XLTEK SLEEP SYSTEM by EXCEL TECH. LTD.

The Sleep Headbox works in conjunction with Excel Tech Sleep software. This Sleep System is used to acquire and review sleep recordings (polysomnography) in research or clinical environments for:

Digital recording of high-level output signals (such as EEG, respiratory and oximetry signals) from conventional polygraphic recorders, signal transducers or amplifiers.
Selection of recorded signal sections for on-screen review, annotation and marking of sleep stages.
Computer-assisted event marking and quantitative analysis of EEG, respiratory and oximetry signals.
Computer-assisted reporting of simple measures obtained from the recorded signals (such as magnitude, time and frequency and simple statistical measures of marked events)

The SLEEP System is not intended to replace conventional devices or methods used for sleep monitoring in critical care or intraoperative settings.

The SLEEP System requires competent user input, and its output must be reviewed and interpreted by trained polysomnographers or trained medical professionals who will exercise professional judgment in using this information.

The SLEEP System does not make any judgment of normality or abnormality of the displayed signals or the result of an analysis. In no way are any of the functions represented as being in and of themselves diagnostic.

Device Description

The SLEEP Headbox is a digital polysomnograph headbox used in conjunction with XLTEK SLEEP Software to acquire and review sleep recordings.

AI/ML Overview

This document is a 510(k) summary for a medical device called the "XLTEK Sleep System," which is a polysomnography headbox. It describes the device's intended use and claims substantial equivalence to previously cleared devices.

Based on the provided text, there is no information presented regarding acceptance criteria or a study proving the device meets acceptance criteria.

The document primarily focuses on:

Identification of the device and submitting organization.
Common and Classification names for the device.
Identification of predicate devices (XLTEK PSG-40 Polysomnography Headbox, Masimo Radical Pulse Oximeter, XLTEK Ambulatory EEG) to establish substantial equivalence.
Description of the modifications (incorporating Masimo pulse oximetry technology and circuitry from Ambulatory EEG) and a statement that these modifications do not affect intended use, safety, or fundamental scientific technology.
Indications for Use: Listing the functions of the Sleep Headbox in conjunction with XLTEK SLEEP Software, such as digital recording of signals (EEG, respiratory, oximetry), selection/review of recorded sections, computer-assisted event marking and quantitative analysis, and computer-assisted reporting of measures.
Limitations on Use: Stating it's not intended to replace conventional devices in critical care or intraoperative settings, requires competent user input and interpretation by trained professionals, and does not make judgments of normality or act as a diagnostic tool.
FDA correspondence: An FDA letter confirming substantial equivalence and providing regulatory information.

Therefore, I cannot provide the requested information about acceptance criteria, device performance, study details, sample sizes, expert involvement, adjudication, MRMC studies, standalone performance, or ground truth establishment because these details are not present in the provided text.

Summary

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Ku22037


![Image of XILTEK and SPECIAL 510(K) DEVICE MODIFICATION](image_url)

**XILTEK**

SPECIAL 510(K)
SLEEP SYSTEM

SPECIAL 510(K) DEVICE MODIFICATION

JUNE 17, 2002

## Section F – 510(k) SUMMARY

SEP 1 0 2002

PAGE 49 of 53

This summary of 510(k) safety and effectiveness information is being submitted in accordance with the requirements of the SMDA 1990 and 21 CFR § 807.92.

| Name:                | Cameron Mahon<br>Vice President, Customer Satisfaction                                                                                           |
|----------------------|--------------------------------------------------------------------------------------------------------------------------------------------------|
| Address:             | XLTEK<br>2568 Bristol Circle<br>Oakville, Ontario<br>Canada, L6H 5S1                                                                             |
| Telephone:           | (905) 829-5300                                                                                                                                   |
| Fax:                 | (905) 829-5304                                                                                                                                   |
| E-mail:              | research@xltek.com                                                                                                                               |
| Common Names:        | Sleep Headbox                                                                                                                                    |
| Classification Name: | Electroencephalograph                                                                                                                            |
| Predicate Devices:   | XLTEK PSG-40 Polysomnography Headbox<br>K9991900                                                                                                 |
|                      | Masimo Radical Pulse Oximeter<br>[K992340](https://510k.innolitics.com/device/K992340)/[K000126](https://510k.innolitics.com/device/K000126)                                                                                                 |
|                      | XLTEK Ambulatory EEG<br>[K982479](https://510k.innolitics.com/device/K982479)                                                                                                                  |
| Description:         | The SLEEP Headbox is a digital polysomnograph<br>headbox used in conjunction with XLTEK SLEEP<br>Software to acquire and review sleep recordings |

