ResMed Narval CC Professionell-Gebrauchsanweisung Seite 10

Recommended titration process for a Narval CC appliance
The protrusion of the Narval CC appliance can be adjusted in increments of 1 mm. It can be fine-tuned in
increments of 0.5 mm.
Step 1: At the fitting appointment, the patient should not experience any muscle/TMJ pain. If there is
any pain, reduce the protrusion by replacing the connecting rods with longer ones until the patient feels
comfortable.
Step 2: At the follow-up appointment, once the patient is used to sleeping with the Narval CC appliance,
ask about symptom improvements. If all symptoms are resolved, proceed to step 4.
Step 3: If some symptoms persist and the patient can tolerate a greater protrusion, replace the existing
connecting rods with shorter ones to increase protrusion. Protrusion should not be increased by more
than 1 mm a week. Set up another follow-up appointment one or two weeks later and repeat step 3
until the symptoms are resolved or you reach the tolerance limit of your patient, whichever happens first.
Step 4: If the patient has OSA inform your sleep specialist partner of their status and MAD titration.
The patient should undertake a controlled sleep recording with their Narval CC appliance to measure
treatment efficacy on breathing parameters.
How to adjust Narval CC appliance protrusion
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1. Turn the Narval CC appliance so that the bow
tie shape of the connecting rod is aligned
with the cut out on the splint.
2. Disconnect the lower side first, as the bow
tie-shaped cut out is more visible here.
3. Remove the connecting rod by firmly pushing
with your thumb at the top of the rod where
it meets the
triangular portion
of the splint.
Repeat for the
other side of the
lower splint, then
for both sides of
the upper splint.
4. Select the appropriate connecting rods:
- to increase protrusion, use a shorter
connecting rod.
- to decrease protrusion, use a longer
connecting rod.
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5. Hold the
connecting rod
perpendicular to
the splint. Line up
the bow tie on the
connecting rod
with the cut out on
the splint.
6. Click into place to re-engage the connecting
rod.
Treatment follow-up
Once the titration process is complete, it is
important to schedule regular follow-ups with
the patient to assess potential side effects and
ensure treatment efficacy and safety in the long
term.
Patients can be directed to their sleep specialist
to evaluate the efficacy of their Narval CC
appliance via an objective monitoring process
(PG or PSG).
For OSA patients, if a satisfactory improvement
in symptoms and an objective sleep recording
validation cannot be achieved after titration,
discuss about alternative treatments with your
sleep specialist partner.
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