Dual-sided Hypoglossal neRvE stimulAtion for the treatMent of Obstructive Sleep Apnea (DREAM) (DREAM)

A Multicenter Study to Assess the Safety and Effectiveness of the Genio Dual-sided Hypoglossal Nerve Stimulation System for the Treatment of Obstructive Sleep Apnea in Adults Subjects

A multicenter study to assess the safety and effectiveness of the Genio dual-sided hypoglossal nerve stimulation system for the treatment of obstructive sleep apnea in adults subjects.

Study Overview

• Status: Active, not recruiting
• Conditions: Obstructive Sleep Apnea
• Intervention / Treatment: Device: Genio™ system

• Study Type: Interventional
• Enrollment (Estimated): 115
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Australia
  • New South Wales
    • Wollongong, New South Wales, Australia, 2500
      • Wollongong Private Hospital
  • Victoria
    • Heidelberg, Victoria, Australia, 3084
      • Institute Breathing and Sleep Austin Hospital
  • Western Australia
    • Nedlands, Western Australia, Australia, 6005
      • Hollywood Hospital
• Belgium
  • Antwerp, Belgium, 2650
    • Universitair Ziekenhuis Antwerpen
• Germany
  • München, Germany, 80333
    • Technische Universität München
• United States
  • Alabama
    • Birmingham, Alabama, United States, 35233
      • University of Alabama at Birmingham
  • Florida
    • Boca Raton, Florida, United States, 33487
      • ENT and Allegy Associates South Florida
    • Tampa, Florida, United States, 33606
      • University of South Florida-Tampa General Medical Center
  • Georgia
    • Atlanta, Georgia, United States, 30342
      • Advanced Ear Nose & Throat Associates
  • Indiana
    • Carmel, Indiana, United States, 46032
      • CENTA (Center for ENT & Allergy)
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • University of Iowa- Institute for Clinical & Translational Science
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Harvard/ Massachusetts Eye & Ear
  • New York
    • New York, New York, United States, 10024
      • Weill Cornell Medicine Otolaryngology - Head and Neck Surgery
  • Ohio
    • Columbus, Ohio, United States, 43221
      • The Ohio State University, Wexner Medical Center
    • Dublin, Ohio, United States, 43017
      • Ohio Sleep Medicine Institute
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19107
      • Thomas Jefferson University Department of Otolaryngology
    • Philadelphia, Pennsylvania, United States, 46032
      • University of Pennsylvania
  • Tennessee
    • Memphis, Tennessee, United States, 38163
      • The University of Tennessee Health Science Center- Dept. of Otolaryngology
    • Nashville, Tennessee, United States, 37232
      • Vanderbilt University Medical Center
  • Virginia
    • Richmond, Virginia, United States, 23298
      • Virginia Commonwealth University
  • Wisconsin
    • Milwaukee, Wisconsin, United States, 53226
      • Medical College of Wisconsin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 22 years to 75 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

1. Age from 22 to 75 years (inclusive). Participant cannot be under guardianship, under curatorship or under judicial protection.
2. Body mass index (BMI) ≤ 32 kg/m2.
3. Cricomental space positive (≥ 0 cm). The cricomental space is the distance between the neck and the bisection of a line from the chin to the cricoid membrane when the head is in a neutral position.
4. Has either not tolerated, has failed or refused positive airway pressure (PAP) treatment
5. Moderate to severe OSA (15≤AHI4≤65 where combined central and mixed AHI < 25% of the total AHI) based on a screening PSG.
6. Non-supine AHI > 10 events on the screening PSG or participant has either not tolerated, has failed or refused positional therapy.
7. Written informed consent obtained from the participant prior to performing any study specific procedure.
8. Willing and capable to comply with all study requirements, including specific lifestyle considerations, performing all follow-up visits and sleep studies, evaluation procedures and questionnaires for the whole duration of the trial.
9. Willing to consent to long term follow-up of 5 years post-surgery.

Exclusion Criteria:

1. Inadequately treated sleep disorders other than OSA that would confound functional sleep assessment:

   1. Severe chronic insomnia
   2. Insufficient sleep syndrome (<6 hours sleep per night)
   3. Narcolepsy
   4. Restless legs syndrome
   5. REM behavior disorder
   6. Others deemed sufficient disorders that would confound functional sleep assessment in the judgment of the investigator
2. Night shift worker defined as individual working between the hours of 10:00 pm and 7:00 am at least 3 nights per working week.
3. Taking medications that in the opinion of the investigator may alter consciousness, the pattern of respiration, or sleep architecture.

4. Major anatomical or functional abnormalities that would impair the ability of the Genio System to treat OSA:

   1. Craniofacial abnormalities narrowing the airway or the implantation site
   2. Palatine tonsil size 3+ or 4+ by the Brodsky Classification
   3. Fixed upper airway obstructions (tumor, polyps, nasal obstruction)
   4. Congenital malformations in the airway
   5. Hypoglossal nerve palsy (bilateral limited tongue movement, or unilateral unintended tongue deviation during protrusion)
   6. Existing swallowing difficulty as measured by a score of ≥3 on the EAT-10 questionnaire
   7. Others deemed sufficient to impair the ability of the Genio® System to treat OSA in the judgment of the investigator

