Inclusion Criteria:

1. Participant age is 22 years and older
2. Participant has failed, is unable to use, unwilling to use or dissatisfied with Positive Airway Pressure (PAP) or mandibular advancement devices (MAD)
3. Participant is diagnosed with Obstructive Sleep Apnea with an AHI ≥30 OR AHI ≥ 15 and BMI of ≥ 30 at enrollment (CA/MA ≤ 25%)
4. Participant is willing and capable of receiving the study procedure, completing all the questionnaires and returning for all follow-up evaluations and sleep studies
5. Participant is willing and capable of providing informed consent

Exclusion Criteria:

1. Participant is currently participating in other premarket investigational studies unless approved by Sponsor in writing

2. Any reason for which, in the judgment of the investigator, the participant is considered to be a poor study candidate, which may include, but is not limited to: any uncontrolled neurological, medical, social, or psychological problems that could complicate the required procedures and evaluations of the study (e.g. uncontrolled Type 1 or 2 diabetes with neuropathy, debilitating acute or chronic cardiac, lung, liver, kidney, central nervous system or psychiatric disease)

3. Participant has a BMI > 40 kg/m2 at enrollment

4. Women who are pregnant or of childbearing potential (WOCBP defined as fertile following menarche and until becoming post-menopausal unless permanently sterile) who are unwilling to practice an appropriate method of contraception from screening through 6-month follow-up.

   Concomitant Medication Exclusions

5. Participant is actively taking ACEs/ARBs for hypertension AND is either of black race, of female gender, or >65 years of age

6. Participant is actively undergoing immunotherapy (Allergy shots), and unwilling to wash out of allergy shots at least 2 weeks prior to study procedure

7. Participant is taking any of the following medications that, in the opinion of the investigator, could affect study endpoints: AD109, benzodiazepines, Z-drugs (zolpidem and eszopiclone), opiates, antipsychotics (neuroleptics), phenothiazines, and prescription stimulants (including Sunosi, Provigil, and Nuvigil)

   Significant Airway Risk Factors

8. Participants with severe uncontrolled asthma

9. Participants with a history of angioedema

10. Participants with hereditary angioedema (confirmed with a Complement Component C4 blood test <13mg/dL)

11. Participant has uncontrolled autoimmune disorders including active thyroid disease, lupus, multiple myeloma, and chronic lymphocytic leukemia that could lead to acquired angioedema

12. Participant has a history or presence of cold urticaria at the time of screening

13. Participant has a history of cryoglobulinemia or Paradoxical Adipose Hyperplasia (PAH)

14. Participant has a history of allergy to glycerin History of Oral/Airway Comorbidities/Interventions

15. Participant has a prior airway interventions that alter or excise the tissue of the soft palate or the tongue base

16. Participant has any airway intervention within 12 weeks of scheduled procedure performed to alter or excise the soft tissue of the airway or larynx

17. Participant has an active, implanted, nerve stimulator for the treatment of OSA

18. Participant has oral cancer or non-healing oral wounds

19. Participant has a history of radiation therapy to neck or upper respiratory tract

20. Participant has other severe sleep disorders that, in the opinion of the investigator, confound functional assessments of sleepiness such as narcolepsy with cataplexy, severe insomnia/insomnia secondary to chronic pain, PTSD

    Major Anatomical Exclusions

21. Participant has severe maxillary mandibular insufficiency or obvious severe fixed upper airway obstructions (tumors, polyps, nasal obstruction) that, in the opinion of the investigator, is thought to be the primary cause of OSA

22. Participant has obstructions identified at the tonsils (palatine tonsils size 3+ or 4+)

23. Participant has lingual tonsils size 4+

24. Participant has Friedman tongue position IV

25. Participant has a mandibular intermolar width < 32mm

26. Participant has trismus as defined by a maximal inter-incisal opening of < 35mm

    Significant Comorbidities that Contraindicate Surgery or General Anesthesia

27. Participant has resistant hypertension, defined as a blood pressure that remains above goal despite concurrent use of three antihypertensive agents of different classes taken at maximally tolerated doses

28. Diagnosis of any moderate to severe congestive obstructive pulmonary disease (COPD)

29. Active, severe pulmonary vascular disease (for example pulmonary arterial hypertension or pulmonary embolism).

30. Uncontrolled Diabetes (including Diabetes Mellitus [DM] or Insulin Dependent Diabetes Mellitus [IDDM]) with HbA1c >9 at time of screening.

31. Currently receiving treatment for severe cardiac valvular dysfunction, NYHA Class III or IV heart failure, unstable angina or recent (< 12 months) myocardial infarction or severe cardiac arrhythmias

32. Participants with bleeding event, known bleeding diathesis, impaired immunity for any reason, or heart attack or stroke within the last 12 months

33. Clinical evidence of severe renal failure (Stage 4 or 5) undergoing dialysis or expected to institute dialysis within 6 months

34. Participant has contraindication to general anesthesia or, in the opinion of the Investigator, would not be able to tolerate the procedure, including intubation during the procedure

    Lifestyle considerations

35. Participant is a current smoker or nicotine vaper (>1 pack/day or equivalent)

36. Participant conducts work or regular activities requiring vigilance (e.g., commercial driver, heavy machine operator, shift worker, etc.) that does not accommodate untreated OSA.

37. Participant has sleep hygiene behavior that is likely to interfere with measurement outcomes during PSG

38. Participant exhibits ongoing misuse of alcohol or recreational drugs that would impact either the results of or the participation in a sleep study