K Number
K103179
Device Name
PRELUDE II TOUNGE SUSPENSION SYSTEM
Date Cleared
2010-12-20

(53 days)

Product Code
Regulation Number
872.5570
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP AuthorizedThirdparty
Intended Use
The Siesta Medical, Inc. PRELUDE II Tongue Suspension System is intended to be used for anterior advancement of the tongue base by means of a bone screw threaded with suture. It is indicated for the treatment of mild or moderate obstructive sleep apnea (OSA) and /or snoring.
Device Description
The PRELUDE II Tongue Suspension System is designed for anterior tongue base suspension by fixation of the soft tissue of the tongue base to the mandible bone using a bone screw and suture. The PRELUDE II Tongue Suspension System consists of a pair of suture passers pre-loaded with size 2.0 braided polyester suture, a titanium bone screw that is pre-mounted on an inserter, a bone screw lock tool, and size 1 monofilament polypropelyne suspension suture.
More Information

Not Found

No
The device description and performance studies focus on mechanical components and their physical properties, with no mention of AI or ML.

Yes
The device is intended for the treatment of mild or moderate obstructive sleep apnea (OSA) and/or snoring, which are medical conditions, and it uses a physical intervention (suspension of the tongue base) to achieve this treatment.

No
The device is described as a system for anterior advancement of the tongue base for treating obstructive sleep apnea and snoring, which is a therapeutic function, not a diagnostic one.

No

The device description explicitly lists hardware components such as suture passers, bone screws, and tools, indicating it is a physical medical device, not software-only.

Based on the provided information, the Siesta Medical, Inc. PRELUDE II Tongue Suspension System is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • Intended Use: The intended use is for the treatment of mild or moderate obstructive sleep apnea (OSA) and/or snoring by physically suspending the tongue base. This is a therapeutic intervention performed directly on the patient's body.
  • Device Description: The device consists of surgical components (suture passers, bone screw, suture) used for a surgical procedure.
  • Lack of IVD Characteristics: There is no mention of the device being used to examine specimens derived from the human body (like blood, urine, tissue) to provide information for diagnosis, monitoring, or screening.

IVD devices are used outside the body to analyze samples for diagnostic purposes. This device is used inside the body for a therapeutic purpose.

N/A

Intended Use / Indications for Use

The Siesta Medical, Inc. PRELUDE II Tongue Suspension System is intended to be used for anterior advancement of the tongue base by means of a bone screw threaded with suture. It is indicated for the treatment of mild or moderate obstructive sleep apnea (OSA) and /or snoring.

Product codes

ORY

Device Description

The PRELUDE II Tongue Suspension System is designed for anterior tongue base suspension by fixation of the soft tissue of the tongue base to the mandible bone using a bone screw and suture. The PRELUDE II Tongue Suspension System consists of a pair of suture passers pre-loaded with size 2.0 braided polyester suture, a titanium bone screw that is pre-mounted on an inserter, a bone screw lock tool, and size 1 monofilament polypropelyne suspension suture.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

tongue base, mandible bone

Indicated Patient Age Range

Not Found

Intended User / Care Setting

Not Found

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

This submission supports the position that the Siesta Medical, Inc. PRELUDE II Tongue Suspension System is substantially equivalent to the PRELUDE Tongue Suspension System [K101060]. The 510(k) notice contains summaries of in vitro studies (Suture Endurance Test, Bone Screw Torque Strength Test, and Bone Screw Fixation Strength Test) that were conducted to evaluate the performance characteristics of the PRELUDE II Tongue Suspension System. The data presented demonstrate that the performance characteristics of the PRELUDE II Tongue Suspension System compare favorably to the predicate device. The single patient use components of the PRELUDE II Tongue Suspension System are provided sterile.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

K101060

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 872.5570 Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea.

(a)
Identification. Intraoral devices for snoring and intraoral devices for snoring and obstructive sleep apnea are devices that are worn during sleep to reduce the incidence of snoring and to treat obstructive sleep apnea. The devices are designed to increase the patency of the airway and to decrease air turbulence and airway obstruction. The classification includes palatal lifting devices, tongue retaining devices, and mandibular repositioning devices.(b)
Classification. Class II (special controls). The special control for these devices is the FDA guidance document entitled “Class II Special Controls Guidance Document: Intraoral Devices for Snoring and/or Obstructive Sleep Apnea; Guidance for Industry and FDA.”

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Image /page/0/Picture/0 description: The image shows the logo for Siesta Medical. The logo is in black and white and features the word "SIESTA" in large, bold letters with a line above it. Below "SIESTA" is the word "MEDICAL" in smaller, block letters.

Image /page/0/Picture/1 description: The image contains a handwritten string of alphanumeric characters. The string appears to be "K103179". The characters are written in a casual, slightly slanted style, with varying stroke thicknesses. The background is plain and white.

