2 Overview The Nox Team – a leader in Sleep Diagnostics NOX T3 – Starting a new era in home sleep testingEasy, quick and comfortableWireless extendibility and accessibilityAdvanced technology for better diagnosticsRespiratory Inductance Plethysmography (RIP) technology at it’s bestTrue audio recording and reliable snoring detectionDesigned as the next generation of Sleep DiagnosticsThe ease of using NoxturnalThe next generation
3 It‘s been more than a decade that ... Market leading sleep diagnostics was driven by “Icelanders”Sleep diagnostic hardware developed in Iceland got to a standard in Polygraphy (Embletta®) and Polysomnography (A10, N/S Series)Single use RIP technology was introduced to Sleep Diagnostics – designed at Flaga, IcelandA still well known software platform (Somnologica™ Studio and Somnologica™ Science) was engineered by a team of software developers in Iceland
4 Here we are ... (again): Nox Medical Company setupMain Office Reykjavik, IcelandSales via worldwide distribution networkVery effective structure for R&D, Support, Sales and MarketingInternational clinical advisors
5 “Nox in Roman mythology is the goddess of the night. A shadowy figure, Nox stood at or near the beginning of creation, and was the mother of personified gods such as Hypnos (sleep) and Thánatos (death).Her appearances in mythology are sparse, but reveal her as a figure of exceptional power and beauty.”
6 Sleep DiagnosticsHow much do we really need (and want)? (Astronaut John Glenn, Thesis_RCS_Methods.pdf, Internet:
7 PG – Speed, Ergonomics and Reliable Data How small can a recorder be?How many belts and straps around the patient are needed?How can we maximize patient comfort?Reliable DataAHI – is there a reliable backup signal for the flow available?Snore – how reliable is the snore analysis?What additional information is available (e.g. flow limitation)?Cost efficiency – from a user’s point of viewHow much time do I need to hook up a patient?How can I ensure best the success of the study?How quickly can I get my data analyzed and reported?One of the reasons to be reluctant for HST was the reliability of studies and data. If this can be ensured and it is more cost efficient than PSG – the world will move this way.
8 Our Answer: NOX T3NOX T3 - The smallest and most lightweight polygraph recorderEase of useQuick setupDiagnostic statistics instantly available after downloadLatest technology to minimize cabling and patient impactBuilt-in data streaming capabilities via Bluetooth
9 NOX T3 Overview “Standard” PG Requirements The Plus of NOX T3 Nasal cannula flow (and mask pressure)Abdomen and Thorax respiratory effort and derived flow from RIP technologyActivity and Body positionSpO2, Pulse (and Plethysmography)The Plus of NOX T31 GB Internal memory providing multiple night recordingsInterface with up to 7 auxiliary devices via Bluetooth (e.g. EtCO2)2 x bipolar channels (ExG or others)Audio from a built-in microphone
10 Easy, quick and comfortable The most simple hook upThe minimum of straps and wiresThe maximum of freedom for the patient
12 Moving into a Wireless World NOX T3 receives signals wirelessly:General: up to seven auxiliary Bluetooth devicesNonin Bluetooth oximeter: eliminating the longest sensor wire in PGNonin end tidal CO2 (EtCO2): wireless data transfer minimizing cablingFuture: more and more new device generations will offer data streaming via Bluetooth to be connected to T3Emerging feature - NOX T3 transmitting signals wirelessly:Online recordings via Bluetooth or Bluetooth / LAN / WLANRemote access via Bluetooth or Bluetooth / LAN / WLAN
13 Advanced Technology - RIP Years of experienceSingle use RIP technology in Sleep Diagnostic for more than a decade2007: AASM clear recommendation for RIP (superior to Piezo)Nox 2008: New and patented type of disposable RIP beltsNo cutting or crimping: 4 different sizesSuper stretchable elastics comfortable for patient and clinician24k Gold plated Snap-ons highest signal quality and proper connectionQuick setup 50% time saving in preparing/training the patientThe belt and clip must be available for a live demonstration !
