention is directed to a device for maintaining the patency of a user's upper airway. The device includes a radially expandable and contractible tubular support element, having proximal and distal ends and means for selectively placing the tubular support element in a radially contracted condition and a radially expanded condition. The support element is sized to pass through the nostril and into the user's upper airway for positioning within the upper airway when in the radially contracted condition. The support element creates an air passageway through the support element between the proximal and distal ends when in the radially expanded condition.
A second aspect of the invention is directed to a method for maintaining the patency of a user's upper airway. A radially expandable and contractible tubular support element, having proximal and distal ends, is placed through a nostril and into the user's upper airway. The support element is positioned within the user's upper airway. The support element is radially expanded thereby creating an air passageway within the support element between the proximal and distal ends. The support element is radially contracted and the radially contracted support element is removed through the nostril.
A third aspect of the invention is directed to a device for filtering air passing through a user's upper airway. The device includes a radially expandable and contractible tubular element having proximal and distal ends. The tubular element is sized to pass through a nostril and into the user's upper airway to be positioned at a desired location within the user's upper airway so that when the tubular element is radially expanded, an air passageway is created within the support element between the proximal and distal ends. The tubular element comprises a porous filter section extending at least partially across the air passageway so to filter air passing through the air passageway.
A fourth aspect of the invention is directed to a method for filtering air passing through a user's upper airway. A radially expandable and contractible tubular element having proximal and distal ends is selected. The tubular element through a nostril and into the user's upper airway and is positioned at a desired location within the user's upper airway. The tubular element is radially expanded thereby creating an air passageway within the tubular element between the proximal and distal ends. Air passing through the air passageway is filtered.
A fifth aspect of the invention is directed to device for delivering an agent to tissue of a user. The device includes a radially expandable tubular element having proximal and distal ends. The tubular element is sized to pass through a nostril and into the user's upper airway to be positioned at a desired location within the user's upper airway so that when the tubular element is radially expanded, an air passageway is created within the support element between the proximal and distal ends. The tubular element comprises a body material and an agent releasable from the body material when the tubular element is radially expanded.
A sixth aspect of the invention is directed to a method for delivering an agent to tissue of a user. A radially expandable tubular element having proximal and distal ends is selected. The tubular element is placed through a nostril and into the user's upper airway. The tubular element is positioned at a desired location within the user's upper airway. The tubular element is radially expanded thereby creating an air passageway within the tubular element between the proximal and distal ends. The tubular element is chosen to include a body material and an agent releasable from the body material. The agent is released for delivery to tissue of the user.
One of the advantages of the invention is that it is simple in construction and can be made at a reasonable cost. This is important because even if the invention performs a function in some improved manner, it will not be widely used if it is considerably more costly than the alternatives available. Another advantage is that it is simple to use and in a very real sense simple to understand. This will encourage its adoption and use by patients and medical personnel. It will also tend to keep cost low. A further advantage is that the procedure for use is simple so that the device and procedure may be self administered by the patient.
Other features and advantages of the invention will appear from the following description in which the preferred embodiments have been set forth in detail in conjunction with the accompanying drawings.
Tubular support element 6 is preferably formed as a mesh of individual non-elastic filaments (called “yarns” in the braiding industry). However, it can have some elastic filaments interwoven to create certain characteristics. The non-elastic yarns can be materials such as polyester, PET, polypropylene, polyamide fiber (Kevlar, DuPont), composite filament wound polymer, extruded polymer tubing (such as Nylon II or Ultem, commercially available from General Electric), stainless steel, Nickel Titanium (Nitinol), or the like so that axial shortening causes radial expansion of the braid. These materials have sufficient strength so that support element 6 will retain its expanded condition in the lumen of the body while positioned to maintain the airway. Further, all expandable mechanisms described heretofore can be manufactured using shape memory materials so that they are self expanding or even expandable when certain temperatures or thermal energies are delivered to the mechanisms. Such material characteristics can be accomplished with different programming methods such as, but not limited to Two Way Shape Memory (TWSM) alloys.
Support element 6 may be of conventional construction, comprising round filaments, flat or ribbon filaments, square filaments, or the like. Non-round filaments may be advantageous to decrease the axial force required for expansion to create a preferred surface area configuration or to decrease the wall thickness of the tubular braid. The filament width or diameter will typically be from about 0.5 to 50 mils, usually being from about 5 to 20 mils. Suitable braids are commercially available from a variety of commercial suppliers.
In a preferred embodiment, the filaments of support element 6 may be of a material that has physical properties that prevent the collapse of the nasopharyngeal tissues. They may contain a hydrophilic coating to prevent tissue damage and provide for comfort. Any one of a number of commercially available materials are available for this use.
To remove support element 6 from upper airway 14, the patient simply places sheath 4 over support element 6 and advances sheath 4 over support element 6. With traction on support element 6 and continued advancement of sheath 4, support element 6 will collapse into sheath 4 (be retracted into it) so that it is fully contained within. Device 2 is then removed from nostril 16. Insertion typically takes place before the user's sleep cycle while removal typically takes place after the user's sleep cycle.
