Apparatus for treatment of obstructive sleep apnea utilizing cryolysis of adipose tissues

Background

0001Obstructive sleep apnea (OSA) is disease that affects up to 20% of the adult population. OSA generally occurs during sleep when soft tissue obstructs the airway and creates cessation of, or impedes, breathing. Obstruction can occur at one or more levels including the retropalatal and retrolingual areas. Surgical correction of such obstructions remains a challenge, specifically for the retrolingual area. Removal or ablation of tongue tissue has been utilized with poor results due to complications, such as severe bleeding, abscess formation, and/or the inability to move the tongue anterior enough to relieve the obstruction.

0002It is known that patients with OSA have a higher percentage of adipose deposits in the areas of obstruction, specifically, the soft palate and uvula, base of tongue and lateral pharyngeal walls. The adipose tissue may be up to or greater than 40% of the total volume of tissues in these areas. Removal of the fat deposits in these areas would permit relief from OSA symptoms while preserving surrounding tissue. To date, however, cryolytic treatment of OSA has involved procedures analogous to ablation, merely substituting cryolytic cold for electrolytic heat and nonselectively destroying tissue in a similar manner-and with the same complications.

0003<patcit id="pcit0001" dnum="US20120197361A"><text>US Publication No. 2012/0197361</text></patcit> discloses a system for performing cryolysis to selected oropharyngeal tissue to treat obstructive sleep apnea. <patcit id="pcit0002" dnum="US20110155143A"><text>US Publication No. 2011/0155143</text></patcit> describes a device for preventing snoring and obstructive sleep apnea that has a plate portion that applies suction to the tongue to prevent backward movement, a hood portion that fits around the tip of the tongue and a balloon portion that prevents soft tissue from contacting portions of the tongue. <patcit id="pcit0003" dnum="WO9744092A"><text>PCT Publication No. WO/97 44092</text></patcit> describes an ablation device for debulking the tongue using a cooled electrolytic solution and an RF source. <patcit id="pcit0004" dnum="US6045549A"><text>US Patent No. 6,045,549</text></patcit> describes an upper airway tissue ablation device delivering RF energy and a temperature stabilization liquid to the target tissue.

Summary

0004The invention is as defined in claim 1. Dependent claims 2-14 disclose exemplary embodiments.

0005The disclosed technology allows for the treatment of apnea by causing adipolysis of subcutaneous adipose tissue of the tongue without damaging the surface tissue. Cold temperature is delivered to the base to the tongue to invoke a cryolytic tissue response that triggers the apoptosis process within the tissue. To this end, the cold temperature is not of sufficient level and duration to cause immediate tissue destruction (often associated with ablation where the cell dies from necrosis - a form of traumatic cell death due to acute cellular injury). Rather, the apoptosis process is a biological response within the natural life cycle of the cell, also referred to as a programmed cell death. The exposure to the cold triggers the apoptosis process which causes the cell to naturally die over a period of time (e.g., over a period of several weeks and/or months), thereby reducing the size of the tissue that may be obstructing the airway.

0006The disclosed technology enhances the mechanism that cold temperature is delivered to the tongue by reducing blood flow through the tongue during the application of the cold temperature, thereby allowing for several benefits, for example, but not limited to, (i) a shorter treatment time (namely, the application and/or exposure time of the cold temperature by the patient), (ii) a deeper penetration of the cold delivery into the tongue, thereby increasing the effective range and size of the treatment, (iii) a higher treatment temperature (as compared with no constriction of the vascular flow). Additionally, in reducing the blood circulation within the tongue, the thermal load of the tongue is reduced, thereby a smaller heat exchanger can be employed, the smaller apparatus being more comfortable to the patient when employed during the treatment.

0007The disclosed method, not according to the invention, further employs pharmacological and/or chemical agents, independently, or in conjunction, with the disclosed technology to treat apnea. The chemical agents may be administered to perform adipolysis. Alternatively, or in addition to, the pharmacological agent may be a vasoconstrictor to reduce the blood circulation.

