2. 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

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, Iceland
A 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 setup
Main Office Reykjavik, Iceland
Sales via worldwide distribution network
Very effective structure for R&D, Support, Sales and Marketing
International 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 Diagnostics
How 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 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.

8. 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

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 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

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

11. An ideal solution for pediatrics?
!!!

12. 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

13. 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 !

14. 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

15. 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.

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

17. 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)

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 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.

19. 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

20. 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

21. The Ease of Use: Noxturnal Signal View

22. 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

23. 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

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 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

25. Thank you for your attention !
Set standards  built in bluetooth
Ahead 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 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

28. 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