Product Review Nox T3 Home Sleep Test Device- By CareFusion

Dear Colleague:

This is my 1st go at a hands-on product report. Hope you find this useful. I don’t usually “plug” commercial products, but in this case, I couldn’t resist.

I have just had a chance to try out a new 3rd Generation Level 3 Home Sleep Study Recorder. It’s called the NOX T3, and it’s made by NOX Medical, an Icelandic Company, and distributed in Canada by

Nox T3 by Carefusion medical grade sleep Bruxism monitor
Nox T3 Home Sleep Test by CareFusion

Cardinal Health. Distributed in the US by Carefusion

The 1st generation devices (Edentrace II, Remmers SnoreSat, ApleaLINK, StarDUST) were superseded by newer 2nd generation models (Stardust II. ApneaLINK Plus, Alice PDX, Embletta and Medibyte – to name a few). Now, the 3rd generation of portable sleep recorders is upon us.

The NOX-T3 is a highly miniaturized device (see attached product brochure) that provides an astonishing array of signals, including:

  • Activity (via Actigraphy) – a poor “man’s” way of determining sleep
  • Body Position – 3 axis supine, left/right and upright
  • Airflow – pressure or thermistor or both
  • Respiratory effort – via a thoracic Z-RIP belt and an abdominal Z-Rip belt, which are then “fused and summed” into a virtual flow channel, to assist in the determination of central sleep apnea, paradoxical breathing and Cheyne-Stoke respirations
  • Snoring – there is actually a microphone which records audio all night long, to give a very accurate idea of degree of snoring
  • Oxygen Saturation – via plethysmography, and also decodes heart rate and pulse transit time

 

In addition, it can accommodate an End Tidal CO2 monitor for assessment of hypoventilation. And it is the only Level 3 device (that I am aware of) on the Canadian market that is certified for the paediatric population. Finally, it integrates with CPAP machines, and can give special reports on PAP therapy.

What’s interesting about this device is that the oximetry sensor is wireless and conveys signals to the recorder by Bluetooth, thus eliminating one area for entanglement.

  • It’s also has the ability to monitor Sub-mental muscle activity (to detect bruxism)
  • Left and Right leg activity (to detect Periodic Limb Movement Disorder
  • BiPolar Channels can monitor EMG, EEG or ECG signals

I have done 2 full night studies with it, one on a patient with mild sleep apnea using a dental splint, and one on a normal patient. After prepping the machine for a new study (and you can set it to be turned on manually, or to turn itself on and off at scheduled times), it is ridiculously easy to attach to the patient. The recorder clips to one’s sleep wear, and then the 2 Z-RIP belts are placed around the patient and attached to the recorder. The flow cannula (any brand can be used) attached to a universal filter which plugs into the recorder. Finally the wireless Bluetooth oximeter is attached.

At the completion of the study, the data is downloaded to the workstation with a USB cable, and it went flawlessly. It takes anywhere from 2-4 minutes to download a full study. The NOXTURNAL Software interface is elegant but very powerful, more along the line of full polysomnography software, but at the same time intuitive and fairly easy to use. Analysis of the data was quick (I can’t yet comment on accuracy), and the scoring can be manually corrected by a technician. I have attached a copy of my study (and yes, my dental splint needs adjusting!).

1st IMPRESSIONS:

 

PRO – While this device is very powerful, and simple to use, it does require a good understanding of sleep biology, and polysomnography. I think it is a perfect adjunct to full polysomnography, and would be most useful as an ambulatory recorder for a sleep lab. If the device is set up by a knowledgeable RRT, and the scoring done by same or an RPSGT, then it’s an amazing device. Likewise, a CPAP company that does a lot of Level 3 monitoring might want to consider this device, but I would suggest its use be limited within the company to 1 or 2 trained RRT’s who become experts at scoring on it.

The sensors and connectors are all PSG Lab pro grade, and designed accurate signal recording and transduction.

 

CON – The files are massive (1.4 GB with full audio) and thus emailing them is impossible. Stripping out the audio still gives a 100MB file size. If the studies are scored by an RPSGT, then a summary of the data can be emailed to the interpreting physician for a report. But if the files are not scored by an RPSGT, then the will need to be burned to a DVD or placed on a USB Thumb drive an couriered to the physician. One could conceive of uploading them to a “Dropbox”-like shared cloud folder, especially if the audio is stripped out.

RECOMMENDATIONS:

To date, this is the best level 3 Sleep Recorder I have seen (and used) and am thoroughly impressed at its capabilities. I would love to have the ability to use these in my new Sleep Lab alongside Level 1 studies.

It has all the capabilities one would want in an ambulatory Sleep Recorder, and more than meets the suggested guidelines for the Canadian Sleep Society/Canadian Thoracic Society.

Nox T3 home sleep test by CareFusion

It is ideal for companies that have already amassed expertise in level 3 monitoring, and have staff who are very comfortable at reviewing level 3 data and analysing it. If you are doing any work with children (ie 12 and under), this is the only game in town.

If you are interested in trialing the unit, this can be arranged via the Canadian company rep, Natalie Moran (nmorin@sleepstrategies.com) in the US contact Randy Clare (Randy.Clare@Carefusion.com)

 

Cheers

Alan Hoffman

 

====================================

Alan G.D. Hoffman, PhD, MD, FRCPC, FCCP

Internal Medicine/Critical Care Medicine/Chest Medicine

Member, American Academy of Sleep Medicine

Adjunct Professor

Sleep Disorders Consultant

Faculty of Science

Center for Respiratory Health and Sleep Science

Thompson Rivers University
Box 3010, 900 McGill Road
Kamloops, BC, Canada V2C 5N3

Tel: +1.250.732.0317

Fax: +1.250.748.7848

Email:  ahoffman@tru.ca

Support Materials

L3218_Rev_A_

Respiration Report (NoxT3-Dr.H)

loresNOXturnal_Validation[1]

Bob_Bruxism 2 (4)

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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