5. Significant comorbidities that contraindicate surgery or general anesthesia:

   1. Revised Cardiac Risk Index Class III or IV
   2. Persistent uncontrolled hypertension (defined as systolic pressure 160 mm Hg or a diastolic pressure of 120 mm Hg) despite medications
   3. Coagulopathy or required anticoagulant medications (such as warfarin, clopidogrel (Plavix) or similar; prophylactic aspirin not exclusionary) that cannot be safely stopped in the perioperative period
   4. Degenerative neurological disorder (i.e., Parkinson's disease, Alzheimer's disease)
   5. Acute illness or infection
   6. Diagnosed psychiatric disease (e.g., psychotic illness, uncontrolled major depression or acute anxiety attacks) that prevents participant compliance with the requirements of the investigational study testing
   7. Substance or alcohol abuse history within the previous 3 years. Alcohol and substance abuse are defined as follows:

   i. Alcohol: no days with less than 3 or 4 standard drinks for women and men, respectively

   ii. Substance: the use of any substance in an amount unapproved by the investigator or considered illegal. The drugs most commonly abused include cocaine, marijuana, heroin (or substitution treatment), prescription drugs (especially painkillers), methamphetamines, and various other illegal substances.

   h) Life expectancy less than the primary endpoint study period (12 months post-surgery)

   i) Any other chronic medical illness or condition that contraindicates a surgical procedure or general anesthesia in the judgment of the investigator.

6. Prior surgery or treatments that could compromise the effectiveness of the Genio System:

   1. Airway cancer surgery or radiation
   2. Mandible or maxilla surgery in the previous 5 years (not counting dental treatments)
   3. Other upper airway surgery to remove obstructions related to OSA in the previous 3 months (e.g., uvulopalatopharyngoplasty (UPPP), tonsillectomy, nasal airway surgery)
   4. Prior hypoglossal nerve stimulation device implantation
7. Has an Active Implantable Medical Device (AIMD) even if the device can be temporarily turned off.
8. Participation in another clinical study with an active treatment arm that could confound the results of the DREAM study.
9. Plan to become pregnant, currently pregnant, or breastfeeding during the study period.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Genio Therapy; The Genio™ system is an implantable neurostimulation system comprised of one implanted device	Device: Genio™ system; The Genio™ device is a permanent implant. It is implanted in the chin area and delivers stimulation to both hypoglossal nerve branches (i.e., the left and right branches). The implant does not include a battery or an embedded software and is externally powered.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Apnea Hypopnea Index (AHI4%)	percentage of responders at 12 months based on AHI4	12 months
Change in Oxyhemoglobin Desaturation Index (ODI4%)	percentage of responders at 12 months based on ODI4	12 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
FOSQ-10	Mean change from baseline to the 12-month visit in FOSQ-10	12 months
SNORE-25	Mean change from baseline to the 12-month visit in SNORE-25	12 months
ESS	Mean change from baseline to the 12-month visit in ESS	12 months
ODI4	Mean change from baseline to the 12-month visit in ODI4	12 months
SaO2 < 90%	Mean change from baseline to the 12-month visit in SaO2 <90%	12 months
AHI4	Mean change from baseline to the 12-month visit in AHI4	12 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of device-related SAEs	Incidence of participants with device-related SAEs.	Observed during the study for a period of 12 months post-implantation.

Collaborators and Investigators

• Sponsor: Nyxoah S.A.
• Collaborators: Nyxoah Inc.
• Investigators: Principal Investigator: Tucker Woodson, MD, Medical College of Wisconsin

Publications and helpful links

General Publications

• Woodson BT, Kent DT, Huntley C, Hancock MK, Van Daele DJ, Boon MS, Huntley TC, Mickelson S, Gillespie MB, Suurna MV, Kacker A, Roy A, MacKay S, Withrow KP, Dedhia RC, Huyett P, Heiser C, Nicola SD, Makori F, Vanderveken OM, Padyha TA, Magalang UJ, Chio E, Kezirian EJ, Lewis R. Bilateral hypoglossal nerve stimulation for obstructive sleep apnea: a nonrandomized clinical trial. J Clin Sleep Med. 2025 Nov 1;21(11):1883-1891. doi: 10.5664/jcsm.11822.
• Woodson BT, Suurna MV, Gillespie MB, Huntley TC, Hancock M, Santos A, Subbaroyan J, Makori F, Fesneau G, Heiser C, Kent DT. Multicentre study conducted across centres in the USA, Europe and Australia to assess the safety and effectiveness of a bilateral hypoglossal nerve stimulation system for the treatment of obstructive sleep apnoea in adults: a protocol for a pivotal, multicentre, open-label, single-arm study. BMJ Open. 2024 Dec 20;14(12):e085218. doi: 10.1136/bmjopen-2024-085218.

Study record dates

Study Major Dates

• Study Start (Actual): October 14, 2020
• Primary Completion (Actual): February 20, 2024
• Study Completion (Estimated): February 1, 2028

Study Registration Dates

• First Submitted: March 7, 2019
• First Submitted That Met QC Criteria: March 7, 2019
• First Posted (Actual): March 11, 2019

Study Record Updates

• Last Update Posted (Actual): April 14, 2026
• Last Update Submitted That Met QC Criteria: April 9, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Hypoglossal nerve stimulation
• Additional Relevant MeSH Terms: Nervous System Diseases; Respiratory Tract Diseases; Respiration Disorders; Sleep Wake Disorders; Apnea; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
• Other Study ID Numbers: CL-GEN-002033

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: Yes
• product manufactured in and exported from the U.S.: No