Overview

This is a prospective, multicenter, non-randomized single-arm safety and performance study to collect data to evaluate the safety of the Cryosa procedure to treat obstructive sleep apnea (OSA) in patients with moderate to severe OSA. The study will also evaluate the chronic performance of the Cryosa system and collect clinical measures for therapy effectiveness that will be used to demonstrate safety and effectiveness in the next clinical study.

Eligibility

Inclusion Criteria:

1. To participate in this study, the subject must meet ALL of the following inclusion

   criteria

2. Age 22 - 70 years
3. Not able to use, refuse to use or intolerant of Positive Airway Pressure (PAP) or Mandibular Advancement Device (MAD) if using, must be < 4 hours per night, < 5 days/week.
4. Failed, are not candidates for, or have refused other invasive procedures such as hypoglossal nerve stimulation or pharmacotherapy for the primary treatment of OSA such as Tirzepatide.

ARCTIC-3, Protocol 11515 Page 75 of 78 5. BMI ≥30 or ≤ 40 kg/m2 at enrollment 6. AHI ≥30 at enrollment based on in-lab polysomnography study OR AHI ≥ 15 and BMI of ≥ 30 at enrollment based on in-lab polysomnography study Is geographically stable and in close proximity to the site 7. Able and willing to provide written consent to participate in the study

Exclusion Criteria:

1. Contraindication to general anesthesia or in the opinion of the Investigator would not be able to tolerate the procedure, including intubation during the procedure or in response to an adverse event
2. Actively taking ACEs/ARBs
3. Actively undergoing immunotherapy (Allergy shots)*, or unwilling to washout of allergy shots at least 2 weeks prior to study procedure.
   • Patients receiving immunotherapy may be eligible if they undergo a 2-week wash-out prior to the study procedure
4. Severe uncontrolled asthma
5. Severe maxillary mandibular insufficiency that in the opinion of the investigator thought to be the primary cause of OSA
6. Obvious severe fixed upper airway obstructions (tumors, polyps, nasal obstruction)
7. Previous surgery within 12 weeks of scheduled procedure performed on the soft tissue of the upper airway (e.g., uvula, soft palate, or tonsils).
8. Oral cancer or non-healing oral wounds
9. Prior sleep surgeries, including tongue base reduction, UPPP and hypoglossal nerve stimulation.
10. History of radiation therapy to neck or upper respiratory tract
11. Surgical resection for cancer or congenital malformations in the larynx, tongue, or throat (with exception of tonsillectomy and/or adenoidectomy)
12. History presence of cold urticaria at the time of screening History of cryoglobulinemia
13. History of allergy to glycerin
14. History of hospitalization with mechanical ventilation due to COVID-19 per investigator discretion
15. Resistant hypertension defined as a blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes taken at maximally tolerated doses
16. Patients with diagnosed autoimmune disorders including thyroid disease, lupus, multiple myeloma, chronic lymphocytic leukemia
17. Neuromuscular disease or other neurologic deficits (for example multiple sclerosis, muscular dystrophy, Parkinson's disease, transient ischemic attack, epilepsy or cerebrovascular accident)
18. Diagnosis of any moderate to severe congestive obstructive pulmonary disease (COPD)
19. Active, severe pulmonary vascular disease (for example pulmonary arterial hypertension or pulmonary embolism) History of angioedema of the airway
20. Hereditary angioedema and other autoimmune disorders that could lead to acquired angioedema - confirmed with a compliment component C4 blood test <13mg/dL.
21. Uncontrolled Diabetes (including Diabetes Mellitus [DM] or Insulin Dependent Diabetes Mellitus [IDDM]) with HbA1c >9.
22. Currently receiving treatment for severe cardiac valvular dysfunction, NYHA Class III or IV heart failure, unstable angina or recent (< 12 months) myocardial infarction or severe cardiac arrhythmias
23. Subjects with bleeding event, known bleeding diathesis, impaired immunity for any reason, or heart attack or stroke within the last 12 months
24. Clinical evidence of severe renal failure (Stage 4 or 5) undergoing dialysis or expected to institute dialysis within 6 months
25. History or current clinical evidence of TIA or stroke or muscular dysfunction
26. Current smoker (≥ 1 pack/day)
27. Presence of occupational shift work or anticipation of shift changes during the next 2 years
28. Subject has sleep hygiene behavior that is likely to interfere with measurement outcomes during PSG and/or HSAT
29. Known active substance use disorder
30. Other severe sleep disorders that in the opinion of the investigator, confound functional assessments of sleepiness such as narcolepsy with cataplexy, severe insomnia/insomnia secondary to chronic pain, PTSD
31. Patients taking any of the following medication that could affect study endpoints: benzodiazepines, Z-drugs (zolpidem and eszopiclone) opiates, antipsychotics (neuroleptics), phenothiazines, and prescription stimulants (including Sunosi, Provigil, and Nuvigil)
32. Active psychiatric disease (psychotic illness, major depression, or acute anxiety attacks) which prevents subject's ability to meet study requirements and ability to provide study consent
33. Females who are pregnant or females of childbearing age with intention to become pregnant during the study period (≤ 3 months from treatment date)
34. Any other reason the investigator deems subject is unfit for participation in the study
35. Subject currently participating in other premarket investigational studies unless approved by Sponsor in writing