Overview The Nox Team – a leader in Sleep Diagnostics NOX T3 – Starting a new era in home sleep testing Easy, quick and comfortable Wireless extendibility and accessibility Advanced technology for better diagnostics Respiratory Inductance Plethysmography (RIP) technology at it’s best True audio recording and reliable snoring detection Designed as the next generation of Sleep Diagnostics The ease of using Noxturnal The next generation

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, Iceland A still well known software platform (Somnologica™ Studio and Somnologica™ Science) was engineered by a team of software developers in Iceland

Here we are ... (again): Nox Medical Company setup Main Office Reykjavik, Iceland Sales via worldwide distribution network Very effective structure for R&D, Support, Sales and Marketing International clinical advisors

“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.”

Sleep Diagnostics How much do we really need (and want)? (Astronaut John Glenn, Thesis_RCS_Methods.pdf, Internet: http://theses.ulb.ac.be/ETD-db/collection/available/ULBetd-06112008-210149/unrestricted/Thesis_RCS_Methods.pdf)

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 Data AHI – 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 view How 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.

Our Answer: NOX T3 NOX T3 - The smallest and most lightweight polygraph recorder Ease of use Quick setup Diagnostic statistics instantly available after download Latest technology to minimize cabling and patient impact Built-in data streaming capabilities via Bluetooth

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 technology Activity and Body position SpO2, Pulse (and Plethysmography) The Plus of NOX T3 1 GB Internal memory providing multiple night recordings Interface with up to 7 auxiliary devices via Bluetooth (e.g. EtCO2) 2 x bipolar channels (ExG or others) Audio from a built-in microphone

Easy, quick and comfortable The most simple hook up The minimum of straps and wires The maximum of freedom for the patient

An ideal solution for pediatrics ? !!!

Moving into a Wireless World NOX T3 receives signals wirelessly: General: up to seven auxiliary Bluetooth devices Nonin Bluetooth oximeter: eliminating the longest sensor wire in PG Nonin end tidal CO2 (EtCO2): wireless data transfer minimizing cabling Future: more and more new device generations will offer data streaming via Bluetooth to be connected to T3 Emerging feature - NOX T3 transmitting signals wirelessly: Online recordings via Bluetooth or Bluetooth / LAN / WLAN Remote access via Bluetooth or Bluetooth / LAN / WLAN

Advanced Technology - RIP Years of experience Single use RIP technology in Sleep Diagnostic for more than a decade 2007: AASM clear recommendation for RIP (superior to Piezo) Nox 2008: New and patented type of disposable RIP belts No cutting or crimping: 4 different sizes Super stretchable elastics  comfortable for patient and clinician 24k Gold plated Snap-ons  highest signal quality and proper connection Quick setup  50% time saving in preparing/training the patient The belt and clip must be available for a live demonstration !

Advanced Technology – True Audio The first Sleep Diagnostic Device with built-in microphone Full audio recording – 8 kHz sampling No additional sensors and sensor fixation required Record the sound signal with or without possible audio playback Listen to your patient Playback the true audio recording Analyze the sound Add information to snoring data from a neck piezoelectric vibration sensor and / or cannula Compare snoring data from different sources Analyze peak and average frequencies of the snoring sound  differentiate snoring in a new manner

Snoring NOISE  best assessed by audio What is snoring? “Symptom that is observed in the ear of another individual.” NOISE  best assessed by audio Why does it occur? Partial obstruction of the upper airway with increased respiratory effort causing tissue vibration.

The assessment of snoring No "gold standard" available for subjective or objective measurement of snoring A wish …

The assessment of snoring The reality … Nasal cannula and standard Piezo Snoring Sensor  semiquantitative, qualitative measurement Piezo Sensor: signal amplitude also depending on the body position Sound microphone: quantitative (decibelmeter)

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 audio Listening for two teeth grinding episodes in audio to confirm diagnosis Confirms with all the channels described in the AASM2007 manual to assess bruxism, even if is not a full polysomnography recording.

NOX T3 – Additional insights Nasal Cannula Filter  patient safety and proper long-term device functionality Safety connection to the device  prevents strangulation risk Soft material  ensures highest signal quality ( flow limitation) High-Speed standard USB connection Study download within less than a minute (including analysis) No proprietary cables required for recorder preparation / download Long term convenience No rechargeable battery lifetime limitations Easy battery door exchange

The Ease of Use: Noxturnal Overview Immediate recording results (automatic analysis) Overview Window Automatically filled Top Right Section Summary: Sleep Parameter Scale based on AASM - AHI, Snore, FLI, ODI Direct 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 trace Direct 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

The Ease of Use: Noxturnal Signal View

The Ease of Use: Noxturnal Reports Standard reports fully implemented Export capabilities to Word, Excel, pdf (one click open to MS-Word) Report customization based on existing report templates Easy workflow to design completely new reports - Quick selection of existing report sections - Ordering - Preview if hoovering over

The Ease of Use: Nox Recording Library - AHI Sorting Searching options Tag concept (columns as sort options) Custom Lists Add locations by drag and drop

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 possible Will it be a wireless future ? Remote access to device information Sleep recordings transfer via the “Cloud” Understanding sleep diagnostics as a network A new generation of Sleep Diagnostics Slide to be used only to selected distributors – taken out for the support website

Thank you for your attention ! Set standards  built in bluetooth Ahead of others  integrated sound, upcoming calibrated RIP

Backup ... Set standards  built in bluetooth Ahead of others  integrated sound, upcoming calibrated RIP

BT – Example NOX EtCO2 Interface Fits with the Nonin RespSense™ Capnography Monitor Adds full end tidal CO2 (EtCO2) signal interface to the T3 system Does not occupy any other channels of the T3 recorder No cables between recorder and EtCO2 monitor, only nasal cannula connected to the patient

WristOx2TM, Model 3150 Oximeter optimized for NOX T3 developed in co-operation with Nox Medical Designed to support the NOX T3 system. Smaller and lighter, supports pediatric usage. Simple - Elegant - Reliable