Safety and Effectiveness of the Genio® bilAteral Stimulation for Treatment of Complete Concentric CollapsE and OSA. (ACCCESS)

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 Subjects With Complete Concentric Collapse of the Soft Palate.

The solution offered by the Genio System to treat OSA patients with CCC using bilateral HGNS has a favorable risk-benefit ratio, as demonstrated by evidence from 2 studies.

Study Overview

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

Detailed Description

Nyxoah has developed the Genio® 2.1 System with the intention of treating patients with moderate to severe obstructive sleep apnea.

In overview, the System includes an Implantable Stimulator (IS) designed to stimulate the hypoglossal nerve branches (i.e., both the left and the right). The IS does not include a battery but receives energy pulses transmitted by an Activation Chip (AC) which is attached to an adhesive Disposable Patch (DP) and placed on the patient's skin under the chin. Stimulation of the hypoglossal nerve causes the tongue muscles to contract with the intention to maintain an open airway.

• Study Type: Interventional
• Enrollment (Estimated): 124
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Colorado
    • Colorado Springs, Colorado, United States, 80923
      • Colorado ENT & Allergy
  • Florida
    • Boca Raton, Florida, United States, 33487
      • ENT and Allergy Associates of Florida, LLC
    • Miami, Florida, United States, 33136
      • University of Miami
    • Miami, Florida, United States, 33176
      • PharmaDev Clinical Research Institute,
    • Tampa, Florida, United States, 33620
      • University of South Florida
  • Indiana
    • Carmel, Indiana, United States, 46032
      • Center for ENT and Allergy, PC Ascension Medical Group
  • Iowa
    • Iowa City, Iowa, United States, 52242
      • University of Iowa Institute for Clinical & Translational Science
  • Kansas
    • Kansas City, Kansas, United States, 66160
      • University of Kansas
  • Massachusetts
    • Boston, Massachusetts, United States, 02114
      • Massachusetts Eye & Ear
  • New York
    • Rochester, New York, United States, 14627
      • University of Rochester
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19107
      • Thomas Jefferson University Department of Otolaryngology
    • Philadelphia, Pennsylvania, United States, 19104
      • Hospital of the University Pennsylvania
  • South Carolina
    • Columbia, South Carolina, United States, 29201
      • Bogan Sleep Consultants, LLC
  • Tennessee
    • Nashville, Tennessee, United States, 37232
      • Vanderbilt University Medical Center
  • Texas
    • Dallas, Texas, United States, 75390
      • University of Texas Southwestern Medical Center
  • Virginia
    • Norfolk, Virginia, United States, 23507
      • Eastern Virginia Medical School

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. Positive cricomental space (≥ 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) treatments.

  5. Moderate to severe OSA (15≤AHI4≤65 where combined central and mixed AHI<25% of the total AHI) based on a screening HST and confirmed in Baseline PSG.

  6. Complete concentric collapse at the level of the soft palate based on screening DISE.

  7. Willing and capable of complying 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.

• 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. Taking medications that may alter consciousness, the pattern of respiration, or sleep architecture as determined by the investigator.

  3. 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.

  4. Significant comorbidities that contraindicate surgery or general anesthesia:

     1. Revised Cardiac Risk Index Class III or IV,
     2. Persistent uncontrolled diagnosed hypertension despite medications,
     3. Coagulopathy or required anticoagulant or antiplatelet medications (such as warfarin, clopidogrel (Plavix) or similar; prophylactic aspirin not exclusionary) that cannot be safely stopped in the perioperative period, Subjects meeting any of the following criteria will be excluded from participation in this study:

  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. Taking medications that may alter consciousness, the pattern of respiration, or sleep architecture as determined by the investigator.

  3. 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.

  4. Significant comorbidities that contraindicate surgery or general anesthesia:

     1. Revised Cardiac Risk Index Class III or IV,
     2. Persistent uncontrolled diagnosed hypertension 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. Any other chronic medical illness or condition that contraindicates a surgical procedure or general anesthesia in the judgment of the investigator.
  5. 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,

  6. 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.

  7. Life expectancy of less than 12 months.

  8. 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.
  9. Has an Active Implantable Medical Device (AIMD) even if the device can be temporarily turned off.
  10. Participation in another clinical study with an active treatment arm.
  11. 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® 2.1 System; System Component Genio® System 2.1 Implantable Stimulator (IS) Genio® Implantable Stimulator External Stimulator (ES) Genio® External Stimulator Disposable Patch (DP) Genio® Disposable Patch Activation Chip (AC) Genio® Activation Chip (AC) Model #2364 Charging Unit (CU) Genio® Charging Unit (CU) Model #2238 Sleep Lab Application Genio® Sleep Lab Application Smartphone Application (optional) Genio® Smartphone Application

Device: Genio System; The Genio® IS electrode placement does not require an extensive surgical manipulation of the hypoglossal nerve, it requires only a single incision site and does not require battery replacements as those are external components. Whereas UPPP surgery and other similar upper airway enlargement surgeries are much more extensive, are irreversible and tend to have more complications and modest long-term results in reducing OSA severity and symptoms. In summary, the solution offered by the Genio System to treat OSA patients with CCC using bilateral HGNS has a favorable risk-benefit ratio, as demonstrated by evidence from 2 studies.; Other Names: Genio System 2.0

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Primary Effectiveness Endpoint	The effectiveness endpoint of the study is assessed through the reduction in the severity of OSA over a period of 12 months post-implant. Primary effectiveness endpoint: percentage of responders based on a change in apnea-hypopnea index (AHI4) and oxygen desaturation index (ODI4) at 12 months post-activation. A responder is defined as any subject with a reduction of 50% in AHI4 from Baseline and a remaining AHI4 < 20 events/hour (aka "Sher Criteria"), AND 25% in ODI4 from Baseline.	The duration of the study is expected to be approximately 4.5 years.

Collaborators and Investigators

• Sponsor: Nyxoah S.A.
• Collaborators: Nyxoah Inc.
• Investigators: Study Director: Jey Subarroyan, PhD, Nyxoah S.A.

Study record dates

Study Major Dates

• Study Start (Actual): December 28, 2022
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): September 1, 2028

Study Registration Dates

• First Submitted: October 13, 2022
• First Submitted That Met QC Criteria: October 20, 2022
• First Posted (Actual): October 24, 2022

Study Record Updates

• Last Update Posted (Estimated): September 5, 2025
• Last Update Submitted That Met QC Criteria: August 27, 2025
• Last Verified: August 1, 2025

More Information

Terms related to this study

• 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-CCC2022

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