NorthEast Monitoring, Inc. advancing Holter technology™ DR180+ 3-CH Holter Recorder  DR200/HE Holter Recorder  Holter LX Analysis Software A NEW DEVICE FOR HOME SCREENING OF OBSTRUCTIVE SLEEP APNEA USING HOLTER OXIMETRY Jordan C. Stern, M.D. Redmond Shouldice, Ph.D. Scott Gold, M.D. Robert Pincus, M.D. Conor Heneghan, Ph.D.  OxyHolter Recorder  LX Sleep Software  12-Lead Recorder  DR200/E Event Recorder  LX Event Software  Industry-leading 3-year warranty NorthEast Monitoring, Inc. Two Clock Tower Place, Suite 555 Maynard, MA 01754 U.S.A. www.nemon.com

NorthEast Monitoring, Inc. ABSTRACT Purpose: This report describes the use of two new devices for screening of obstructive sleep apnea syndrome (OSAS). Holter apnea monitoring (continuous electrocardiogram recording) and Holter oximetry (continuous electrocardiogram recording and continuous pulse oximetry) were used on patients in the home setting to diagnose OSAS. We describe the reliability of these devices used in the unattended home environment. Method: The Holter apnea monitor produces an apnea hypopnea index (AHI) based on an automated processing method of a continuous electrocardiogram...

NorthEast Monitoring, Inc. MATERIALS AND METHODS Over a 10 month period from March 2006 to January 2007, a total of 64 patients presenting with clinical manifestation obstructive sleep apnea (in an otolaryngology practice), were offered a home sleep apnea screening test using the new screening devices. Fourteen patients were tested with the Del Mar Reynolds Lifescreen Apnea device (Del Mar Reynolds, Inc. 1 Ames Court, Plainview NY 11803 USA) and 46 patients were tested using the NEMON OxyHolter DR 180+ recorder (NorthEast Monitoring-NEMON, Maynard Mass, USA). There were 4 children (ages 6, 7,...

NorthEast Monitoring, Inc. rate of less than 1%. RR intervals are defined as the interval between successive QRS detection points. Suspect RR-intervals were found by applying a 5 point median filter; automatic interpolation/deletion was performed. An interval-based RR sequence (60 second epoch length) power spectral density (PSD) estimate was calculated. The sequence was zero-padded to length 256. Averaging of four adjacent frequency bins yielded a 64-point PSD estimate of which the first 32 points were used as features. The time domain features used were the first five serial correlation coefficients,...

NorthEast Monitoring, Inc. We noted that oximetry data was completely absent in 1 patient. In 12% of cases oximetry data was absent greater than 50% of the study time, and in 27% of cases oximetry data was absent 20% of the study time. The absence of data was caused by movement artifact of the finger probe during sleep. Patients were free to add comments on the questionnaire regarding their experience with the device. Three patients had written comments: One that the device was “awkward”, one complained about chest electrodes discomfort, and one suspected more awakenings due to the device. DISCUSSION...

NorthEast Monitoring, Inc. and not likely to be cost effective. In one study 33% of unattended home PSGs were too unreliable and in 11% of cases had discordant results.15 Simpler home screening devices are often less reliable but easier to use by patients. We believe that the Holter oximeter represents a very promising new method of screening for OSAS in the unattended home environment. It is especially promising in the pediatric population where the most common screening device has been pulse oximetry alone. Many studies have evaluated pulse oximetry alone as a measure of OSAS. This method has...

NorthEast Monitoring, Inc. CONCLUSION This report has described the clinical use of a new technology to diagnose obstructive sleep apnea in an unattended home setting. It uses time tested inexpensive devices (Holter and pulse oximetry) to produce a reliable and sensitive measure of the Apnea Hypopnea Index (AHI). Compared to other tests currently used for home screening of sleep apnea it has a very high reliability rate (100% in our series of 64 patients), and correlates very well with PSG. It should become a first line screening tool for OSAS in the adult population. As results of further testing...

NorthEast Monitoring, Inc. REFERENCES: 1 Young T, Palta M, DempseyJ, et al. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;32:1230-5. 2 Young T, Evans L, Finn l, et al. Estimation of the clinically diagnosed proportion of sleep apnea syndrome in middle-aged men and women. Sleep 1997; 20; 705-6 3 Gislason T and Benediktsdottir B. Snoring, apneic episodes, and nocturnal hypoxemia among children 6 months to 6 years old. Chest 1995;107;963-6 4 Ali NJ, Pitson D, Stradling JR. Snoring, sleep disturbance and behaviour in 4-5 year olds. Arch Dis Child 1993;68;360-6...

NorthEast Monitoring, Inc. 15 Portier F, Portmann A, Czernichow P, et al. Evaluation of home versus laboratory polysomnography in the diagnosis of sleep apnea syndrome. Am J Resp Crit Care Med 2000;162; 814-818 16 Whittle AT, Finch SP, Mortimore IL, et al. Use of home studies for diagnosis of the sleep apnea/hypopnea syndrome. Thorax 1997; 52;1068-1073 17 Redline S, Tosteson T, Boucher MA, et al. Measurement of sleep-related breathing disturbances in epidemiologic studies: assessment of the validity and reproducibility of a portable monitoring device. Chest 1991; 100;1281-1286 18 Kiely JL, Delahunty...