1. Explore Noxturnal 4.4
Note: This presentation is intended to summarize main changes from 3.2 up to 4.4. Detailed feature and bug fixes information for only upgrading Noxturnal 4.3 to 4.4 is addressed in the Release Bulletin for Noxturnal

2. Purpose Summary of main feature changes between Noxturnal 3.2 and 4.4
Serve as a self-training guide
Offer material for other information about Noxturnal 4.4
Explain key differentiators of Noxturnal 4.4

3. Overview Software License Implementation Device Support
A1 PSG recording setup (online and ambulatory)
T3 PG setup with enhanced workflow options (ambulatory)
Auxiliary device connections via Bluetooth and IP
User Interface Enhancements
New Scoring and Analysis Tools
New Powerful and Flexible Report Engine
Nox Calibrated RIP Technology
Extended Data Export Functionality for Scientific Users
Enhanced Network Support: Administrator / User Settings

4. Noxturnal 4 Licensing concept
60 day trial license after first installation with all functionality open
After initial 60 day period:
Full T3 functionality supported (including all analysis and reporting features)
Any other optional license requires license activation
Item Code
Item Description
Functionality (in addition to regular Nox T3 system ambulatory Polygraphy use)
Noxturnal A1 PSG File Format License
Allows to read / write / analyze / report on any kind of Nox A1 recordings (incl. video playback), enables preparation and download for ambulatory Nox A1 PSG recordings.
Noxturnal A1 Online Acquisition License
Enables online acquisition from PSG without video. At the same time it allows to read / write / analyze / report on any kind of Nox A1 recordings (incl. video playback), enables preparation and download for ambulatory Nox A1 PSG recordings.
Major A1 Licenses
Noxturnal Video Online Acquisition License
Required to add online video acquisition to regular PSG online acquisition
Noxturnal EBM PG File Format Reading License
Required to read Embla format data in polygraphy recordings directly (raw data will be kept in ebm format – no conversion)
Noxturnal EBM PSG File Format Reading License
Required to read Embla format data in Polysomnography recordings directly (raw data will be kept in ebm format – no conversion)
Noxturnal EDF File Format Reading License
Required to read EDF data (raw data will be kept in edf format – no conversion)
Optional Functionalities
Note: Specific Knowledge Base Article about License concept and License activation is available on noxmedical.com

5. Device Handling in Noxturnal

6. Supported Nox Systems Nox A1 and Nox T3 systems
Nox A1: ambulatory setup and download
Nox A1: online acquisition via BlueGiga Access Point (optional incl. video)
Nox T3: ambulatory setup and download
Noxturnal App for flexible device control and setup in all online and ambulatory. studies
BlueGiga Access-Point for Bluetooth to LAN conversation

7. Device Access and Download
General start window w/o attached device:
“View Existing Recordings”
“Start a New Recording” (to start online recordings)
Access to Analysis / Report / Device Profiles and Settings always available
Attaching a Nox A1 / T3 device:
Devices show up with SN and FW status
“Download and View Recording” to be used for downloading
“Start a New Recording” to be used for setup ambulatory recordings
Communication with devices similar to USB drive (no drivers required)

8. Nox Systems Configuration
Recording Templates combine
Recording type
Sensor selection
AUX devices (in case of ambulatory studies)
Battery selection
Recording type configuration combine
Customizable Workspaces (a combination of signal sheets)
Customizable Analysis Protocol
Customizable Report

9. Recording Templates
Recording templates for Nox devices and type of use (ambulatory vs online):
Standard Templates offered
Any required custom profiles to be created either “Based on” or as “New”
Final device preparation now faster by using prepared recording templates
Example A1: EEG / EMG and bipolar channel setup
Nox A1 and T3 Respiratory channel setup
Sensor selection for bipolar and unipolar inputs
New: Parallel recording option “Cannula and mask”
Note: Specific Knowledge Base Article for Nox T3 users on Noxturnal 4.4 is available on noxmedical.com

