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Lifelines R40 Integration to Nox A1s PSG Systems

Introduction

Welcome to the support guide for integrating and using the Lifelines R40 EEG amplifier with Noxturnal software. This document will walk you through the essential steps needed to set up, configure, and effectively use the Lifelines R40 amplifier alongside the Nox A1s and Nox C1 devices. By following this guide, you will ensure a smooth setup and operation, enabling accurate and efficient data recording during sleep studies.

Note: Noxturnal 7.1 and latest Nox A1s and C1 firmware are required for the integration of the Lifelines R40 Neuro amplifier. 

Set-up the Lifelines R40: 

  • The Lifelines R40 will come with a USB cable. Connect the R40 via the cable to the rear of the Nox C1. 

Set-up the R40 Device in Noxturnal

Step 1: Access the Device Menu

  • Open Noxturnal software and navigate to the Device menu.
  • Select the specific room where you intend to add the R40 device.

Step 2: Add the R40 Device

  • In the device menu, click on “Add Device.”
  • From the list of available devices, select “LifeLines R40” as the device type.
  • Assign a unique name to the device (e.g., R40 #001). This makes it easier to manage and identify devices compared to using serial numbers. Tip, use a label maker to add the unique name to the device if you plan to move the device between rooms. 
  • Confirm the device has been added to the room.

Lifelines R40 Online Room Configuration.mp4

  • Ensure that the minimum required devices for a PSG study are present in the room. For a standard PSG with 10-20 EEG, the room will require: 
    • Nox C1
    • Nox A1s 
    • Lifelines R40 
    • Nonin Oximeter 3150BLE 
    • Video camera 

Supported Channels at Launch

At launch with Noxturnal 7.1, the R40 supports recording EEG, EOG, chin EMG, and two additional bipolar channels. The Nox A1s will record the other signals, but the unipolar inputs on the A1s will be disabled during this configuration.

  • The Lifelines Neuro’s R40 EEG Amplifier allows for the recording of 26 unipolar channels and 2 additional bipolar. Channels supported at launch:
    • 21 EEG inputs (orange)
    • 2 EOG inputs (orange - PG1 and PG2) 
    • 3 chin EMG inputs (blue)
    • 2 additional bipolar channels (purple)
    • REF (red)
    • and PGND (green). 

Configuring the R40 for Recording

Step 1: Configure a Standard Recording Type

  • Navigate to the “Recording Types” section in the Noxturnal device menu.
  • Select a standard PSG recording configuration and duplicate it to create a new configuration for the R40.
  • Modify the recording type to include the R40 alongside other devices like the Nox A1s, Nox C1, and Nonin 3150 Oximeter.
  • The R40 by will record the supported channels. These cannot be edited at the time of the Noxturnal 7.1 release. 
  • The 4 bipolar channels for the A1s can be configured for different set-ups for the A1 configuration e.g. thermistor. 

Device Setup and Configuration

Step 1: Overview of Devices

  • The integration requires multiple devices: Lifelines R40, Nox C1, Nox A1s, Nonin Oximeter, and a video device.
  • Each device has specific recording capabilities, such as EEG, EOG, EMG for the R40, and other signals like ECG and thermistor for the Nox A1s.
Lifelines 40 Amplifier  Lifelines 40 Amplifier  Nonin Oximeter 3150 BLE
  • EEG
  • EOG
  • Chin EMG
  • 2x Bipolar inputs (optional, though records by default)
  • 4 bipolar channels:
    • ECG
    • 2x Limb EMG
    • 1x thermistor (optional and needs to be set-up in device profile)
  • 2x RIP
  • Audio
  • Snore
  • Body Position
  • Nasal Pressure and Flow
  • Other derived channels 
  • SpO2
  • Heart rate
  • Pleth
 

Not all channels on the Lifelines R40 are supported for recording with Noxturnal 7.1. At the moment, users cannot configure the R40 to record more channels than those supported with Noxturnal 7.1. Please send us your feedback if you require additional channels and we will consider this for future development projects. 

Step 3: Troubleshooting Common Issues

  • Ensure the R40 is properly added to the Noxturnal room.
  • Check that the A1s is activated before starting the recording, as this affects the R40’s recording capability.

Recording with the R40

Step 1: Start a Recording Session

  • Once the devices are properly configured, begin a recording session by selecting the R40 from the device list.
  • Ensure all devices, including the Nox A1s and Nox C1, are activated and ready to record.

