Tag Archives: sleep medicine

Overlooked No More – Hybernite Rainout Control System


ScreenShot146 Overlooked No More   Hybernite Rainout Control SystemCould a Different Tube Actually Make the Difference in the Battle for Compliance?

The CPAP compliance equation usually hinges on a common belief: find the right mask and comfort will follow. Comfort equals compliance, and compliance equals reimbursement. The strategy makes sense, but variables can complicate matters.

For example, what if the “best” mask is still too uncomfortable? Johan Verbraecken, MD, a pulmonologist and medical coordinator at the Belgium-based Sleep Disorders Centre, has seen this scenario on many occasions. One recent patient wanted to stop CPAP treatment after many failed attempts. “I asked him to try one more thing before he stopped,” says Verbraecken. “The only thing we changed was adding a heated tube. The patient was comfortable and happy with this intervention. We focus so much on changing masks, but tubes are often overlooked.”

Using the heated tube from the beginning, along with the heated humidifier, can also benefit sleep labs economically since fewer patients are likely to stop due to condensation. “Patients get moisture on their face at night, and it is not comfortable,” says Verbraecken. “The condensation can also make noise in the tube, similar to the sound of boiling water. This noise can often lead to stopping CPAP use, but the right tube can completely prevent it.”

New Respect

A few companies have been paying close attention to tubes, and clinicians are now looking to the technology in an effort to find any edge in the race to boost compliance. The transfer of air from machine to patient is no longer overlooked. In fact, the field is literally getting hotter with heated tubes reducing the pesky problem of condensation.

A company called Plastiflex Healthcare, a division of Plastiflex Group NV, decided to use its considerable experience manufacturing industrial flexible hoses and apply it to CPAP. Plastiflex contacted Verbraecken’s Centre about 2 years ago as it reached out to the European market.

Plastiflex offered the Hybernite® Rainout Control (ROC) System, which includes the proprietary Hybernite® Heated Breathing Tube (HBT) and Hybernite® Power Supply Unit (PSU). The HBT connects to the PSU via a plug-and-play connector, with copper wires embedded in the tubing wall.

The wires generate heat that maintains air temperature inside the tube, ultimately warding off problematic condensation. Verbraecken notes that the wires are positioned for uniform heating along the tube’s entire length, a system that avoids water droplets on the wall of the tube—and the resulting accumulation of moisture. The combination of the heated tube and the humidifier works to control condensation.

Ludo van der Poel, area manager at Netherlands-based Vivisol, a home care company that supplies Hybernite systems to patients, agrees that the seemingly minor detail of the tube can make a major difference. “The old saying about the weakest link in the chain also applies here,” says van der Poel. “If you have a superior mask and a superior CPAP device, but a bad tube, you will not get the best results.”

Universality is Key

With critical CE approval in hand, Verbraecken says the Hybernite’s appeal stems from its ability to be used with each kind of humidifier. Other heated tubes on the market can only be used on one machine. “This tube is universal,” says Verbraecken. “That is a major advantage.”

Some manufacturers choose to make tubes that are only compatible with their own machines—a mistake in Verbraecken’s eyes. “I think it’s the wrong decision,” he says. “You are obliged to use their machine, and it’s protection for them. The market is so huge that it does not make sense anymore.”

Titrations with Humidification?

At the moment, titration with humidification and heated tubing is not common. However, in cases involving chronic sinusitis and nasal obstruction, Verbraecken contends that the ScreenShot145 Overlooked No More   Hybernite Rainout Control SystemHybernite could be an advantage. “You could eliminate specific side effects that could be disturbing and that could make a difference,” he says. “For many people, condensation feels as if the water is running from their nose and on to their face. It is like being in a swimming pool, and for many it is unacceptable.”

Better tubes have the potential to enhance CPAP and ultimately improve patient care, although studies must be done to back up this notion. “There is room to use these tubes in a routine setting and not just as an escape tool,” says Verbraecken. “We need large trials to look at the effects of routine application, which has the potential to enhance the objective of compliance.”

Nuts and Bolts

Close proximity to Plastiflex’s European headquarters fostered a relationship with officials at Vivisol who were able to give advice during Hybernite’s development. “We discovered this product before it was launched,” reveals van der Poel. “We were involved in the early stages, giving input from the field to the developers at Plastiflex to further refine the product prior to its launch.”

Years prior to contacting Verbraecken, Plastiflex officials also underwent an exhaustive fact-finding period that took them to numerous trade shows and visits with industry professionals. Designers narrowed down CPAP tubing complaints to condensation and comfort, and refining technology to deal with these two problems has remained the top priority.

After taking into account all this information, engineers developed a Hybernite® ROC that essentially consists of two main parts; one is a heated breathing tube and the other is a power supply. With standard conical connectors, company engineers claim that the Hybernite® ROC can fit the role of a universal solution that can be fully integrated into any humidifier—including all types of masks that use standard tubes. “We like the flexibility of the tubing and the high quality plastic,” adds van der Poel. “A tube that is not flexible or long enough could prevent patients from moving in an easy way. Poor quality can also lead to breakage.”

The system itself does not take power or require power to be taken from the humidifier. It takes the energy straight out of the socket in the wall via the Power Supply Unit (PSU). The system works with all humidifiers that currently use standard tubing—which is 99% of the market.