pg 1 of 2

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|                                    | SPECIAL 510(K)<br>SLEEP SYSTEM |
|------------------------------------|--------------------------------|
| SPECIAL 510(K) DEVICE MODIFICATION | JUNE 17, 2002<br>PAGE 50 of 53 |

Substantial Equivalence: The SLEEP Headbox is substantially equivalent to the XLTEK PSG-40 ([K991900](https://510k.innolitics.com/device/K991900)) incorporating Masimo pulse oximetry technology ([K992340](https://510k.innolitics.com/device/K992340)/K0000126). It comprises circuitry that is substantially equivalent to the XLTEK Ambulatory EEG ([K982479](https://510k.innolitics.com/device/K982479)). These modifications do not affect the predicate device's intended use, safety, or fundamental scientific technology.

## Indications for Use:

The Sleep Headbox works in conjunction with Excel Tech Sleep software. This Sleep System is used to acquire and review sleep recordings (polysomnography) in research or clinical environments for:

- Digital recording of high-level output signals (such as EEG, respiratory and . oximetry signals) from conventional polygraphic recorders, signal transducers or amplifiers.
- Selection of recorded signal sections for on-screen review, annotation and . marking of sleep stages.
- Computer-assisted event marking and quantitative analysis of EEG, respiratory t and oximetry signals.
- Computer-assisted reporting of simple measures obtained from the recorded . signals (such as magnitude, time and frequency and simple statistical measures of marked events)

The SLEEP System is not intended to replace conventional devices or methods used for sleep monitoring in critical care or intraoperative settings.

The SLEEP System requires competent user input, and its output must be reviewed and interpreted by trained polysomnographers or trained medical professionals who will exercise professional judgment in using this information.

The SLEEP System does not make any judgment of normality or abnormality of the displayed signals or the result of an analysis. In no way are any of the functions represented as being in and of themselves diagnostic.

pg 2 of 2

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Image /page/2/Picture/1 description: The image shows the logo for the U.S. Department of Health & Human Services. The logo consists of a stylized eagle in flight, with its wings and body represented by thick, curved lines. The eagle is positioned within a circular border that contains the text "DEPARTMENT OF HEALTH & HUMAN SERVICES USA" in a sans-serif font. The text is arranged to follow the curve of the circle, with "DEPARTMENT OF" at the bottom, "HEALTH & HUMAN SERVICES" on the left side, and "USA" at the top.

Food and Drug Administration 10903 New Hampshire Avenue Document Control Room -WO66-G609 Silver Spring, MD 20993-0002

Excel-Tech Ltd. Sonja Markez Regulatory Affairs 2568 Bristol Circle Oakville, Ontario Canada, L6H 5S1

APR - 9 2012

Re: [K022037](https://510k.innolitics.com/device/K022037)

Trade/Device Name: XLTEK Sleep System Regulation Number: 21 CFR 882.1400 Regulation Name: Electroencephalograph Regulatory Class: II Product Code: OLV, GWQ Dated (Date on orig SE Itr): August 9, 2002 Received (Date on orig SE ltr): August 12, 2002

Dear Ms. Markez:

This letter corrects our substantially equivalent letter of September 10, 2002. We have reviewed your Section 510(k) premarket notification of intent to market the device referenced above and have determined the device is substantially equivalent (for the indications for use stated in the enclosure) to legally marketed predicate devices marketed in interstate commerce prior to May 28, 1976, the enactment date of the Medical Device Amendments, or to devices that have been reclassified in accordance with the provisions of the Federal Food, Drug, and Cosmetic Act (Act) that do not require approval of a premarket approval application (PMA). You may, therefore, market the device, subject to the general controls provisions of the Act. The general controls provisions of the Act include requirements for annual registration, listing of devices, good manufacturing practice, labeling, and prohibitions against misbranding and adulteration. Please note: CDRH does not evaluate information related to contract liability warranties. We remind you, however, that device labeling must be truthful and not misleading.

