MATRx™ Titration Procedure - Zephyr Sleep Technologies
Contents
1. 1 2 3 Advance the mandible in three separate 0 2mm steps i e total advancement of 0 6mm by pressing the Up Arrow button NOTE The OATRx software will impose a 5 second delay in between each 0 2mm step so as not to disturb the patient s sleep After completing each 0 6mm step WAIT 2 minutes for equilibration of the patient s response to protrusion NOTE TAG the mandibular position at each 0 6mm step similar to the tagging procedure used during CPAP titration At the end of each titration exercise the mandible may be retruded in a series of 0 2mm steps in preparation for the next titration attempt Single step retrusion of the mandible is accomplished by clicking on the Down Arrow button located at the bottom left hand corner of the Control Panel Continue titration until apneas and or hypopneas have been eliminated or the patient s upper limit i e maximum protrusion is reached NOTE Emergent central sleep apnea may occur during titration Continue titration in response to observed obstructive apneas and or hypopneas despite any central events that may be present Titration Considerations 1 The titration process should be started after the patient enters a deeper stage of sleep During this time the patient will not be able to consciously resist movements of the mandible NOTE Initiation of the titration process when the patient is awake or in lighter stages of sleep will expose the patient to the background2. sleep especially REM or when the patient changes body position especially from side to supine 7 The titration procedure should be repeated several times during the night as to test the ability of the device to eliminate respiratory events under different circumstances i e combinations of sleep stage and body position 8 When frequent apneas and or hypopneas are observed a series of small advancement steps may be performed in succession 9 In some cases a more aggressive step titration procedure may be necessary to ensure there is adequate study time to observe REM sleep In this instance be careful not to cause arousals and or awakenings CS762 V2 0 CO 15 039 3 OATRX Technology ZEPHYR MATRx Titration Procedure Sleep Technologies gt Place MATR x titration trays in Confirm patient s mouth OATRx scale readings re gt Confirm comfort amp retention provided by the Dentist gt Attach MP Start study at Lower Limit Position MP Mandibular Positioner OAT Oral Appliance Therapy Patient Set up 4 Monitor patient s sleep behavior A Xx monitor wait observe kal REM Observations Goal To Determine if the Patient Meets Interpretive Criteria gt if patient remains lateral use judgment experience to have patient move to supine position gt If patient cannot be treated successfully in REM supine use judgment experience to have patient move to lateral position Protrude in 3X 0 2mm st
3. ZEPHYR MATRx Titration Procedure Sleep Technologies The MATR x titration process consists of gradual advancement of the mandible in small steps of predefined magnitude until all evidence of airway obstruction is eliminated The goal is to study the patient during REM sleep in the supine position since this represents the worst case scenario for maintaining patency of the upper airway and achieving a successful therapeutic outcome with oral appliance therapy The data collected during the MATRx study will enable the sleep physician to 1 Accurately select patients who will respond to oral appliance therapy 2 Prescribe the target protrusive position i e OATRx Number for each responder In addition to this titration procedure please review the following resource documents e MATRx User Manual e MATR x Clinical Applications Guide Before beginning your MATRx study you should have e Created an OATRx channel in your PSG montage e Successfully calibrated the mandibular positioner MP using the patient s OATRx scale readings provided by the dentist e Successfully calibrated and integrated the MATRx device to your PSG system Preparing for Titration 1 Ensure the MATRx system s software known as OATRx TS is open and the Polysomnograph Initialization Panel is displayed on your PSG screen 2 Press the Down Arrow button to ensure you are beginning the MATRx study with the trays set at the patient s lower limit po
4. eps total 0 6mm e O D 5 E i F v Lower Limit Position Refer to the MATRx Clinical Applications Guide Section The MATRx Study Titration Considerations interpretive Criteria Refer to the MATR x Clinical Applications Guide Section Clinical Applications MATRx Interpretive Criteria Standard Titration Procedure Powered by CS762 V2 0 CO 15 039 4 re ATRX Technology
5. noise generated by the MP and may delay the onset of sleep In most cases a step size of 0 2mm should not cause arousals and or awakenings However if the patient does experience arousals and or awakenings wait until the patient is in a deeper stage of sleep before continuing with titration The primary goal of the MATRx study is to eliminate apneas and or hypopneas during REM sleep in the supine position NOTE If time permits and the patient s upper limit i e maximum protrusion has not been reached titration may be continued in response to observed HUAR e g IFL RERAs and snoring A five minute period of REM sleep in the supine position is recommended for MATRx study interpretation During this period there should be less than 2 apneas and or hypopneas observed NOTE REM lateral may only be used if the pre study documentation confirms the patient is a known side sleeper AND REM supine is not observed during the MATRx study If the patient fails to sleep in the supine position after 2 3 hours enter the patient room and move the patient onto their back Repeat as necessary until the patient experiences REM sleep while supine CS762 V2 0 CO 15 039 2 OATRX Technology ZEPHYR MATRx Titration Procedure Sleep Technologies 6 It is important to study the patient in all stages states of sleep and in both the supine and lateral body position NOTE Respiratory disturbances may return when the patient enters deeper stages of
6. sition also known as their habitual bite or resting position 3 Press the Start Titration button The Control Panel will now be displayed a Set the Step Size at 0 2mm b Single step protrusion or single step retrusion of the mandible will be accomplished by clicking on the Up Arrow or Down Arrow buttons located at the bottom left hand corner of the Control Panel c At any time during the study a specific mandibular position can be set by pressing the Desired Position button located to the right of the Down Arrow button and entering a position in mm 4 Ensure the patient s trays are securely connected to the previously calibrated MP and insert them into the patient s mouth Instruct your patient to relax their jaw in order to get used to how the trays feel in their resting position CAUTION Please ask the patient to refrain from pushing against the trays and or resisting the movement of the trays during the study Voluntary resistance may damage the MP s motor 5 Make sure your patient is comfortable and in the supine position Proceed with the study CS762 V2 0 CO 15 039 1 OATRX Technology MATRx Titration Procedure ZEPHYR Sleep Technologies Titration Procedure After sleep onset observe for apneas and or hypopneas If observed start titration i e gradual protrusion of the patient s mandible until these events are eliminated The following titration procedure is recommended to minimize the risk of arousal
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