This Release Bulletin announces the release of the following Noxturnal software

• Noxturnal – 7.4.0 - 42893

• Noxturnal US – 7.4.0 - 42893

Noxturnal 7.4 introduces Ventilatory Burden as a parameter and a key advancement in the assessment of sleep-disordered breathing. Ventilatory Burden is designed to provide additional insight beyond traditional event-based respiratory indices. The release also introduces Nox Flow, a flow signal derived from the RIP belts, which enables the derivation of Minute Ventilation %eupnea signal. Alongside these major additions, the release includes new parameters for MSLT reporting, new AHI ≥3% desaturation-only parameters, additional Nox Connect support, and improvements supporting PSG and SAS readiness for Noxturnal Web. Automatic association of arousals and PLMs has also been extended to live recordings. The release further includes important bug fixes and stability improvements.
 

Frequently asked questions (FAQ) about Noxturnal 7.4 can be found here.

Downloading Software

The software can be downloaded from different download locations and is available on the Nox Support Site.

Noxturnal & Noxturnal US

https://noxmedical.com/downloads-row/

https://noxmedical.com/downloads-usa/

List of Features and Bug Fixes

The following features and bug fixes are included as part of the Noxturnal software with this release: 

Features new to Noxturnal 7.4

🔹Feature: Ventilatory Burden

• Noxturnal 7.4 introduces Ventilatory Burden, a new parameter that quantifies the cumulative reduction in ventilation associated with respiratory events throughout the night. By taking into account the depth, duration, and frequency of these events, ventilatory burden provides additional insight into the impact of sleep-disordered breathing beyond traditional event-based respiratory indices. You can select Ventilatory Burden to display in your parameter overview and include it in your customized reports. Click here for more information on Ventilatory Burden.
  

Ventilatory Burden is derived by generating a minute ventilation signal from flow data, then combining event depth, duration, and rate to calculate the total burden (% eupnea min/hour). The average respiratory event, in terms of ventilation, is generated and used to define the average event duration and average event depth. Figure is adapted for marketing purposes from Labarca G, Vena D, Hu W, et al. Am J Respir Crit Care Med. 2023;208:1134–1146. Copyright © 2023 by the American Thoracic Society. This figure is protected by copyright and is reproduced here for reference only.
 

🔹Feature: Nox Flow

• Nox Flow is a new respiratory flow signal derived from calibrated Nox RIP technology using the thoracic and abdominal RIP belts. Unlike cRIP Flow, Nox Flow is used to derive a new Minute Ventilation signal, displayed as a percentage of eupnea (% eupnea), which supports the calculation of Ventilatory Burden. The new signal can be found under Signals & Data. 

For more information about Nox Flow, see our published article here.

Ventilatory burden, Nox Flow and Minute Ventilation are supplementary informational outputs provided for evaluation only and are not intended for clinical decision-making. They do not replace or change the clinical use of established respiratory signals and parameters.

 

🔹Feature: Additional calculations for MSLT Reporting

• You can now add new calculations to your MSLT reports, including Average REM Latency of all Naps and Number of Naps where Sleep Occurred.

🔹Feature: New AHI ≥ 3% Desaturation Only Parameters

• New AHI parameters include only hypopneas associated with a ≥3% desaturation, excluding hypopneas that qualify based on arousal alone. This provides updated AHI reporting for showing AHI without arousals. The parameters are also available by supine, non-supine, REM, and NREM.

🔹Feature:  Automatic association for Arousals and PLMs for live recordings

• Automatic association of arousals and PLMs, introduced in Noxturnal 7.3, is now also available for live recordings.

🔹Feature: PSG and SAS readiness for Nox Connect

• Enhancements to Nox Connect support PSG and SAS workflows, including improved video handling and multi-user authentication, additional PAP summary parameters, and the ability to offer the SAS frontal signal filter in Noxturnal Web.

⚠ Known Issues Fixed

• AHI 4% parameter issue
• EDF export issue
• Single click scoring issue
• Pie chart rendering in reports
• Scoring page shifting forward during live recordings

Upgrade Recommendation and Workarounds for Nox Users

Noxturnal Upgrade Wizard

Noxturnal 7.4.0

Noxturnal 7.4.0 has a built-in upgrade wizard for all users upgrading from 5.X or 6.X versions of Noxturnal. This upgrade wizard prompts the user with selections on whether they want to upgrade with their old settings as part of the installation procedure or if they want a fresh installation.

Noxturnal US 7.4.0

Upgrading from Noxturnal US 6.X.X

The Upgrade wizard will pop up with information on whether the user wants to maintain old user settings or if they want a fresh installation.

Upgrading from version 5.x or older

If upgrading in the US market from a version 5.X or older, consider the upgrade instructions here.

Older Noxturnal Versions

If users are working on an older version of Noxturnal (3.X and 4.X), it is recommended to do a fresh installation and setup of the software since so many things have changed in recent releases and updating on top will create more problems than it solves.