0008In one aspect, the present disclosure describes a heat exchanger for causing cryolysis of adipose tissue of a human tongue. The heat exchanger includes a cooling inlet, a cooling outlet, and a body having one or more channels for circulating a heat-transfer fluid therein (e.g., chilled water, refrigerant, and/or water-glycerin solution). The one or more channels connects the cooling inlet and cooling outlet. The body forms a contact surface to cover the base of the tongue in which the body includes (i) a first region having a contact surface (e.g., wherein the contact surface is curved or substantially flat) to contact a portion of the dorsal surface of the tongue and (ii) a second region formed to contact a portion of the base of the tongue, the second region forming a protrusion that extends from the first region and curves over and around the tongue to contact the base of the tongue. The heat exchanger includes a pair of side walls that extends from the body and forms a pair of side contact surfaces. The side walls are dimensioned so that they contact the dorsal and lateral surfaces of the tongue in a manner so as to constrict the tongue when the contact surface is in contact with the tongue .

0009In some embodiments, the contact surface includes one or more concave recesses, whereby the recesses create a suction force between the interior surface of the concave recess and the corresponding surface of the base of the tongue when the contact surface is in contact with the base of the tongue. In some embodiments, the contact surface is concave (e.g., C-shaped, U-shaped, or V-shaped).

0010In some embodiments, the first region and the second region are of substantially the same thickness (e.g., less than 10% difference). In some embodiments, the second region is between about 2.54 and 5.08 cm (between about 1 and 2 inches) in length. The pair of side walls, in some implementations, forms a gap therebetween. The gap, in some embodiments, is between about 3.81 and 5.08 cm (between about 1.5 and 2 inches). In some embodiments, the contact surface and the side contact surfaces have a combined surface area between about 25.8 and 64.5 square centimeters (between about 4 and 10 square inches).

0011In some embodiments, the one or more channels form a serpentine pattern that span a substantial portion (e.g., greater than about 50%) of the interior of the body.

0012In some embodiments, the cooling inlet and the cooling outlet are located at a distal end of the body. In some embodiments, each of the cooling inlet and the cooling outlet comprises a quick-disconnect fitting. In some embodiments, at least one of the cooling inlet and the cooling outlet is angled with respect to the body.

0013In some embodiments, the heat exchanger further includes a suction inlet located on the contact surface; a suction outlet having a coupling to couple to a hose; and a suction channel connecting the suction inlet and the suction outlet. In some embodiments, the suction outlet is located (i) at the distal end of the body and (ii) proximal to the cooling inlet and cooling outlet.

0014In some embodiments, the heat exchanger further includes one or more thermal sensors (e.g., thermocouples). At least one of the thermal sensors is located at a location selected from the group consisting of a distal end of the contact surface of the body, the inlet, the outlet, and a proximal end of the contact surface of the body.

0015In some embodiments, the body comprises a material selected from the group consisting of copper, silver, and aluminum. The body, in some embodiments, includes a top-side exterior surface, said surface being curved to correspond to the oral cavity surface.

0016In another aspect, the present disclosure describes a method, not according to the invention, for causing adipolysis of adipose tissue of a human tongue to treat apnea. The method includes applying a heat exchanger so as to contact a portion of the dorsal surface of the tongue and a portion of the base of a tongue. The heat exchanger includes a body having a first region and a second region for contacting the tongue in which the first region has a contact surface (e.g., wherein the contact surface is curved or substantially flat) to contact a portion of the dorsal surface of the tongue, and in which the second region forms a protrusion that extends from the first region and curves over and around the tongue to contact the base of the tongue.

0017The method further includes constricting the tongue in a manner to create a pressure thereon, whereby the dorsal surface and lateral surface of the tongue is confined by the constriction. The method further includes circulating a heat-transfer fluid through the heat exchanger (e.g., to maintain the contact surface of the heat exchange at a temperature between - 15 °C and 0 °C, preferably at -10 °C) (e.g., for a pre-defined treatment time, e.g., between 10 minutes and 2 hours).

0018In some embodiments, the method further includes administering a chemical adipolysis formulation into the tongue. The chemical adipolysis formulation, in some embodiments, comprises at least one compound selected from the group consisting of: phosphatidylcholine (PC), sodium deoxycholate (DOC), and deoxycholic acid (DC) (e.g., deoxycholate, cholanoic acid, and 3α, 12 α-dihydroxy-5β-cholanate).

0019In some embodiments, the method further includes administering a vasoconstriction agent (e.g., epinephrine) to the tongue.