10. Auxiliary Device Support
Nox A1 PSG
Nox T3 PG
W7 - Interfaces (online and ambulatory)
Nox W7 – S: Sentec (TcCO2) (incl. Sentec FW 8.0)
Nox W7 – R:
ResMed S9
Radiometer (TcCO2) (models: TCM4, TCM4 Combi M, TCM40, TOSCA)
Nonin Respsense (EtCO2)
Nox EtCO2 (ambulatory)
Nonin Respsense (EtCO2)
LAN – IP direct data access to Noxturnal
TxLink (incl. EasyCare Tx 8.2) (including ResMed Air Solutions Devices)
Sentec (TcCO2) (incl. Sentec FW 8.0)
Note: Specific Knowledge Base Articles about the Integration of auxiliary devices is available on noxmedical.com

11. Nox T3 Firmware
Noxturnal: Firmware status detection and upgrade advice (if upgrade chosen  automated procedure)
Improved robustness for T3  Oximeter connection
Connection process to oximeter faster
Robust study startup connectivity to oximeter based on repeated connectivity checks and re-attempts
Likelihood of conditional boot error in oximeters greatly reduced.
Display / devices timeout is 2 minutes (previously 40 seconds).
Improved RIP signal handling
Disconnected RIP belts now displayed as flat lines.

12. User Interface Enhancements

13. User Interface Enhancements
Recording Result Page – new features
PSG View (including spectrogram)
Directly accessible artifact location (signal information)
Directly accessible period markers (enter, delete period markers)
Possibility for manual sleep scoring based on spectrogram
Direct introduction and improved visibility for “Invalid data” periods
General Sheet Layout
Quick change access to analysis start / stop synchronized with “Recording Results”
Quick introduction for all period markers (analysis, PAP, NAP …)
Quick Split screen setup and access (incl. sheet synchronization)
Special sheet templates for A1 – impedance data and TxLink
Workspace Concept
Combination of multiple sheet templates to allow for different user preferences
All additional special views owned by Workspaces

14. User Interface Enhancements
Permanent access to view / switch Scorer and Periods
New view options
Spectrogram
Flow Volume Loops
Support for Nox A1 impedance check and information
Setting Changes:
All settings unified in “Tools” – “Settings” menu
New setting available for Navigation for flip full page / half page
Others
Customizable name properties for recording folder
Customizable name properties for exported reports
Patient Document Control within the recording folder

15. Recording Results and Scorer / Window Period Access
Access and change for Scoring sessions.
Special Sleep Information (Spectrogram, Hypnogram).
Direct Print option for Results Page.
Access and change for Time Periods.

16. Periods Definition / Scoring Access in Recording Results
Manual Sleep Scoring from Spectrogram.
Definition and identification of Period markers.
“Invalid data” definition / improved period visibility.
Information: Artefact location and duration.

17. Sheet Layout, Analysis (and others) Period Markers
Access to general sheet layout options.
Analysis Start: can be easily shifted
on both shown locations.
 Synchronizes with Recording Results.
Analysis End: can be easily shifted
on both shown locations.
 Synchronizes with Recording Results.
Red bar indicates time outside of the analysis window.
All Period Markers: facilitated access and introduction (right mouse click on synchro-arrow in the time bar).

18. Split Screen and Window Synchronization
Window Split Marker (after drag and drop)
Synchronization Markers
Window length indicator
WindowSync- /
Unsync-
Option

19. Workspace Layouts and Direct Scoring Access
Workspace and Sheet templates Access
Custom Workspace
Default Workspace
Access and change for Scoring sessions

20. New View Options EEG - Spectrogram
Whole night spectrogram as special view
Quick channel selection and color scheme adjustment
Note: previously offered derived trace spectrograms still available
Visualization of inspiratory and expiratory flow and effort
Differentiation between kind and severity of obstruction
Powerful titration support
Flow-Volume-Loop and Konno-Mead Loop *
* Specific presentation for this topic is in preparation.