DEC 2 0 2010

Attachment 2 510(k) Summary (per 21CRF 807.92)

General Company Information
Name:Siesta Medical, Inc.
Contact:Michael Kolber
Vice President, Regulatory Affairs
Address:101 Church Street, Suite 3
Los Gatos, CA 95030
Telephone:408-505-6626
Fax:408-399-7600
Date Prepared:December 1, 2010
General Device Information
Product Name:PRELUDE II Tongue Suspension System
Common Name:Bone Screw System
Classification:21CFR872.5570; Intraoral devices for snoring and intraoral
devices for snoring and obstructive sleep apnea.
Device Class:Class II
Product Code:ORY
Predicate Device
ManufacturerDevice Name510(k) Number
Siesta Medical, Inc.PRELUDE Tongue
Suspension SystemK101060
DescriptionThe PRELUDE II Tongue Suspension System is designed for anterior tongue base suspension by fixation
of the soft tissue of the tongue base to the mandible bone using a bone screw and suture. The PRELUDE
II Tongue Suspension System consists of a pair of suture passers pre-loaded with size 2.0 braided
polyester suture, a titanium bone screw that is pre-mounted on an inserter, a bone screw lock tool, and
size 1 monofilament polypropelyne suspension suture.
Intended Use (Indications)The Siesta Medical, Inc. PRELUDE II Tongue Suspension System is intended to be used for anterior
advancement of the tongue base by means of a bone screw threaded with suture. It is indicated for the
treatment of mild or moderate obstructive sleep apnea (OSA) and /or snoring.
Substantial EquivalenceThis submission supports the position that the Siesta Medical, Inc. PRELUDE II Tongue Suspension
System is substantially equivalent to the PRELUDE Tongue Suspension System [K101060].
The 510(k) notice contains summaries of in vitro studies (Suture Endurance Test, Bone Screw Torque
Strength Test, and Bone Screw Fixation Strength Test) that were conducted to evaluate the performance
characteristics of the PRELUDE II Tongue Suspension System. The data presented demonstrate that the
performance characteristics of the PRELUDE II Tongue Suspension System compare favorably to the
predicate device. The single patient use components of the PRELUDE II Tongue Suspension System are
provided sterile.
ConclusionsSiesta Medical, Inc. believes that the information provided demonstrates that the proposed device is
substantially equivalent to the predicate device and does not raise any new issues of safety or efficacy.
Based on the indications for use, technological characteristics, and comparison to the predicate device,
the PRELUDE II Tongue Suspension System has been shown to be substantially equivalent to predicate
device as described under the Federal Food, Drug and Cosmetic Act.

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Image /page/1/Picture/0 description: The image shows the logo for the Department of Health & Human Services USA. The logo consists of a circular seal with the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" arranged around the perimeter. Inside the circle is an abstract symbol resembling an eagle or bird in flight, composed of three curved lines.

DEPARTMENT OF HEALTH & HUMAN SERVICES

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Mr. Michael Kolber Vice President, Regulatory Affairs Siesta Medical, Incorporated 101 Church Street. Suite 3 Los Gatos, California 95030

DEC 2 0 2010

Re: K103179

Trade/Device Name: Siesta Medical, Incorporated PRELUDE II Tongue Suspension System Regulation Number: 21 CFR 872.5570 Regulation Name: Intraoral Devices for snoring and Intraoral Devices for Snoring And Obstructive Sleep Apnea Regulatory Class: II Product Code: OR Y Dated: December 6, 2010

Received: December 7, 2010

Dear Mr. Kolber:

We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations. Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Page 2 - Mr. Kolber

Enclosure

Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to

http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled, "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportalProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

Sincerely yours,

Jh for

Anthony D. Watson, B.S., M.S., M.B.A. Director Division of Anesthesiology, General Hospital, Infection Control and Dental Devices Office of Device Evaluation Center for Devices and Radiological Health

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Image /page/3/Picture/0 description: The image shows the words "SIESTA MEDICAL" stacked on top of each other. The word "SIESTA" is in a larger font than the word "MEDICAL". There is a line above the word "SIESTA". The text is in all caps.

Indications for Use

DEC 2 0 2010

510(k) Number (if known): K103179

Device Name: Siesta Medical, Inc PRELUDE II Tongue Suspension System

Indications for Use: The Siesta Medical, Inc. PRELUDE II Tongue Suspension System is intended to be used for anterior advancement of the tongue base by means of a bone screw threaded with suture. It is indicated for the treatment of mild or moderate obstructive sleep apnea (OSA) and /or snoring.

| Prescription Use
(Part 21 CFR 801 Subpart D) | X | AND/OR | Over-The-Counter Use
(21 CFR 801 Subpart C) | |

--------------------------------------------------------------------------------------------------------------

(PLEASE DO NOT WRITE BELOW THIS LINE-CONTINUE ON ANOTHER PAGE IF NEEDED)

Signature

(Division Sign-Off)

Concurrence of CDRH, Division of Anesthesiology, General Hospital

Division of Device Evaluations (ODE)

Infection Control, Dental Devices

510(k) Number:K103179
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