0020In another aspect, the present disclosure describes a method for causing cryolysis of adipose tissue of a human oropharynx to treat apnea. The method includes administering a chemical adipolysis formulation into the oropharynx. The chemical adipolysis formulation, in some embodiments, is injected into the tongue (e.g., at a depth between about 1 and 5 cm).

0021In some embodiments, the chemical adipolysis formulation is injected into the uvula/palate. In some embodiments, the chemical adipolysis formulation is injected into the pharyngeal fat pads.

0022In some embodiments, the chemical adipolysis formulation comprises phosphatidylcholine (PC) having a concentration between about 0.1 and 1.0 mg/ml (e.g., at about 0.5 mg/ml).

0023In some embodiments, the chemical adipolysis formulation comprises sodium deoxycholate (DOC) having a concentration between about 0.1 and 1.0 mg/ml (e.g., at about 0.21 mg/ml).

0024In some embodiments, the method further includes causing cryolysis of adipose tissue of a human tongue. The method comprises (i) applying a heat exchanger so as to contact a portion of the dorsal surface of the tongue and a portion of the base of a tongue and (ii) circulating a heat-transfer fluid through the heat exchanger (e.g., to maintain the contact surface of the heat exchange at a temperature between -15 °C and 0 °C) (e.g., for a pre-defined treatment time, e.g., between 2 minutes and 2 hours). The heat exchanger, in some embodiments, includes a body having a first region and a second region for contacting the tongue. The first region, in some embodiments, has a contact surface (e.g., wherein the contact surface is curved or substantially flat) to contact a portion of the dorsal surface of the tongue. The second region, in some embodiments, forms a protrusion that extends from the first region and curves over and around the tongue to contact the base of the tongue.

0025In some embodiments, the step of causing cryolysis of adipose tissue of a human tongue further includes constricting the tongue in a manner to create a pressure thereon, whereby the dorsal surface and lateral surface of the tongue is confined by the constriction.

Brief Description of the Drawing

0026<ul id="ul0001" list-style="none" compact="compact"><li><figref idref="f0001">FIG. 1</figref> is a diagram depicting a side cross-sectional view of a head of a human patient with a heat exchanger placed on the tongue to treat apnea.</li><li><figref idref="f0002">FIG. 2</figref> is a diagram showing a perspective view of a heat exchanger for causing cryolysis of adipose tissue of a tongue (e.g., that of a human), according to an illustrative embodiment.</li><li><figref idref="f0002">FIG. 3</figref> is a diagram showing another perspective view of the heat exchanger of <figref idref="f0002">FIG 2</figref>, according to another illustrative embodiment.</li><li><figref idref="f0003">FIG. 4</figref> is a diagram showing a front view of the heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0003">FIG. 5</figref> is a diagram showing a side view of the heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0004">FIG. 6</figref> is a diagram showing a bottom view of the heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0004">FIG. 7</figref> is a diagram showing a top view of the heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0005">FIG. 8</figref> is a diagram showing a disassembled view of the heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0005">FIG. 9</figref> is a diagram showing a side view of the interior of the heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0006">FIG. 10</figref> is a diagram showing the heat exchanger with thermal sensors, according to an illustrative embodiment.</li><li><figref idref="f0007">FIGS. 11A-C</figref> are diagrams of a heat exchanger, according to an illustrative embodiment.</li><li><figref idref="f0008">FIG. 12</figref> is a flowchart illustrating a method for causing adipolysis of adipose tissue to treat apnea, according to an illustrative example.</li><li><figref idref="f0009">FIG. 13</figref> is a flowchart illustrating a method for causing adipolysis of adipose tissue to treat apnea, according to an illustrative example.</li></ul>

Detailed Description

0027In order for the present disclosure to be more readily understood, certain terms are first defined below. Additional definitions for the following terms and other terms are set forth throughout the specification.

0028In this application, the use of "or" means "and/or" unless stated otherwise. As used in this application, the term "comprise" and variations of the term, such as "comprising" and "comprises," are not intended to exclude other additives, components, integers or steps. As used in this application, the terms "about" and "approximately" are used as equivalents. Any numerals used in this application with or without about/approximately are meant to cover any normal fluctuations appreciated by one of ordinary skill in the relevant art. In certain embodiments, the term "approximately" or "about" refers to a range of values that fall within 25%, 20%, 19%, 18%, 17%, 16%, 15%, 14%, 13%, 12%, 11%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, or less in either direction (greater than or less than) of the stated reference value unless otherwise stated or otherwise evident from the context (except where such number would exceed 100% of a possible value).

