Nox T3 Portable Sleep Monitor – Product Review

The Nox T3 portable sleep monitor received FDA 510K clearance and was introduced for sale in the United States in 2009. This small but powerful device was designed by a team of engineers from Nox Medical in Reykjavík Iceland to address an epidemic of undiagnosed sleep apnea patients.  Epidimiological studies indicate that the population of patients with obstructive sleep apnea and daytime sleepiness are as high as 7% of the general population. As it happened the introduction of the Nox T3, in the United States, could not have happened at a better time for patients and the clinicians seeking to help them.

“the prevalence of obstructive sleep apnea associated with accompanying daytime sleepiness is approximately 3 to 7% for adult men and 2 to 5% for adult women in the general population. Disease prevalence is higher in different population subsets, including overweight or obese people, those of a minority race, and older individuals.”[1] American Thoracic Society

Home Sleep Testing

Until the release of the Nox T3, the over riding standard for sleep diagnostics was the in lab sleep study ordered by a physician and monitored in the hospital or private lab by a sleep technologist. In the United States this care has a high cost and the study requires an overnight stay in a sleep lab which can be inconvenient. Home sleep testing is not intended to replace the in lab test however if a patient suffers from Sleep Apnea home sleep testing meets the clinical standard for diagnosis (A_Pilot_Validation_Study_for_the_Nox_T3_Portable_Monitor_as_a_Screener_for_OSA) according to the AAST guidelines:

“Out of center sleep testing (OCST) can be used as an alternative to full, attended polysomnography (PSG) for the diagnosis of obstructive sleep apnea (OSA) in adult patients meeting clinical eligibility criteria. In order to determine eligibility, a comprehensive sleep evaluation is necessary. OCST may be used as an alternative to polysomnography for the diagnosis of OSA when there is a high pretest probability of moderate to severe OSA. “ [2]American Association of Sleep Technologists

AASM Guidelines

The most important consideration for home sleep testing equipment is the number of channels collected and adherence to the diagnostic guidelines as established by the American Academy of Sleep Medicine (AASM). This is critical because insurers and clinicians alike rely on these standards as a method of monitoring testing quality and ultimately qualification for reimbursement. In my opinion a portable sleep monitor that meets the AASM guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients[3], is a minimum standard. The Nox T3 with 18 channels meets this requirement easily.

AASM minimum home sleep test technology

List of Nox T3 Channels and the source sensor

  • Thorax Breathing Effort (RIP)
  • Abdomen Breathing Effort (RIP)
  • Respiratory Sound (Mic)
  • Audio Volume (Mic)
  • Gravity (3D axis, x, y, z)
  • Oxygen saturation levels (wireless oximeter)
  • Pulse (wireless oximeter)
  • Plethysmograph (wirelss oximeter, necessary for PTT)
  • ExG 1 (general purpose bipolar input channel)
  • ExG 2 (general purpose bipolar input channel)
  • Nasal or mask pressure (pressure transducer)
  • Calibrated RIP Sum (the sum of the RIP belts)
  • Calibrated RIP Phase (the phase difference between the abdoment and thorax belts)
  • Calibrated RIP flow (derived from the sum of the RIP belts and is a good substitute for nasal flow)
  • Activity (accelerometer)
  • Position (accelerometer)
  • Flow (nasal pressure)
  • Snore (nasal pressure)

Nox Medical

The development team at Nox Medical in Iceland have an extensive background in sleep diagnostics. The motto of the organization is “Sleep For All” a core value which has motivated the employees of Nox Medical since the company was founded. The approach to sleep diagnosis and therapy has changed a great deal in the last 10 years. The Nox T3 is predominantly used to diagnose adults with symptoms of sleep disordered breathing. It was originally designed to address pediatric populations and remains the only level three portable sleep monitor with FDA clearance for patients aged 2 years through adult.

As access to professional diagnostic information becomes more accessible improved access to care is helping introduce sleep  therapy to larger range of providers than was previously possible.

The response to the Nox T3 globally has been very strong with over 12,000 devices sold since 2009. An estimated 2 million patients, of all ages, are diagnosed annually with the Nox T3 portable sleep monitor. In 2016 the government of Iceland recognized Nox Medical for its contribution, not only to the global medical industry, but also to the economy of Iceland. For more click here

Nox T3 has the capability using EMG channels of monitoring the clenching and grinding of a patients teeth known as sleep bruxism.  The scoring algorithm will calculate an Apnea Bruxism Index (ABI) closing a recognized gap in sleep diagnostics, the oral cavity.

AASM Sleep Bruxism Scoring Rules

Dental practitioners are rapidly introducing sleep apnea dentistry to their practices. Therapies provided in addition to oral appliances include body position, weight loss and ongoing management as part of bi annual dental appointments. The use of a portable sleep monitor to titrate an oral appliance or evaluate continued efficacy for a patient currently under care is a critical part of a dental sleep apnea management program.

“HST’s make it possible to objectively check, modify appliance titration when necessary, and objectively recheck how well titration efforts are working; while the patient sleeps in their own bed, in the manner they are accustomed to sleeping. The information deemed with an HST is also helpful when dealing with residual supine related apnea. Body position is critical to the treatment of a Sleep Apnea patient with an oral appliance. “[4]– John Viviano DDS

The Noxturnal software is the heart of the Nox T3 system. When the Nox T3 is connected to the computer via USB cable. It takes less than a minute to download the sleep data from the recorder. Auto scoring analysis takes another minute or so. Autoscore can be discarded and the study can easily be scored maunally by a registered sleep technologist or the study can be imported into a sleep system that will read .EDF files and the study can be scored.

Key to any portable sleep monitor protocol is ease of use for the patient. The Nox T3 requires only five connection points. Two belts, and a nasal cannula; the pulse oximeter connects via blue tooth so it doesn’t require a connection. This makes the patient experience very easy. See the video below.

Summary

In Summary the Nox T3 is a portable sleep monitor that can be used to support sleep diagnostic best practice models. The wide range of configurations and the ongoing R&D efforts make this a device that will hold up over time. Ease of use and low cost per test make this device user friendly with a very gentle learning curve.

[1] Proc Am Thorac Soc. 2008 Feb 15; 5(2): 136–143. doi:  10.1513/pats.200709-155MG

[2] American Academy of Sleep Technologists, Out of Center Sleep Testing (OCST) – Updated July 2012  retrieved from https://go.aastweb.org/Resources/Guidelines/OCSTguide.pdf

[3] Collop NA, et al. Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Journal of Clinical Sleep Medicine, 2007;3:737-47

[4] Titration End Point; What standard of Care are you striving for? – April 29, 2015  retrieved from http://www.thesleepandrespiratoryscholar.com/titration-end-point-what-standard-of-care-are-you-striving-for

Resources

 

CareFusion Estore

StattDDS

Whip Mix

Homesleepstudy.com

DDMEOnline

Nox Academy

 

Randy Clare

Randy Clare

Randy Clare brings to The Sleep and Respiratory Scholar more than 25 years of extensive knowledge and experience in the sleep and pulmonary function field. He has held numerous management positions throughout his career and has demonstrated a unique view of the alternate care diagnostic and therapy model. He is considered by many an expert in the use of a Sleep Bruxism Monitor in a dental office. He is also very involved with physician office spirometry for the early detection of COPD and Asthma

Mr. Clare’s extensive sleep industry experience assists Sleep Scholar in providing current, relevant, data-proven information on sleep diagnostics and sleep therapies that are effective for the treatment of sleep disorders.

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