Description

PURPOSE To evaluate the efficacy of the non-invasive Alesis Low-Level Light Therapy (LLLT) medical device in treating obstructive sleep apnea (OSA) by assessing changes in upper airway fat deposits via. Magnetic resonance imaging (MRI) after treatments; Apnea-Hypopnea Index (AHI) events; and STOP-BANG scores pre- and post-treatment; determining its potential to reduce fat and improve airway patency in adults with mild to severe OSA.

OBJECTIVES

• To evaluate changes in the size of the tongue and soft tissue structures in obese subjects diagnosed with obstructive sleep apnea (OSA).
• To assess improvements in the Apnea-Hypopnea Index (AHI) following treatment with the Alesis Airway LLT Modification Device.

STUDY DESIGN

• Type: Prospective, repeated measures, double blind, randomized controlled trial
• Participants: N = 70 for original study, N = 5-10 MRI subset, N = 35 for ethical consideration offering (See Ethics considerations)
• Sampling Method: Volunteer convenience sample
• Duration: 6 months
• Special subset A: A subset of 3-10 participants will undergo a MRI evaluation to measure submental and tongue fat size, pre- and post-treatment (Reference: Schwab, et al. 2014, Tongue fat and OSA relationship)
• Repeated Measures: Post-Treatment HST week 2, week 3

PARTICIPANTS Inclusion Criteria

• Suspicion of OSA
• STOP BANG score of 3 or greater (See STOP BANG CRITERIA)
• Age ≥ 18 years - 70
• Obese (BMI ≥ 25) Exclusion Criteria
• Beards - beard
• Central Sleep Apnea
• Inability to hold mouth open 12 minutes
• Age > 75/ < 18
• Severe comorbid conditions that may affect treatment or inability to lie flat or sit for 20 minutes (e.g., severe cardiac disease, uncontrolled diabetes)
• Contraindications to MRI (e.g., non-MRI-compatible pacemakers).
• History of recent upper airway surgery.
• Active cancer or cancer treatment completion within 1 year

DEMOGRAPHICS & COMORBIDITIES

• Demographics
• Participants Identifier Number
• Age•
• Sex
• Height
• Weight
• BMI
• Significant Comorbidities (e.g., diabetes, hypertension, cardiac disease, kidney disease, memory issues, narcolepsy)
• Comorbidities: Although not exclusion criteria, document significant medical history, including:
• Diabetes
• Hypertension
• Cardiac disease
• Kidney disease
• Memory loss or cognitive issues
• Narcolepsy
• Other relevant conditions
• Medication use contraindicated on consent

TREATMENT PROTOCOL & INTERVENTION

• Device: Alesis OSA-1
• Pre-Admission Steps
• Basic health history
• Qualitative survey for participants for anecdotal data and quotes
• STOP BANG assessment (Score of ≥ 3 )
• Consent to treat and Informed consent for study participation
• Pre-Treatment Steps
• Randomization into treatment and control groups using alternative numbering system
• Baseline height and weight
• Baseline physical measurements per tape measure on neck circumference included in the STOP BANG
• Baseline AHI Study using WatchPat device
• 3D Imaging of treatment area
• SUBSET A: 5 participants will get baseline MRI
• Measure tongue adipose, size, and structure shape
• Measure submental tissue size
• SUBSET B: 10 randomly selected participants will get pre and post

Session Details

• Duration: 12 minutes per treatment session -Facing front with mouth open
• LLLT 5 cm from face/neck
• Goggles for eye protection
• Frequency: 6 sessions over a set period (e.g., 3 weeks), 2 x week x 3 weeks
• Control group will receive light therapy with a sham connector between the control console and light/arm assembly, that operates the cooling fans with the 635nm light off in order to mimic invisible light.

Post-Treatment Steps:

• After the last treatment in week 3: Post treatment AHI test, Weight, STOP BANG score, neck circumference measurement, and qualitative questionnaire 5 questions.
• After week 3 and last week of treatment - 3D Imaging will be completed using the Vector camera system
• Qualitative data survey for participants for anecdotal data and quotes
• SUBSET A: MRI Group - MRI repeated after week 3, session 6.
• SUBSET B: PFT Group - PFTs repeated after last treatment in week 3, session 6.

Ethical Considerations

• To benefit health care and do the ethical thing for society, control group participants will be offered the intervention treatments, post-study, if results demonstrate a reduction in incidence of AHI 20% or greater.
• Control participants (Group A) that opt for the treatments post study, will utilize the home study sleep monitoring and data will be used to compare to data collected during their control group assignment.

TOOL • Home Monitoring: Participants will use the WatchPAT device to monitor AHI prior to study and repeated after 6 treatments.

MEASUREMENTS

• Pre-Treatment Assessment
• AHI Monitoring:
• Use WatchPAT devices for baseline AHI measurement.
• AHI event occurrence per hour
• Respiratory Disturbance Index data: apneas, hypopneas, respiratory effort related arousals (RERAs) per hour of sleep
• Oxygen disturbance Index data: SpO2 % drop data
• SpO2 levels via pulse oximetry: nadir/lowest, average during sleep, thresholds
• Vital signs - Heart rate average, HR variability patterns
• Total sleep time
• Latency - time to fall asleep
• REM latency - time to REM
• Sleep stage data - estimate
• Snoring intensity
• Body position
• Cheyne-stokes respirations for Central Sleep Apnea
• Movement
• Peripheral arterial tone (sympathetic responses and events
• MRI Measurements on 10 randomized participants:
• Post-Treatment Assessment
• AHI Monitoring:
• Repeat AHI measurement with WatchPAT system after the completion of all treatment sessions.
• MRI Measurements on 5-10 randomized participants:
• Repeat MRI to evaluate airway size, volume, and structure/changes

DATA ANALYSIS

• Analysis Methods:
• Compare pre- and post-treatment AHI values using paired t-tests or Wilcoxon signed-rank tests as appropriate.
• Analyze changes in MRI measurements using repeated measures ANOVA or mixed-model analysis.
• Correlation between fat loss and reduction in AHI events, STOP BANG using Pearson's Correlation Coefficient

EXPECTED OUTCOMES

• Identification of correlations between treatments and changes in the volume or tongue and submental tissue volume
• Evaluation of the effectiveness of the Alesis OSA1 treatment in reducing AHI in participants with OSA.

ETHICAL CONSIDERATIONS

• Obtain informed consent from all participants.
• Ensure confidentiality and data protection throughout the study.
• Offer post-treatment procedures to control group participants if results demonstrate 20% or greater reduction in AHI events

CONCLUSION

• This study aims to provide insights into the effects of non-invasive LLLT airway modification treatment on OSA, enhancing understanding of the relationship between soft tissue structures and apnea severity in obese individuals.