The BfArM (CA)approved the trial in Nov 2008. However, the responsible EC refused approval in March 2009.

This proof-of-concept study is to assess the potential benefit of botulinum toxin for patients with sleep-related breathing disorders.

Mono-center, double-blind, 1:1 randomized, placebo-controlled trial 18 treated patients, 9 patients per group.

Patients will be randomly assigned to treatment with NT 201 or placebo in a ratio of 1:1. In addition, within each treatment group patients will be randomly assigned to injection into the left or right soft palate.

Primary variable:

Comparison of the ratio of snoring time over sleeping time (Snoring Index). Other secondary variables will be analysed.

Inclusion Criteria:

1. Male and female outpatients of at least 18 years of age.
2. Patient who understand the nature of the study and provide written informed consent prior to protocol-specific procedures.
3. Patients suffering from sleep-related breathing disorders for at least 3 months prior to study start and seeking help for their snoring.
4. Non-REM RDI ≤ 25/h (according to Medicare Criteria) at baseline PSG.
5. AHI ≤ 10/h at baseline PSG.
6. Snoring Index ≥ 15 at baseline PSG.

Exclusion Criteria:

1. Patients with known hypersensitivity to:

   • botulinum neurotoxin type;
   • any of the excipients (human albumin, sucrose).

2. Patients with upper respiratory tract pathology as assessed by an ear, nose, and throat [ENT] specialist.

3. Patients with generalized disorders of muscle activity (e.g. myasthenia gravis, Lambert-Eaton syndrome).

4. Patients with bleeding disorders of any type and/or receiving anticoagulant therapy.

5. Patients with a profound sleep disorder (pathological number and duration of episodes of hypopnea and apnea), upper airway resistance syndrome [UARS], or obstructive sleep apnea syndrome [OSAS].

6. Obese patients (BMI ≥ 30).

7. Presence of concomitant diseases:

   • severe or unstable cardiovascular (e.g. severe angina pectoris, post myocardial infarction and ventricular extra systoles), pulmonary, or endocrine disease; clinically relevant renal or hepatic disease or dysfunction; hematological disorder; any other clinically relevant medical condition that could increase the risk to the study participant;
   • malignant disease of any kind during the previous 5 years except for successfully treated skin (basal or squamous cell) cancer;
   • amyotrophic lateral sclerosis or other diseases which result in peripheral neuromuscular dysfunction;
   • risk of developing an angle closure glaucoma;
   • alcohol, drug, or medication abuse within the past year;
   • severe psychiatric or neurological disorders;
   • acute infections of the pharynx.

8. Patients likely to need concomitant medication as follows:

   • 4-aminochinolines;
   • aminoglycosides or spectinomycin, or other medical products interfering with neuromuscular transmission, e.g. tubocurarine-type muscle relaxants;
   • daily psychotropic medication;
   • regular intake or onset of hypnotics, e.g. benzodiazepines, chloralhydrate and combinations, barbiturates (except of mild phytotherapeutics, e.g. valerian, hop and combinations);
   • anti-snoring products during the course of the study such as foams, dental devices.

9. Pregnant or nursing women, or women of childbearing potential who are not using and not willing to continue using a medically reliable method of contraception for the entire study duration, such as oral, injectable, or implantable contraceptives, or intrauterine contraceptive devices, unless they are surgically sterilized/ hysterectomized.

10. Participation in a clinical study within the last 30 days prior to the start of the study.

11. Patients who are employees, relative or spouse of the investigator, of other staff of the investigational site or the sponsor or the CRO.

12. Any donation of germ cells, blood, organs, or bone marrow during the course of the study.

13. Patients who are expected to be non-compliant and/or not cooperative.

14. Patients who are not contractually capable.