Sleep Review interviews Guy Lapierre, director of systems engineering, Stellate Systems Inc; and Keith Thornton, DDS, founder and CEO of Airway Management Inc.

Guy LapierreInput from health care professionals plays a significant role in the development of quality products. Sleep Review spoke with Guy Lapierre, director of systems engineering, Stellate Systems Inc, Montreal, about the research and development behind the Stellate DUO™ Amplifier.

SR: How does the Stellate DUO Amplifier advance the quality and delivery of patient care?
Lapierre: The Stellate DUO Amplifier takes its name from its dual functionality—that of an amplifier for PSG and for EEG. It has advanced features for both these applications and is perfectly adapted to both. In this respect, it allows hospitals and laboratories to have equipment that is flexible and economical, thus optimizing patient care. The DUO amplifier operates within Stellate’s Harmonie system and a multifunction application that covers PSG, EEG, and long-term monitoring, all from the same database and user interface. DUO and Harmonie combine to make a PSG system with great power and flexibility, including automatic event marking, online event editing, flexible trending, and configurable reports. The quality of patient care is also well served by Stellate’s professional service staff, available 24/7.

SR: What advanced technology features does the Stellate DUO Amplifier include?
Lapierre: The DUO amplifier includes wide-band multipurpose amplifiers with programmable bandwidths and sampling rates for all channels, with sampling rates up to 1,000 Hz; a large number of PSG, EEG, and DC channels; and a USB interface that makes it compatible with desktop and laptop computers. The amplifier also includes an integrated electrode impedance display, measuring values from all electrodes, including the common reference and ground leads.

SR: How do these features distinguish the amplifier from others?
Lapierre: DUO offers a large number of EEG channels (up to 33); a full array of PSG channels to record EMG, ECG, sound, flow, effort, body position, and temperature; and an integrated pulse oximeter providing SpO2, pulse rate, and a plethysmogram. In addition, the system includes up to 12 high-level DC inputs, three direct pressure inputs, and a light sensor. The possibility of sampling channels at 1,000 Hz also offers unique opportunities to investigate high-frequency EEG activity.

SR: How do you expect the Stellate DUO Amplifier to impact the marketplace?
Lapierre: Customers have already shown a great interest in the DUO amplifier and Stellate’s Harmonie system because of its remarkable combination of performance and low price.

Keith Thornton, DDSSleep Review spoke with Keith Thornton, DDS, founder and CEO of Airway Management Inc (AMI), Dallas, about using mandibular advancement devices (MADs) in combination with CPAP to manage snoring and sleep apnea.

SR: Most oral appliances that treat snoring and OSA are mandibular advancement devices. How do they work?
Thornton: They work by protruding the mandible to a position that opens the airway and then maintains that position over time. This is very similar to thrusting the mandible forward during CPR or anesthesia.

SR: How is the Thornton Adjustable Positioner (TAP) different than the other MADs?
Thornton: The TAP is the only MAD that is infinitely adjustable and that can move the patient’s mandible into a passively stretched position. This is the reason that the published treatment results are significantly better than those of other MADs and why it is the only one that can treat severe OSA consistently.

SR: What other unique features does it have?
Thornton: The TAP is the only appliance that can be adjusted vertically, laterally, and protrusively after construction; can be adjusted by the patient while in the mouth; has an attachment for CPAP; and can be titrated in the sleep lab.

SR: How does the combination TAP-CPAP work?
Thornton: Again, this is similar to CPR. If the jaw is placed in the proper position, then ventilation can occur at lower pressures. I have written a report about a patient that we treated by this means in the January 2002 issue of Sleep Review where we lowered the pressure from 16 to 7 cm of water. By holding the jaw closed, we can also prevent mouth leakage. The attachment to the TAP prevents movement of the mask and improves comfort and leakage.

SR: Compliance is an issue for CPAP users. Are TAP users compliant? If so, how does the TAP address the need for increased compliance?
Thornton: In virtually all compliance and preference studies, oral appliances are significantly ahead of CPAP. This is particularly true since the TAP can treat snoring without the intrusiveness of the sound of the CPAP. Therefore, the bed partner is a big factor in compliance. We are also offering a monitor for those who want to measure compliance.

SR: What are sleep apnea patients saying after using the TAP?
Thornton: They are thrilled. Most of my patients either have failed CPAP or want something that they can wear when they can’t wear CPAP or don’t want to take it on a trip. Once they get on the TAP, they usually stop wearing the CPAP. If the TAP doesn’t manage their sleep apnea, then we add the mask combination, which they prefer greatly over the regular mask.