0029"<b>Administration</b>": The term "administration" refers to introducing a substance into a subject. In general, any route of administration may be utilized including, for example, parenteral (e.g., intravenous), oral, topical, subcutaneous, peritoneal, intra-arterial, inhalation, vaginal, rectal, nasal, introduction into the cerebrospinal fluid, or instillation into body compartments. In some embodiments, administration is oral. Additionally or alternatively, in some embodiments, administration is parenteral. In some embodiments, administration is intravenous.

0030"<b>Animal</b>": As used herein, the term "animal" refers to any member of the animal kingdom. In some embodiments, "animal" refers to humans, at any stage of development. In some embodiments, "animal" refers to non-human animals, at any stage of development. In some embodiments, the non-human animal is a mammal (e.g., a rodent, a mouse, a rat, a rabbit, a monkey, a dog, a cat, a sheep, cattle, a primate, and/or a pig). In some embodiments, animals include, but are not limited to, mammals, birds, reptiles, amphibians, fish, and/or worms. In some embodiments, an animal may be a transgenic animal, genetically-engineered animal, and/or a clone.

0031"<b>Approximately</b>": As used herein, the term "approximately" and "about" is intended to encompass normal statistical variation as would be understood by those of ordinary skill in the art as appropriate to the relevant context. In certain embodiments, the term "approximately" or "about" refers to a range of values that fall within 25%, 20%, 19%, 18%, 17%, 16%, 15%, 14%, 13%, 12%, 11%, 10%, 9%, 8%, 7%, 6%, 5%, 4%, 3%, 2%, 1%, or less in either direction (greater than or less than) of the stated reference value unless otherwise stated or otherwise evident from the context (except where such number would 15 exceed 100% of a possible value).

0032"<b>Biologically active</b>": As used herein, the phrase "biologically active" refers to a substance that has activity in a biological system (e.g., in a cell (e.g., isolated, in culture, in a tissue, in an organism), in a cell culture, in a tissue, in an organism, etc.). For instance, a substance that, when administered to an organism, has a biological effect on that organism, is considered to be biologically active. It will be appreciated by those skilled in the art that often only a portion or fragment of a biologically active substance is required (e.g., is necessary and sufficient) for the activity to be present; in such circumstances, that portion or fragment is considered to be a "biologically active" portion or fragment.

0033"<b>Human</b>": In some embodiments, a human is an embryo, a fetus, an infant, a child, a teenager, an adult, or a senior citizen.

0034"<b>Patient</b>": As used herein, the term "patient" refers to a human or any non-human animal (e.g., mouse, rat, rabbit, dog, cat, cattle, swine, sheep, horse or primate) to whom therapy is administered. In many embodiments, a patient is a human being. In some embodiments, a patient is a human presenting to a medical provider for diagnosis or treatment of a disease, disorder or condition. In some embodiments, a patient displays one or more symptoms or characteristics of a disease, disorder or condition. In some embodiments, a patient does not display any symptom or characteristic of a disease, disorder, or condition. In some embodiments, a patient is someone with one or more features characteristic of susceptibility to or risk of a disease, disorder, or condition.

0035"<b>Subject</b>": As used herein, the term "subject" includes humans and mammals (e.g., mice, rats, pigs, cats, dogs, and horses). In many embodiments, subjects are be mammals, particularly primates, especially humans. In some embodiments, subjects are livestock such as cattle, sheep, goats, cows, swine, and the like; poultry such as chickens, ducks, geese, turkeys, and the like; and domesticated animals particularly pets such as dogs and cats. In some embodiments (e.g., particularly in research contexts) subject mammals will be, for example, rodents (e.g., mice, rats, hamsters), rabbits, primates, or swine such as inbred pigs and the like.

0036"<b>Symptoms are reduced</b>": According to the present disclosure, "symptoms are reduced" when one or more symptoms of a particular disease, disorder or condition is reduced in magnitude (e.g., intensity, severity, etc.) and/or frequency. For purposes of clarity, a delay in the onset of a particular symptom is considered one form of reducing the frequency of that symptom.