Johan Verbraecken, MD, is a pulmonologist and medical coordinator at the Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital and University of Antwerp. He also serves as vice president of the Belgian Association for Sleep Research and Sleep Medicine.


Man vs. Machine

Giving Automatic Scoring a Second Thought

Changes in technology have been exponential over the last two decades. The industry has advanced significantly by software innovation. In our to wholeheartedly welcome these enhancements to our processes, we sometimes forget that technology in the form of automation is meant to assist, not replace, our skilled technologists.

To automate or not to automate the scoring of sleep studies remains an ongoing debate in our industry and with software giants looking for ways to expand service offerings, the discussion is unlikely to end any time soon. While the notion of computerized analysis holds the promise of decreased staffing costs and increased efficiency, the reality of this premise is far less simplistic. One would no doubt question the rationale behind the insistence that a plane does not require a pilot in light of autopilot technology. Yet there exists a movement that would apply such logic, resulting in the ultimate redundancy of scoring technologists.

Whether as a primary or secondary resource, a registered technologist is essential for an accurate analysis of a patient study—period.

Sleep medicine is still very much a human-centered industry. With over 80 different currently documented, nothing comes close to replicating the and contextually- reliant assessments made possible by intensive, real-life training and experience.

Any sleep facility or homecare company that are uses automatic scoring as a one-for-one alternative to human analysis is neglecting the clinical aspect of patient care. What begins as a well-intentioned, cost-cutting measure emerges as a practice that risks undermining the credibility of an entire industry.

Like every industry, efforts to streamline business and make processes leaner are present in sleep medicine. What we are seeing, however, are moves to market such software as a turnkey solution—completely undermining the specialized nature of sleep scoring and the skills, knowledge and training that go into delivering this process. Laboratories that wish to remain reputable should take a critical look at automated scoring and question whether the absence of registered technologists involved in this process is putting patient care in jeopardy.

The Reality of No Regulations

None of this is to say that automated scoring is without value. On the contrary, it can prove to help the technologist become a more effective clinician—especially as automation matures and is improved.

Early detection, of irregularities, cost-efficiency and timely performance are just some of the benefits that automated systems bring to the table. To ignore these benefits would be denying progress for the sake of it. However, as the sleep industry is itself still coming of age, it remains vulnerable to unscrupulous business models that risk tarnishing an entire sector by making patient care an after thought.

Discount scoring services have gained significant traction with unsustainably low price points underwritten by unregistered and clinically inexperienced scoring staff. What such practices fail to respect is that scoring is far more than an objective matter of computation. There are qualitative factors that only trained, registered and clinically experienced technologists can assess.

With minimal regulation of the effects of automatic scoring currently in place, the credibility of an entire industry rests on education and best practices. While sleep medicine awaits increased governance to prevent such fly-by-nights from infiltrating a valuable healthcare service, automation could aid in the standardization of certain scoring processes. As long as laboratories incorporate the technology primarily as a labour- cutting device, it may prove to be detrimental.

Assist not Replace

Another area of concern lies in the homecare and sectors. Level III sleep studies are being conducted and automatic analysis is being used for diagnosing patients going against the recommendation to have a secondary review by a Registered Technologist.

In such a case, automated scoring is not only the primary but the solitary mode of analysis. But scoring software can never comprehensively analyze a Level III study—results must be reviewed and assessed against clinical correlation. Software should be viewed as serving a complementary function in that it assists an RPSGT, who later verifies the automated scores manually and cross-references them with clinically-obtained observations.

Furthermore, one must consider the long-term impact of reliance on scoring software. Crucial information is gathered in the RPSGT’s current role as a front-line, integrated health- care professional. The knowledge and skills that arise from working with different patients and various symptoms and conditions could be lost should technologists be removed from the equation.

Know What You’re Getting Into

Pharmacists have also found their profession impacted by automated “advances”. The automated dispensing model they were recently introduced to have raised questions about accountability as dispensing errors can put patients (and businesses) at risk.

It goes without saying that human error can, has and will occur in any facet of healthcare. To be certain, accuracy is one of the dominant selling points of many automated systems used in other fields. However, the rush to market this form of technology may fail because the underlying technology is immature and needs time to evolve as it finds a permanent home within the sleep medicine industry. Even if automatic scoring technology matures to the point that algorithms can account for most variables, it still cannot contend with even the common clinical problems and complexities that come with sleep disorders in order to perform accurate scoring.

This is not to say that automatic scoring has no place in the streamlining of sleep laboratory operations. On the contrary, as time progresses and automated software has been tried and tested perhaps this may well become a fixture in sleep facilities.

But with no current regulations governing the use of such software, it is imperative that we consider the following disclaimer: automatic scoring exists to assist technologists, not replace them.

Natalie Morin, RPSGT is president and CEO of Sleep Strategies Inc., a provider of professional scoring and consulting services for sleep disorders facilities worldwide.

BRPT members stunned by ABSM announcement to Launch New Exam for Sleep Technologists

has been notified that the Board of Directors of the American Academy of () has decided to develop a certification exam for sleep technologists to be administered through the American Board of (). The has indicated that the exam will be developed over the next six to twelve months.

Read Letter to BRPT President from ABSM announcing AASM Board decision

Read BRPT response to ABSM

Will the new credential be good for the field of technologists or the beginning of a controversial struggle for control.

View BRPT discussion forum