PAP Device Integration with Nox Recorders and Noxturnal Software

Noxturnal supports connections with various PAP devices available on the market via different mechanisms. It can interface with PAP devices that support DC output. Noxturnal can integrate with the following PAP set-ups: 

• ResMed PAP devices TxLink and TxLink 2 integration 
• Phillips OmniLab via DC connection 
• ResMed TxLink via DC connection (if Lan IP is not available)
• ResMed PAP device via serial output 
• PAP device that supports DC serial connection (see section of DC set-up). Not all serial input is supported (pending correct serial protocol integration). Please reach out to your Sales Representative to discuss support and options. 
• Mask pressure transducer for any PAP mask set-up  

How a PAP device can interface with Noxturnal

There are multiple options for PAP devices interfacing with Noxturnal and Nox Medical recording devices. These include: 

• IP/TCP Connection 
• DC Input via the DC channels of the Nox C1 
• Mask pressure measurements via the Pressure Transducer on the Nox A1s or T3s recorder 
• Nox C1 pressure transducer 
  • Absolute Maximum Input Pressure: +/- 7 kPa
  • Input Pressure Range: +/- 40 cmH2O
  • Sampling: 16-bit, 250 Sa/s

Different configurations will result in different set-up requirements. Please review the sections below for specific setups and DC signal configuration information. 

ResMed PAP Devices via TxLink 

Noxturnal can interface with both the ResMed TxLink and the TxLink 2. This setup requires 3 pieces of hardware: 

• ResMed PAP device 
• TxLink I or II connection module 
• PC with Noxturnal and EasyCare Tx titration software available

Installation and set-up details will be site-specific, but the TxLink must be configured with Noxturnal via the Online Rooms menu. The steps below explain how to perform this setup. 

ResMed Tx Link Initial Setup for Noxturnal

The following items are needed for the Nox Sleep System setup with a ResMed TX-Link

• Tx-Link Device
• Nox C1 Access Point and a power supply*
• 3x Ethernet Cables
• Switch
• PC Computer**

 

With the installation of the ResMed EasyCare software, the three software programs below are installed:

• ResMed EasyCare Tx 
• ResMed Tx Link Admin
• ResMed Tx Link Setup 

Please contact your IT support to ensure exceptions for these three apps are added to the Windows Firewall, and any other applicable Firewalls (Virus Protection, etc). To check or set the IP address of the TxLink, double-click on the “ResMed TxLink Setup” app. Note: To perform this function, the Tx Link must be connected to the computer by a serial port. 

The Tx Link defaults to “Obtain IP address automatically”, but this is often untrue. The default IP address is not in the subnet needed for the C1 network default settings. A fixed IP address is recommended for the interface to Noxturnal. The subnet of the Tx Link must match the C1’s. ResMed default is 99, which should be changed to 101 (or match the C1).

Once these settings are changed, they should be saved.  Disconnect the Tx Link from the serial cable.  TxLink should be connected to the network switch and powered on. Next, in Noxturnal, go to “Devices' and “Online Rooms”.  Click on “Add Devices'' as shown below:

 

Click on “Scan for IP Devices. The Tx Link should be detected and display the assigned IP address. Click on the device to highlight in blue, and click “Add to Room. The device will be added to the room. Click on “Edit Device to adjust settings.

 

 

The IP address will again be displayed.  Click on the check box to “Display leak as litres per minute” if desired.  Otherwise, the leak will be displayed in litres per second. Click “Next” to name the device differently or “Finish” to complete the setup.

 

If connecting Noxturnal to the TxLink via as above, Noxturnal will automatically stream the following signals (not all ResMed PAP devices will report all of the signals e.g. ResMed S11 CPAP will only stream 1-4). Doing this allows Noxturnal to stream and record the signals and events from the PAP device.

 

ResMed TxLink integration via DC Connection 

If you don’t have enough LAN connections in the sleep room, the ResMed TxLink can also be integrated with Noxturnal via the connections of the Nox C1 access point. The steps below explain how to configure the Resmed TxLink channels for Noxturnal via serial cable connection to the Nox C1. Note that serial DC input into the Nox C1 requires the purchase of a specific license. Contact your local Nox Sales Representative for more details. 

1. Open ResMed Easy Care TX program and click on the MENU dropdown. If it shows ‘not connected’, click on the drop-down, choose a room, choose to connect. Then click on the menu and choose DC output configuration.
2. The DC Output configuration is user configurable; users can set up each channel. Please note that these instructions follow the standard ResMed set-up.
3. Make note of each channel’s output color, signal type, low and high value, and voltage range. Keep this onscreen or write it down.
4. In the bedroom, please be sure to note the cables plugged into the tx link. You should see cables in all 6 inputs if the lab uses dual cables. The cable from red/blue on the tx link would be connected to Aux 1-2 on the back of the base. The cable from green/yellow would be connected to Aux 3-4. The cable from black/white would be connected to Aux 5-6.
5. Please note that IPAP, EPAP and CPAP channel low value is 0 cmH2O, and high value is 30 cm H2O. Leak low value is 0 L/min, and high value is 60 L/min. The voltage range for IPAP, EPAP CPAP and Leak is 0-1 V. Patient flow (or CFLOW channel) channel can be changed to -120 to 120.

The above Signals will need to be created and mapped in Noxturnal. Please look at the section Adding PAP Sensors for DC Connection for instructions. 