0037"Treatment": As used herein, the term "treatment" (also "treat" or "treating") refers to any administration of a substance or application of a medical device that partially or completely alleviates, ameliorates, relives, inhibits, delays onset of, reduces severity of, and/or reduces frequency, incidence or severity of one or more symptoms, features, and/or causes of a particular disease, disorder, and/or condition. Such treatment may be of a subject who does not exhibit signs of the relevant disease, disorder and/or condition and/or of a subject who exhibits only early signs of the disease, disorder, and/or condition. Alternatively or additionally, such treatment may be of a subject who exhibits one or more established signs of the relevant disease, disorder and/or condition. In some embodiments, treatment may be of a subject who has been diagnosed as suffering from the relevant disease, disorder, and/or condition. In some embodiments, treatment may be of a subject known to have one or more susceptibility factors that are statistically correlated with increased risk of development of the relevant disease, disorder, and/or condition.

0038<figref idref="f0001">FIG. 1</figref> is a diagram depicting a side cross-sectional view of a head of a human patient with a heat exchanger 100 placed on the tongue 102 to treat apnea according to an embodiment. <figref idref="f0002">FIGS. 2</figref> is a diagram showing a perspective view of the heat exchanger 100, for example, as that shown in <figref idref="f0001">FIG. 1</figref>, according to an embodiment. <figref idref="f0002">FIG. 3</figref> is a diagram showing a perspective view of another heat exchanger 100, according to another illustrative embodiment.

0039The heat exchangers 100 includes a cooling inlet 202, a cooling outlet 204, and a body 206 having one or more channels 208 (not shown - see <figref idref="f0005">FIGS. 8 and 9</figref>) for circulating a heat-transfer fluid therein (e.g., chilled water, refrigerant, and/or water-glycerin solution). The one or more channels 208 connects the cooling inlet 202 and cooling outlet 204. In some embodiments, the body 206 comprises a material selected from the group consisting of copper, silver, and aluminum.

0040The cooling inlet 202 and the cooling outlet 204, in some embodiments, are located at a distal end 208 of the body 206. In some embodiments, the body 206 includes one or more cooling inlets 202 and one or more cooling outlets 204. In some embodiments, each of the cooling inlet 202 and the cooling outlet 204 includes a quick-disconnect fitting.

0041In some embodiments, at least one of the cooling inlet 202 and the cooling outlet 204 is angled with respect to the body 206. In <figref idref="f0002">FIG. 3</figref>, for example, the cooling outlet 204 is shown angled with respect to the body 206, for example, to allow the heat exchanger 100 to be placed in a compact manner within the oral cavity. The angle 210, in some implementations, are between about 5 and 60 degrees.

0042<figref idref="f0003">FIGS. 4 and 5</figref> are diagrams showing a front and a side view of the heat exchanger 100. The body 206, in some implementations, forms a contact surface to cover the base 106 (see <figref idref="f0001">FIG. 1</figref>) of the tongue 102. The base 106 of the tongue 102 refers to a portion of the oropharynx (which is composed of the base of the tongue 102, the pharyngeal wall 108, and the soft palate/uvula 110). The base 106 of the tongue 102 is located at the back-third region of the tongue and having the oropharyngeal tissue. The base 106 of tongue 102 is bounded anteriorly by the circumvallate papillae, laterally by the glossotonsillar sulci, and posteriorly by the epiglottis. The vallecula is a strip of mucosa that is the transition from the base 102 of the tongue 106 to the epiglottis; it is considered part of the base of tongue. The musculature of the base 106 of tongue 102 is contiguous with that of the oral tongue 112.

0043The top-side exterior surface 416 of the body 206, in some implementations, are curved to correspond to the interior surface of the oral cavity.

0044The body 206, in some implementations, includes (i) a first region 404 having a contact surface 406 (e.g., wherein the contact surface 406 (see also <figref idref="f0004">FIG. 6</figref>) is curved or substantially flat) to contact a portion of the dorsal surface of the tongue 102 and (ii) a second region 408 formed to contact a portion of the base 106 of the tongue 102. The second region 408 forms a protrusion that extends from the first region 404 and curves over and around the tongue 102 to contact the base 106 of the tongue 102. In some embodiments, the second region 408 is between about 2.54 and 5.08 cm (about 1 and 2 inches) in length. In other embodiments, the second region 408 is between about 1.27 and 2.54 cm (about 0.5 inches and 1 inch) in length.