21. Nox A1 - Impedance Information
Impedance Check: available only during Nox A1 running online acquisition
Specific impedance test mode
Accessible via icon (only during running online recording)
Support for EEG hookup (continuous data until stop view)
Always available information:
Views: Continuous impedance data view – including numeric data
Signal labels with impedance-feedback for the (re-referenced) signal (see color of the underlining)

22. Patient Document Control Within the Recording Folder
New design for Recording properties
Attachments as part of the recording folder
All recording and patient related information with icon access
Documents can be attached to a patient:
Noxturnal derived reports with destination Recording Folder will automatically appear hear
Additional patient documents (questionnaires, insurance papers …) can be selected and copied into the Recording Folder
Result: centralized access for patient documents

23. Analysis and Scoring

24. New Analysis and Scoring Tools
Automatic Analysis
Automatic Sleep Staging
Automatic Arousal Scoring (rec. EEG and Chin–EMG)
Pulse Wave (Amplitude Drop) Analysis
Improved sound derived Snoring analysis
Automatic PAP analysis based on recorded pressure
Desaturation Detection independent from Hypopnea Desaturation Link
Manual Scoring
Visual distinction of manual vs automatic events
Powerful sleep scoring with centered epoch handling
Improved access to “Single Click Scoring”
Possibility to compare multiple sleep staging within one sheet

25. Automatic Analysis Changes - EEG
New / Enhanced Analysis
Analysis Results
Sleep Scoring (AASM classification):
C3, C4, O1, O2, 2 x Eyes, EMG Chin
Automatic scoring also possible with less or adjusted input signals
Arousal detection:
C3, C4, O1, O2, EMG Chin
Input signals selection customizable
Quality threshold scale: … … more specific / +10 … less specific

26. Analysis Changes - Others
New / Enhanced Analysis
Analysis Results
Derivation of a Set Pressure signal
Signal derived from Mask Pressure
New signal available for custom PAP reporting purposes

27. Desaturation vs. Hypopnea Detection
Independent detector for “Desaturation” vs. “Apnea/Hypopnea” (Hypopnea link to Desaturation)
Customizable Desaturation detector (AASM: default 3% drop)
ODI value based on these events scored Desaturation-Events
Link Flow Amplitude Drop (AASM: 30% drop) to Desaturation Drop (AASM: default 3%) – all customizable
Hypopneas detected by this threshold which is independent from the Desaturation-Events

28. Event Control and Sleep Scoring
Sleep Scoring Support views
Automatically centered scoring epoch
Stage score shown as automatic / manual w/ scorer information and confidence level
Start /
Stop
Scoring
Easier:
Click into the scoring bar  start ESC stop
Events with scorer information and automatic / manual differentiation

29. Nox Calibrated RIP Technology*
RIP signals vary, based on patient’s size, shape and placement of belts  RIP amplitudes must be weighted for correct flow derivation
Summation of effort signals
Estimated corrective factor (based on phase shift)
Estimated Flow Curve (RIP Flow)
Generating clear effort signals (no ECG disturbance)
Calibration for amplitude summation
Accurate Flow Curve Calculation
* Specific presentation for this topic is in preparation.

30. Nox Calibrated RIP Technology
Accurate flow information based on respiratory effort (RIP)  accurate scoring for flow limitation / hypopnea and apnea
Cannula
Flow
Calibrated
RIP Flow
Un-calibrated
RIP Flow

31. Report Engine

32. Powerful and Flexible Report Engine
Powerful custom reporting and default reports (incl. legacy reports)
Report customization in WYSIWYG editor (similar to MS-Word)
Full text formatting choices
Integrating bitmaps
Creating tables and graphic charts
Intuitive handling for report sections and interpretation notes
Creating of “any” custom variables to report on
Custom report fields based on signals and events properties
Fields show logical explanation within templates and final reports
New: “Arousal Association Table” prepared for custom reports
Import reports from custom Word templates of Embla with automatic variables interpretation
Report Export with filename and destination settings