14 Advanced Technology – True Audio The first Sleep Diagnostic Device with built-in microphoneFull audio recording – 8 kHz samplingNo additional sensors and sensor fixation requiredRecord the sound signal with or without possible audio playbackListen to your patientPlayback the true audio recordingAnalyze the soundAdd information to snoring data from a neck piezoelectric vibration sensor and / or cannulaCompare snoring data from different sourcesAnalyze peak and average frequencies of the snoring sound differentiate snoring in a new manner
15 Snoring NOISE best assessed by audio What is snoring? “Symptom that is observed in the ear of another individual.”NOISE best assessed by audioWhy does it occur? Partial obstruction of the upper airway with increased respiratory effort causing tissue vibration.
16 The assessment of snoring No "gold standard" available for subjective or objective measurement of snoringA wish …
17 The assessment of snoring The reality …Nasal cannula and standard Piezo Snoring Sensor semiquantitative, qualitative measurementPiezo Sensor: signal amplitude also depending on the body positionSound microphone: quantitative (decibelmeter)
18 NOX T3 and Bruxism The Nox T3 can be used to reliably assess bruxism Measure 1-2 channel of EMG activity (chin and/or masseter muscle)Exclude other orofacial activity such as sighing and coughing by listening to audioListening for two teeth grinding episodes in audio to confirm diagnosisConfirms with all the channels described in the AASM2007 manual to assess bruxism, even if is not a full polysomnography recording.
19 NOX T3 – Additional insights Nasal CannulaFilter patient safety and proper long-term device functionalitySafety connection to the device prevents strangulation riskSoft material ensures highest signal quality ( flow limitation)High-Speed standard USB connectionStudy download within less than a minute (including analysis)No proprietary cables required for recorder preparation / downloadLong term convenienceNo rechargeable battery lifetime limitationsEasy battery door exchange
20 The Ease of Use: Noxturnal Overview Immediate recording results (automatic analysis)Overview WindowAutomatically filledTop Right Section Summary: Sleep Parameter Scale based on AASM - AHI, Snore, FLI, ODIDirect manual adjustment for analysis time --> all parameters get adjusted automatically (Drive Report based on the current analysis time)Quick overview to certain signals and events / "events"Statistical summary on the signal / event data on the right hand side of each traceDirect summary for signal quality on the most important signals (SpO2, Airflow, Effort)Signals and events / "events" also shown as diagrams when hoovering over the signal name
22 The Ease of Use: Noxturnal Reports Standard reports fully implementedExport capabilities to Word, Excel, pdf (one click open to MS-Word)Report customization based on existing report templatesEasy workflow to design completely new reports- Quick selection of existing report sections- Ordering- Preview if hoovering over
23 The Ease of Use: Nox Recording Library - AHI SortingSearching optionsTag concept (columns as sort options)Custom ListsAdd locations by drag and drop
24 More to come … Does the traditional sleep diagnostics change ? … Ambulatory sleep testing to increase… Small systems for the ease of use… Polysomnography to become as convenient as possibleWill it be a wireless future ?Remote access to device informationSleep recordings transfer via the “Cloud”Understanding sleep diagnostics as a networkA new generation of Sleep DiagnosticsSlide to be used only to selected distributors – taken out for the support website
25 Thank you for your attention ! Set standards built in bluetoothAhead of others integrated sound, upcoming calibrated RIP
26 Backup ... Set standards built in bluetooth Ahead of others integrated sound, upcoming calibrated RIP
27 BT – Example NOX EtCO2 Interface Fits with the Nonin RespSense™ Capnography MonitorAdds full end tidal CO2 (EtCO2) signal interface to the T3 systemDoes not occupy any other channels of the T3 recorderNo cables between recorder and EtCO2 monitor, only nasal cannula connected to the patient
28 WristOx2TM, Model 3150 Oximeter optimized for NOX T3 developed in co-operation with Nox MedicalDesigned to support the NOX T3 system.Smaller and lighter, supports pediatric usage.Simple - Elegant - Reliable