0045The heat exchanger 100, in some implementations, includes a pair of side walls 410 that extends from the body 206 and forms a pair of side contact surfaces 412. The side walls 412 are dimensioned so that they contact the dorsal and lateral surfaces of the tongue in a manner so as to constrict the tongue 102 when the contact surface (e.g., 406, 408) is in contact with the tongue 102.

0046In some embodiments, the first region 404 and the second region 408 are of substantially the same thickness 414 (e.g., less than 10% difference). In some embodiments, the thickness 414 is between about .25 and 1.27 cm (about 0.1 inches and 0.5 inches), even more preferably between 0.76 and .89 cm (0.3 and 0.35 inches), and even more preferably at about 0.81 cm (about 0.32 inches).

0047In some embodiments, the contact surface (e.g., 406, 408, 412) includes one or more concave recesses, whereby the recesses create a suction force between the interior surface of the concave recess and the corresponding surface of the base of the tongue when the contact surface is in contact with the base of the tongue. In some embodiments, the contact surface is concave (e.g., C-shaped, U-shaped, or V-shaped). The suction allows the heat exchanger 100 to tightly adhere to the tongue 102.

0048<figref idref="f0004">FIGS. 6 and 7</figref> are diagrams showing a bottom view and a top view of the heat exchanger 100. In some embodiments, the pair of side walls 412 forms a gap 602. The gap 602, in some embodiments, is between about 3.87 and 5.08 cm (about 1.5 and 2 inches). This gap 602 is designed to be smaller than the width of the tongue in a relaxed state. To this end, when the heat exchanger 100 is seated on the tongue 102, the tongue 102 is compressed between the pair of side walls 412. The compression of the tongue 102 by the side walls 412 creates a pressure in the tongue so as to reduce the blood flow within the tongue. As a result, the heat exchanger 100 can cool the tongue 102 to a temperature (e.g., to invoke a cryolytic tissue response that triggers the apoptosis process within the adipose tissue) with less application/exposure time and/or more elevated temperature than without the constriction.

0049<figref idref="f0005">FIG. 8</figref> is a diagram showing a disassembled view of the heat exchanger. <figref idref="f0005">FIG. 9</figref> is a diagram showing a side view of the interior of the heat exchanger. As shown in <figref idref="f0005">FIGS. 8 and 9</figref>, in some embodiments, the one or more channels form a serpentine pattern that span a substantial portion (e.g., greater than about 50%) of the interior of the body 206.

0050The body 206, in some implementations, include a main body portion 802 and a cover portion 804 that mates together to form the body 206.

0051In some embodiments, each of the cooling inlet 202 and the cooling outlet 204 includes a quick-disconnect fitting 806 to connect to a hose that is connected to a chilledfluid source (for example, a fluid chilling and circulation system).

0052<figref idref="f0006">FIG. 10</figref> is a diagram showing the heat exchanger 100 with thermal sensors 1002a-d. In some embodiments, the thermal sensors include one or more thermocouples, thermistors, resistance thermometers, and/or silicon band-gap temperature sensors.

0053The thermal sensors 1002, in some implementations are placed at a distal end 1004 of the contact surface of the body 206, the inlet 202, the outlet 204, and a proximal end 1006 of the contact surface of the body 206. The thermal sensors 1002 may be employed in a feedback loop to control, for example, the temperature of the heat transfer fluid being circulated within the heat exchanger or the flow rate of the heat transfer fluid.

0054As shown, the thermal sensor 1002a is placed on the contact surface of the second region 408 formed to contact a portion of the base 106 of the tongue 102.

0055<figref idref="f0007">FIGS. 11A-C</figref> are diagrams of a heat exchanger. The figure illustrates some illustrative dimensions (shown in inches) for the heat exchanger. In some embodiments, the contact surface and the side contact surfaces have a combined surface area between about 25.8 and 64.5 square centimeters (about 4 and 10 square inches).

