Explore Noxturnal 4.4 Note: This presentation is intended to summarize main changes from 3.2 up to...

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 4.4..

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 Purpose

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 Overview

Noxturnal 4 Licensing concept Item CodeItem DescriptionFunctionality (in addition to regular Nox T3 system ambulatory Polygraphy use) 53 40 10 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. 53 60 10 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. 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 53 60 11 Noxturnal Video Online Acquisition License Required to add online video acquisition to regular PSG online acquisition 53 61 10 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) 53 61 12 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) 53 61 11 Noxturnal EDF File Format Reading License Required to read EDF data (raw data will be kept in edf format no conversion) Major A1 Licenses Optional Functionalities Note: Specific Knowledge Base Article about License concept and License activation is available on noxmedical.com

DEVICE HANDLING IN NOXTURNAL

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 Supported Nox Systems BlueGiga Access-Point for Bluetooth to LAN conversation Noxturnal App for flexible device control and setup in all online and ambulatory. studies

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)

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 Nox Systems Configuration

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 Sensor selection for bipolar and unipolar inputsNew: Parallel recording option Cannula and mask Example A1: EEG / EMG and bipolar channel setup Nox A1 and T3 Respiratory channel setup Note: Specific Knowledge Base Article for Nox T3 users on Noxturnal 4.4 is available on noxmedical.com

Nox EtCO2 (ambulatory) Nonin Respsense (EtCO2) 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) Auxiliary Device Support Nox T3 PGNox A1 PSG 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

Nox T3 Firmware 1.5.1.4060 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.

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 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 User Interface Enhancements

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.

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.

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).

Split Screen and Window Synchronization Synchronization MarkersWindow length indicator Window Sync- / Unsync- Option Window Split Marker (after drag and drop)

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

New View Options Whole night spectrogram as special view Quick channel selection and color scheme adjustment Note: previously offered derived trace spectrograms still available EEG - Spectrogram 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.

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)

Patient Document Control Within 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 New design for Recording properties Attachments as part of the recording folder

ANALYSIS AND SCORING

Automatic Analysis Automatic Sleep Staging Automatic Arousal Scoring (rec. EEG and ChinEMG) 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 New Analysis and Scoring Tools

Automatic Analysis Changes - EEG New / Enhanced AnalysisAnalysis 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: -10 +10 -10 more specific / +10 less specific

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

Desaturation vs. Hypopnea Detection 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 Independent detector for Desaturation vs. Apnea/Hypopnea (Hypopnea link to Desaturation)

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

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

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

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 Powerful and Flexible Report Engine

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)

Report Customization in WYSIWYG Editor Word style look and feel Report categories and available sections (fully customizable) Full text search in section names 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

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

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)

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

Explore Noxturnal 4.4 Note: This presentation is intended to summarize main changes from 3.2 up to...

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