Step 2: Set Up for 10-20 EEG Recording

  • When performing a PSG study with the R40, use the 10-20 EEG recording setup. 
  • R40 M1 and M2 are placed in A1 and A2 inputs, not the ear (auricular points of other EEG set-ups). This is so the user has access to the standard PSG channels for staging sleep.  Auricular points can be used, though the signals will keep the M1 and M2 name. 
  • Note that M1 and M2 are not the REF inputs for R40 studies. 
  • For referential recording, place the single REF electrode on the scalp between Cz and Pz 
  • Using this common REF will allow for the digital creation of the PSG channels e.g. F4-M1, via post-processing in Noxturnal. 
  • The PGND requires a single electrode placed in the middle of the forehead (Fpz) between Fp1 and Fp2
  • The A1s bipolar channels will also require a reference and PGND signal attached to the body. We recommend using the left and right hip for these locations to reduce ECG artifacts in the channels. 

Step 3: Understand the Referential Montage

  • The R40 supports a referential recording montage. Only one referential recording montage will be supported at launch (this is how the R40 amplifier records the device, not what montages can be created with digital post-processing of the signals). 
  • The montages recorded by the R40 can be digitally processed in Noxturnal. Users can create custom montages and save them for use in future recordings or when interpreting the data. 

Impedance checks: 

  • Perform an impedance check before starting the study. Note that the R40’s impedance is not recorded automatically, so take a screenshot or make a study note for documentation purposes.
  • No continuous impedance views on the R40 channels - only the active check that will impact the recorded signals. Not recommended to check impedance during NREM sleep. 

Channels recorded on the R40 will not feature active impedance (1) or be available for review in the Impedance View (2). Channels recorded on the A1s will have continuous impedance throughout the recording and available when reviewing the data.  

Lifelines R40 and Nox A1s Streaming Dependency

How does the streaming dependency between R40 and A1s work?

R40 will only stream data when A1s is actively streaming. R40 waits to connect until A1s has connected and started streaming. If A1s disconnects, R40 will disconnect shortly after and wait for A1s to reconnect before resuming streaming.

What happens if the R40 disconnects temporarily, like when a patient goes to the bathroom, but A1s remains connected?

If R40 disconnects and then reconnects while A1s is still streaming, the sync between the devices should not be an issue.

What if both R40 and A1s disconnect and then reconnect, such as when the patient leaves the room?

When the patient returns, A1s will reconnect first. R40 will then wait until A1s starts streaming before reconnecting and streaming. The sync should remain intact.

Will there be sync issues if A1s disconnects but R40 continues streaming?

If A1s disconnects, R40 will stop streaming and wait for A1s to reconnect. Once A1s is streaming again, R40 will resume, maintaining sync.

Viewing Data: 

  • The signals recorded from the R40 have been configured to automatically create the standard PSG worksheet signals for sleep staging. No set-up is required by the user. 
  • The raw channels recorded for EEG are monopolar referential as shown in the montage below (with REF being the reference electrode placed between Cz and Pz). 

Supported Montages in Noxturnal 7.1: 

Montages are classified as longitudinal bipolar (LB), transverse bipolar (TB), or referential (R). 

These can be added to Noxturnal via importing the following configuration file

F7-M1 Fp1-F7 F7-Fp1
T3-M1 F7-T3 Fp1-Fp2
T5-M1 T3-T5 Fp2-F8
Fp1-M1 T5-O1 F7-F3
F3-M1 Fp1-F3 F3-Fz
C3-M1 F3-C3 Fz-F4
P3-M1 C3-P3 F4-F8
O1-M1 P3-O1 T3-C3
Fz-M1 Fz-Cz C3-Cz
Pz-M2 Cz-Pz Cz-C4
Fp2-M2 Fp2-F4 C4-T4
F4-M2 F4-C4 T5-P3
C4-M2 C4-P4 P3-Pz
P4-M2 P4-O2 Pz-P4
O2-M2 Fp2-F8 P4-T6
F8-M2 F8-T4 T5-O1
T4-M2 T4-T6 O1-O2
T6-M2 T6-O2 O2-T6
 

Analysis and Interpretation

Step 1: Custom Analysis Setup

  • Noxturnal does not support sleep stage or arousal auto-analysis for R40 studies at launch. Manual scoring is required for sleep staging and arousals.
  • Create custom analysis protocols for the respiratory and limb movements signals. 
  • Create a respiratory-only analysis for studies focusing on breathing disorders, excluding EEG data.

Troubleshooting and Support

Common Issues:

  • If the R40 is not recording, verify that the A1s is activated and that the R40 is properly configured in Noxturnal.
  • Check device connections and ensure all signals are being captured as expected.
  • For further assistance refer to additional resources available through the Noxturnal support portal.

FAQS: 

  • Recommend to record R40 studies to the local drive of the PC and not directly to a server location. The data can be transferred to a server location after the recording. 
  • Recommend to record only study on the PC used for the R40 and not multiple studies on the same PC. Experienced users can test a multi-room set-up if logistically required to check for performance. 

*Please note that not all features or all products are available in all markets. Our products are medical devices and subject to registration/approval in each market area. For more information on product availability please contact support@noxmedical.com

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