Philips Respironics Omnilab PAP Device Integration with Noxturnal

Noxturnal can also interface with the Philips Respironics Omnilab PAP device. The following items are required to connect the OmniLab PAP device to the Nox C1 access point via DC connection. Note that this configuration is only available with the Nox A1 and A1s recorder, as it requires the Nox C1 access point for the DC connection. 

• OmniLab Connect (1111076) 
• Link Module (1061644A) 
• OmniLab Connect Stereo Connectors (2.5 mm) (1111419)

Connecting the Philips Respironics Omnilab PAP device to Nox C1 via DC Connection. To connect the OmniLab PAP device to the Nox C1, first, you can connect the OmniLab Connect module to the PAP device. Now connect the serial cables to the OmniLab Connect module and the Nox C1 as per below:  

• Connect the Red output on the OmniConnect module to DC1/2, 
• Connect the White output to DC3/4, 
• Connect Blue output to DC5/6, 
• Connect Yellow output to DC7/8. 

The OmniLab Direct software is customisable. Contact your local Phillips customer support representative if you require the OmniLab Direct software. Click on the Settings tool, select Omnilab Connect, and configure the Omni Connect settings to look like this:

 

The image above features the recommended connection settings to ensure proper reporting from within Noxturnal. You can add additional settings with the Yellow channel options if you need additional settings. 

The next step is to create Sensors in Noxturnal to match these input settings and then set them in the C1 Device Profile to match the DC connections.  Please take a look at the section below on Adding PAP Sensors for DC connection for more details.

To save you time, we have collected these signals, are they are available as an attachment at the end of this article to be downloaded and imported directly into Noxturnal. 

Nox A1 and A1s Online - ResMed S9 Setup

The ResMed S9™ has a serial output on the back. Connecting to the Nox C1 Access Point is possible using a ResMed Embletta serial adapter connecting a standard RS-232 to 3.5mm jack serial cable. The setup image for the ResMed S9 can be seen below:

 

The following items are needed for the Nox A1 PSG online system setup with ResMed S9

• ResMed S9 and an Embletta serial adapter
• Nox C1 Access Point and a power supply*
• Ethernet Cable
• RS232(female) to standard 3.5mm jack serial cable
• PC computer**
• Using a Tx-Link, the ResMed S9 can also be connected to the Noxturnal Software.

This requires adding the ResMed S9 as a device to the Online Room. Please select the correct serial (Comm) port as shown below. 

 

Instructions on setting up an online room in the Noxturnal Software and starting an online recording can be found here. Instructions on how to add auxiliary devices to online rooms in Noxturnal can be found here.

Adding PAP Sensors for DC Connection:

The following applies to Online (laboratory) PSGs with the Nox A1/A1s and a Nox C1. The DC input into the Nox C1 allows the Nox system of PSG recorders and software to integrate with any PAP device on the market with compatible DC serial output for the signals. Below outlines the steps required to configure signals within Noxturnal for DC input from PAP devices. 

• Start by creating the Sensors for each DC port. Go to the Menu Devices -> Sensors. From the bottom of the window, click ‘New’. 

• The following window will always open with the Patient Sensor selected. Change it to Auxiliary Sensor.

Give the sensor a Label (you can name it with the name of the device you are building for). Select a Category (one that fits the device that will be connected), a Description (to help clarify the sensor), and finally, a Signal type (one that fits the device that will be connected). The remaining signals are device-specific and must be sourced from the device manual or sales representative. The below example is the setup for a Weinman PAP device. Note that the following items are required for integration of the Weinman PAP device with the Nox C1 access point and Noxturnal software:

• PrimaPSG (WM 100MP) 
• 3.5 mm standard Mono cable 

This process must be completed for each supported signal from the device e.g. leak Filtered, Leak, Minute ventilation, Obstruction, Pressure, Set Pressure, Snore and Tidal Volume. These signals can usually be sourced from the device settings or the product manual. 

Once all the sensors needed have been created, Go to the menu Devices -> Device Profiles. Select one of the existing Nox C1 configurations that fit your needs and click “New Based On.” Give the profile a name and description and press Next. You can select the analog channels on the nox C1 to match the input signal. It is recommended to assign 1 to 1 and 2 to 2 etc. If the cables get mixed up, it is easier to rectify (as well as coloring the cables with strikers to make it simple). In the window, select the channels, tick the box of the signals you want to be active, click to select the sensor, and you will have the option to select one of the sensors created in the prior steps. Once all channels are configured, click Finish, and the profile is configured.

The next step is to use this device profile to create a Recording Type for this setup. Go to Devices -> Recording Types. Select an Online recording type and click “New Based On”. Ensure that the Nox C1 is added to the recording type and that the Nox C1 device profile is changed to the one you created in the prior step. 

Mask Pressure: via Nox A1 and A1s pressure port

The final option for PAP integration is to connect the PAP mask via tubing to the Nox A1 or A1s pressure port to measure mask pressure. The A1 device needs to be setup correctly to measure PAP mask pressure. Go into the device settings for the A1 and select nasal flow and mask pressure as per below. Note that this method only details mask pressure and will be impacted by circuit leak. 

 

Noxturnal can input PAP pressures for CPAP and VPAP devices connected with a method that does not support streaming of device set pressure. This input means technicians can manually change the devices during the titration. The CPAP shortcut is activated with the F5 key and the VPAP input with F6. 

 

*Warning: Only use power supply FRIWO MP115 Medical-7555M/12 with the C1 device. An incorrect power supply may result in electric shock or cause the device to overheat, resulting in patient/operator harm.

** Warning: The computer must comply with the international standard IEC 60950-1 for the safety of information technology equipment.