If your device is classified (see above) into either class II (Special Controls) or class III (PMA), it may be subject to additional controls. Existing major regulations affecting your device can be found in the Code of Federal Regulations, Title 21, Parts 800 to 898. In addition, FDA may publish further announcements concerning your device in the Federal Register.

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Please be advised that FDA's issuance of a substantial equivalence determination does not mean that FDA has made a determination that your device complies with other requirements of the Act or any Federal statutes and regulations administered by other Federal agencies. You must comply with all the Act's requirements, including, but not limited to: registration and listing (21 CFR Part 807); labeling (21 CFR Part 801); medical device reporting (reporting of medical device-related adverse events) (21 CFR 803); good manufacturing practice requirements as set forth in the quality systems (QS) regulation (21 CFR Part 820); and if applicable, the electronic product radiation control provisions (Sections 531-542 of the Act); 21 CFR 1000-1050.

If you desire specific advice for your device on our labeling regulation (21 CFR Part 801), please go to http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHOffices/ucm115809.htm for the Center for Devices and Radiological Health's (CDRH's) Office of Compliance. Also, please note the regulation entitled. "Misbranding by reference to premarket notification" (21CFR Part 807.97). For questions regarding the reporting of adverse events under the MDR regulation (21 CFR Part 803), please go to

http://www.fda.gov/MedicalDevices/Safety/ReportaProblem/default.htm for the CDRH's Office of Surveillance and Biometrics/Division of Postmarket Surveillance.

You may obtain other general information on your responsibilities under the Act from the Division of Small Manufacturers, International and Consumer Assistance at its toll-free number (800) 638-2041 or (301) 796-7100 or at its Internet address http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

http://www.fda.gov/MedicalDevices/ResourcesforYou/Industry/default.htm.

for

Sincerely vours.

Keoia Alexander

Malvina B. Evdelman, M.D. Director Division of Ophthalmic, Neurological, and Ear, Nose and Throat Devices Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

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Image /page/4/Picture/0 description: The image shows the word "TEK" in a stylized font. The letters are bold and have a textured fill. To the left of the word "TEK" is a design of intersecting lines.

SPECIAL 510(K) DEVICE MODIFICATION

SPECIAL 510(K) SLEEP SYSTEM JUNE 17, 2002

PAGE 51 of 53

## Section G - INDICATIONS FOR USE

510(k) Number (if known): KORR C 37

Device Name:

SLEEP System

Indications for Use:

The Sleep Headbox works in conjunction with Excel Tech Sleep software. This Sleep System is used to acquire and review sleep recordings (polysomnography) in research or clinical environments for:

- Digital recording of high-level output signals (such as EEG, respiratory and oximetry signals) from . conventional polygraphic recorders, signal transducers or amplifiers.
- Selection of recorded signal sections for on-screen review, annotation and marking of sleep stages. .
- Computer-assisted event marking and quantitative analysis of EEG, respiratory and oximenty . signals.
- Computer-assisted reporting of simple measures obtained from the recorded signals (such as . magnitude, time and frequency and simple statistical measures of marked events)

The SLEEP System is not intended to replace conventional devices or methods used for sleep monitoring in critical care or intraoperative settings.

The SLEEP System requires competent user input, and its output must be reviewed and interpreted by trained polysomnographers or trained medical professionals who will exercise professional judgment in using this information.

The SLEEP System does not make any judgment of normality of the displayed signals or the result of an analysis. In no way are any of the functions represented as being in and of themselves diagnostic.

(PLEASE DO NOT WRITE BELOW THIS LINE - CONTINUE ON ANOTHER PAGE IF NEEDED)

Concurrence of CDRH, Office of Device Evaluation (ODE)

OR

Prescription Use (Per 218 CFR 801.109)

(Optional Format 1-2-96)

Over-The Counter Use

(Division Sign-Off) Division of General, Restorative and Neurological Devices

510(k) Number_ KOZZD37

Regulation Number and Section

§ 882.1400 Electroencephalograph.

(a)
Identification. An electroencephalograph is a device used to measure and record the electrical activity of the patient's brain obtained by placing two or more electrodes on the head.(b)
Classification. Class II (performance standards).