0056In some embodiments, the heat exchanger further includes a suction inlet located on the contact surface; a suction outlet having a coupling to couple to a hose; and a suction channel connecting the suction inlet and the suction outlet. The suction inlet, in some implementations, is located on the contact surface (e.g., 406, 408, and/or 412). The suction outlet, in some implementations, is located (i) at the distal end of the body and (ii) proximal to the cooling inlet and cooling outlet. The suction outlet may include a fitting to connect to a hose that connect to a vacuum system.

0057<figref idref="f0008">FIG. 12</figref> is a flowchart illustrating a method 1200 for causing adipolysis of adipose tissue to treat apnea. The method 1200 includes applying a heat exchanger 100 so as to contact a portion of the dorsal surface of the tongue 102 and a portion of the base 106 (e.g., the oropharynx) of a tongue 102 (step 1202). The heat exchanger 100 includes a body 206 having a first region 404 and a second region 408 for contacting the tongue in which the first region 404 has a contact surface (e.g., wherein the contact surface is curved or substantially flat) to contact a portion of the dorsal surface of the tongue, and in which the second region 408 forms a protrusion that extends from the first region and curves over and around the tongue to contact the base 106 of the tongue 102.

0058The method 1200 further includes constricting the tongue in a manner to create a pressure thereon (step 1204), whereby the dorsal surface and lateral surface of the tongue is confined by the constriction.

0059The method further includes circulating a heat-transfer fluid through the heat exchanger (step 1206) (e.g., to maintain the contact surface of the heat exchange at a temperature between - 15 °C and 0 °C, preferably at -10 °C) (e.g., for a pre-defined treatment time, e.g., between 10 minutes and 2 hours).

0060In some embodiments, the method 1200 further includes administering a chemical adipolysis formulation into the tongue. The chemical adipolysis formulation, in some embodiments, comprises at least one compound selected from the group consisting of: phosphatidylcholine (PC), sodium deoxycholate (DOC), and deoxycholic acid (DC) (e.g., deoxycholate, cholanoic acid, and 3α, 12 α-dihydroxy-5β-cholanate).

0061The chemical adipolysis formulation may be administered (e.g., injected) to the tongue or treatment area prior to the heat exchanger being placed on the treatment area. Alternatively, the chemical adipolysis formulation may be administered to the tongue or treatment area after the cryolysis treatment with the heat exchanger has been performed and completed.

0062In some embodiments, a hand held transducer is employed prior the administration of the chemical adipolysis formulation to identity the and size of fat accumulation in the tongue, soft palate, and pharyngeal wall. Other imaging modality (e.g., ultrasound, MRI, PET, CT, X-Ray, among others) may be employed to identify the fat accumulation in the tongue for the purpose of administering the chemical adipolysis formulation.

0063In some embodiments, the method 1200 further includes administering a vasoconstriction agent (e.g., epinephrine) to the tongue 102. The vasoconstriction agent, once injected, reduces the flow of blood to and within the tongue, thereby allowing the subcutaneous tissue within the tongue to reach the intended treatment temperature, potentially, with less application time and/or more elevated chilled temperature as compared to no vasoconstriction agent being administered. In some embodiments, the vasoconstriction agent is employed to increase the depth of the treatment (i.e., the treatment effective range) by allowing the treatment temperature to reach deeper adipose tissue within the tongue.

0064In some embodiments, a chilled balloon may be employed in conjunction with the heat exchanger and/or vasoconstriction agent to concurrently treat one or more sites in the oropharynx (for example, the base of the tongue, the lateral pharyngeal wall, and/or the soft palate or uvula). The chilled balloon is selectively expandable between an expanded state and a deflated state and is configured to expand, in the expanded state, in the oropharynx to contact at least one of the pharyngeal wall and the palate (i.e., uvula).

0065<figref idref="f0009">FIG. 13</figref> is a flowchart illustrating a method 1300 for causing adipolysis of adipose tissue to treat apnea. The method 1300 includes administering a chemical adipolysis formulation into the oropharynx.

0066The chemical adipolysis formulation, in some embodiments, is injected into the tongue (e.g., at a depth between about 1 and 5 cm). Deeper injections are preferable, in some embodiments, to cool the deeper adipose tissue. In some embodiments, the chemical adipolysis formulation is injected into the uvula/palate.