33. Default and Custom Reports
Selection of Default Reports available
Custom Reports can get categorized and created either as “based on” or as new
User and standard default reports also accessible via Win-Explorer
All Reports fully customizable (no limitation to previous default sections)
Legacy Reports (Noxturnal 3.2) have been partly converted into the new format and will get supported (limitation apply)

34. Report Customization in WYSIWYG Editor
Complete MS-Word style report editing – create your own report library
Design your own header / footer
Design your own graphics, tables, any kind of sections , add pictures
Drag and Drop: Add / save sections as new Report Parts
Word style “look and feel”
Report categories and available sections (fully customizable)
Full text search in section names

35. Chart Customization in WYSIWYG Editor
Library of charts available to draw:
Signals and/or events
Hypnogram / Spectrogram / position like graphics
Create custom charts, format size in MS-Word style
Define titles of variables
Select required fields from the field library
Preview result
Customize color scheme and / or special chart formats
Save all your report parts and charts and organize your categories
Result

36. Custom Report Fields for Events
Derive new reportable fields based on any possible event configuration (including associations with other events and / or signal conditions)
Example: Desat Count with >= desats of 4% in Non-Supine during Sleep
Choose primary new event condition, compare expected logic to the example given at the right side
Edit step by step all required conditions (see the custom entries in blue)

37. Custom Report Fields for Signals
Derive new reportable fields based on any possible signal condition (including associations with other events)
Example: Total time with Saturation <= SpO2 in Supine during Sleep
Choose primary new signal condition, compare expected logic to the example given at the right side
Edit step by step all required conditions (see the custom entries in blue)
Select required number format

38. Custom Report Fields Used With Reports
New custom Report Fields get added to the Fields library
Search function works in the Field Library and Descriptions
Fields can get classified into existing or new categories
Fields show up with name, short description (bottom) in the WYSIWYG window as “worded logic expression” when hovering over the variable

39. Report Custom Table – Arousal Associations
Default table for Arousal Associations in Report parts
Created custom Report Fields
Created and filled Arousal Associations table
All Report Fields show up with definition within the table (hover over)
Table to be used for customizing reports (is not used in default reports !)

40. Import Word Reports from 3rd Parties
Target: Facilitate change from existing systems and reports to Noxturnal
Required: Word *.dot file and known variables definition
First implementation for Embla Reports (Somnologica / RemLogic)
Drag and Drop:
Locate *.dot file and drag it into the Report WYSIWYG window
Import of layout and bitmaps
Automatic translation of known variables into “Noxturnal-language”  Display field definition in known “worded logic expression”
Unknown variables (“?”) must be manually configured

41. Export Reporting Options
Settings Reports:
Define Name configuration for Report titles
Define Saving Location (standard is the recording folder)
Report “One Click” opening in Word
Export reports to *.pdf / *.rtf and others

42. Exporting of Data

43. Extended Data Export Functionalities
Standard export to EDF and EDF+ (and some other generic formats)
Prepared HIS communication (name change from Vlink)
HL-7 and GDT available
Customizable field associations to be configured with IT support
Customizable export for scientific use
Event / signal grid export

44. Customizable Export for Scientific Data Use
Signal and Event Grids
Signal Grid:
Signals data with time stamps and epoch info
Spectral / statistical info can be derived from signals
Formula editor for special mathematical functions
Event Grid:
Event data with time stamps and epoch info
Customizable detailed event reporting
!!! All custom “Grids” can be saved as sheet templates and exported to statistical programs.

45. Noxturnal Network Support: Administrator and User settings *
Simplified administrator and user settings
Network / Computer Administrator in Noxturnal Admin mode
Define (and lock) general settings
Define access to user settings
Enable / disable user access to configurations / reports etc.
User settings
Settings on local machine per user
Roaming user profiles within networks (regardless of network computer the user will open Noxturnal with his user privileges)
* Knowledge base article available on noxmedical.com

46. For more information go to www. noxmedical
For more information go to and search for more detailed knowledge base articles
Set standards  built in bluetooth
Ahead of others  integrated sound, upcoming calibrated RIP