The remaining figures describe additional embodiments of the invention with like reference numerals referring to like elements. An upper airway device 22, including a tubular element 24, is shown in its relaxed, radially expanded condition in
As indicated in
Tubular element 24 and/or porous filter section 28 may comprise an agent. The agent may include one or more of a for example, a drug therapy agent or a gene therapy agent. The agent may be of a type that is release directly to the tissue being contacted by tubular element 24. In addition, the agent may be of the type that is carried with the air passing along air passageway 8 for delivery to tissue at one or more locations located along a path extending from nasal cavity 17 to the user's lungs. The agent may also be of both types.
In some situations, especially when the purpose is to filter air and/or deliver an agent, it may not be necessary to have the tubular element extend from nostril 16 to positions 18, 20. For example, a tubular element similar to tubular element 24 of
Porous filter sections 28, 48 are shown located at the distal end of the tubular element. However, a filtering device may be located anywhere in the upper airway; for example, the filtering device may be very close to the nostril or anywhere else along the airway. The filter element may be a smaller than those shown or of other shapes, such as spherical, conical, bell-shaped, goblet shaped, etc., as opposed to the shapes of filter sections 28, 48 shown in the figures. The filtering device may also contain a one-way valve in it so that when the person exhales through the upper airway, the valve opens to allow the expelled air to escape easily and not requiring it to pass through the filtering element. These one-way valves are commonly known to those normally skilled in the art such as, but not limited to a duck valve, flapper valve, etc. For example, the narrowed distal end 12 of tubular element 24 of
The various upper airway devices discussed above are designed to maintain patency (that is, an open airway), filter air, treat air and deliver agents. While the various embodiment discussed above have been described as typically accomplishing one or two of these functions, devices made according to the invention can be constructed to accomplish one, some or all of these functions.
If designed for systemic use, the tubular element may be configured so that it is placed only within the nose, and does not primarily act as a splint for the airway. An embodiment of the tubular element for systemic delivery of therapy via the nasal mucosa may be a disposable single use item containing a specific amount of drug or other therapy, which may be placed in the nostril for a specific time. Alternatively, the tubular element may be soaked in a solution of a drug or therapy before administration. The tubular element may be used for slow infusion of a therapy for absorption by the nasal mucosa. One aim is to maximize efficacy and cost-effectiveness by developing tubular elements that consistently deliver the right amount of drug to the right part of the nasal cavity. When the tubular element is designed to reside completely within nasal cavity 17, the device may be designed to be easily retrievable, such as through the use of a retrieval string extending from proximal end 10 through nostril 16. The device may be designed to remain within the upper airway permanently or semi-permanently or to be retrievable by medical personnel and also may be designed to be bioabsorable or biodegradable.
The tubular element may be constructed to facilitate electrical stimulation, iontophoresis, delivery of radiowaves and other forms of electromagnetic energy, vibratory and mechanical energy delivery, or radiation. The shape and size of the tubular mesh braid or other porous tubular element may vary to accommodate different anatomy. Additional embodiments may be used with other modalities, i.e., CPAP, to treat sleep apnea. Portions of the porous tubular element may be covered with a membrane to prevent positive airway pressure from negatively affecting the sinuses.
Still further embodiments consist of an expandable endotracheal or nasotracheal tube. A flexible and expandable nasogastric tube also may be created in a similar manner.
Proximal end 10 of the tubular element of may be enlarged or otherwise configured to help prevent the proximal end of the tubular element from entering nasal cavity 17. A retention device (not shown) may comprise a tether, which is attached to proximal end 10 of the tubular element and draped to the sides, below the ears and around the neck. This would prevent the tubular element from being dislodged into the hypophanynx and causing obstructive problems. Another configuration (not shown) may be to extend the tubular mesh braid from the pharynx, through the nostril and nares so that the external end is externalized. The flaring of the mesh braid external to the nares will serve as a tether to keep the device in place. In fact, the mesh braid may be formed so that the external flaring actually folds comfortably over the nose in a low profile manner, essentially creating a nose mask. Still another configuration (not shown) may be to place the external end of the mesh braid into tension. This would collapse the tubular structure into a string like structure. By adding any one of a number of substances to it, the extended or collapsed configuration may be maintained by essentially gluing the filaments together. This would create a mandrel for pushing the mesh braid from the catheter for deployment, for securing it in place during deployment, and for retrieval after use. Other retention devices (not shown) may include a modified V-clip, an adhesive strip, or other means of securing the device.
Other modification and variation can be made to the disclosed embodiments without departing from the subject of the invention as defined in following claims. For example, the tubular element may include a multiple filter sections 28; some or all of the filter sections may be made, for example, as funnel-shaped tubular braided filter sections similar to that shown in
Any and all patents, patent applications and printed publications referred to above are incorporated by reference.
This application is a divisional of U.S. patent application Ser. No. 10/423,068, filed 25 Apr. 2003, which claims the benefit of U.S. Provisional Patent Application No. 60/377,951 filed 2 May 2002 and U.S. Provisional Patent Application No. 60/435,125 filed 18 Dec. 2002. See also: U.S. Pat. No. 6,450,989; U.S. Pat. No. 6,258,115; U.S. patent application Ser. No. 10/051,848 filed Jan. 17, 2002 entitled “Particle removing medical device and method,” published on 31 Oct. 2002 as Publication No. US-2002-0161392-A1.
Number | Date | Country | |
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60377951 | May 2002 | US | |
60435125 | Dec 2002 | US |
Number | Date | Country | |
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Parent | 10423068 | Apr 2003 | US |
Child | 11692082 | Mar 2007 | US |