0067In some embodiments, the chemical adipolysis formulation is injected into the pharyngeal fat pads. The lateral pharyngeal fat pads have been shown to contribute to sleep apnea. These fat pads are in proximity to vital nerves and the carotid artery making them very difficult to reduce surgically. The disclosed treatment provides a minimally invasive or noninvasive method of reducing the size of the lateral pharyngeal fat pad for the treatment of sleep apnea. Chemical lipolysis and cryolipolysis cause adipose cell death through different actions and may act synergistically. By combining the two methods, the concentration of the DOC and /or PC may be reduced. Also, the exposure time can be reduced and the temperature increased for the cryolipolysis treatment. Chemical lipolysis with or without cryolysis may be employed to reduce the size and volume of lateral pharyngeal fat pads.

0068The chemical adipolysis formulation, in some embodiments, comprises at least one compound selected from the group consisting of: phosphatidylcholine (PC), sodium deoxycholate (DOC), and deoxycholic acid (DC) (e.g., deoxycholate, cholanoic acid, and 3α, 12 α-dihydroxy-5β-cholanate).

0069In some embodiments, the chemical adipolysis formulation comprises phosphatidylcholine (PC) having a concentration between about 0.1 and 1.0 mg/ml (e.g., at about 0.5 mg/ml).

0070In some embodiments, the chemical adipolysis formulation comprises sodium deoxycholate (DOC) having a concentration between about 0.1 and 1.0 mg/ml (e.g., at about 0.21 mg/ml).

0071Deoxycholic acid (DC), also known as deoxycholate, cholanoic acid, and 3α,12α-dihydroxy-5β-cholanate, is one of the secondary bile acids, which are metabolic byproducts of intestinal bacteria and is used by the human body to emulsify fat for absorption in the intestines. Sodium deoxycholate, the sodium salt of deoxycholic acid, is frequently used in mesotherapy injections, mixed with phosphatidylcholine.

0072Without wishing to be bound to a particular theory, the action of Deoxycholic acid (DC) is to destabilize cell membranes. DC activity is neutralized by binding of DC binding proteins on the surface of most cell types. Adipocytes lack sufficient DC binding proteins to minimize the destabilization, thus adipocytes are selected from cell death.

0073Phosphatidylcholines are a class of phospholipids that have also been shown to cause lipolysis when injected. Phosphatidylcholine formulation may be used to dissolve local fat deposits.

0074These agents may be used in conjunction with cryolipolysis to increase adipocyte apoptosis and cell death. These agents can be used individually or together with other agents. These agents can also be used independently or together with the heat exchanger, described herein.

0075These agents, individually or in combination, may be injected into other areas of oropharyngeal fat that may be contributing to sleep apnea, specifically the soft palate/uvula and the lateral pharyngeal fat pads.

0076In some embodiments, the method 1300 further includes causing cryolysis of adipose tissue of a human tongue. The method 1300 comprises (i) applying a heat exchanger 100 so as to contact a portion of the dorsal surface of the tongue 102 and a portion of the base 106 of a tongue 102 and (ii) circulating a heat-transfer fluid through the heat exchanger 102 (e.g., to maintain the contact surface of the heat exchange at a temperature between -15 °C and 0 °C) (e.g., for a pre-defined treatment time, e.g., between 2 minutes and 2 hours). The heat exchanger 100, in some embodiments, includes a body 206 having a first region 404 and a second region 408 for contacting the tongue 102. The first region 404, in some embodiments, has a contact surface (e.g., wherein the contact surface is curved or substantially flat) to contact a portion of the dorsal surface of the tongue. The second region 408, in some embodiments, forms a protrusion that extends from the first region 404 and curves over and around the tongue 102 to contact the base 106 of the tongue 102.

0077In some embodiments, the step of causing cryolysis of adipose tissue of a human tongue further includes constricting the tongue in a manner to create a pressure thereon, whereby the dorsal surface and lateral surface of the tongue is confined by the constriction.

0078Methods disclosed herein contemplate application, adaptation, or use of information and embodiments described in <patcit id="pcit0005" dnum="US35900012" dnum-type="L"><text>U.S. Patent Application, Serial No. 13/359,000</text></patcit>, which was filed on January 26, 2012 entitled "Apparatus and Methods for Treatment of Obstructive Sleep Apnea Utilizing Cryolysis of Adipose Tissues" and published as <patcit id="pcit0006" dnum="US2012197361A1"><text>US 2012/197361A1 on August 2, 2012</text></patcit>.