K Number
K120888
Device Name
PSG-1100 SLEEP DIAGNOSTIC SYSTEM
Manufacturer
Date Cleared
2012-11-09

(231 days)

Product Code
Regulation Number
882.1400
AI/MLSaMDIVD (In Vitro Diagnostic)TherapeuticDiagnosticis PCCP Authorized
Intended Use
The PSG-1100 Sleep Diagnostic System is intended to record the physiological data required for EEG and sleep studies (Polysomnography or PSG). These data may be used by clinicians in Sleep Disorders, Epilepsies and other disorders as a diagnostic aid. This device is intended for use by medical personnel and will be available for use within a medical facility or outside of a medical facility under direct supervision of a medical professional.
Device Description
The PSG-1100 Sleep Diagnostic System is a digital PSG amplifier intended to record the electrical activity of the brain (EEG) and other bio-potential signals and to record physiological data required for sleep studies. The device consists of an amplifier box (head box) and main interface unit. The head box operates with commercially available sensors and interfaces with a main unit which connects to and communicates with computer hardware/ software via Ethernet connection.
More Information

Not Found

No
The document explicitly states "Mentions AI, DNN, or ML: Not Found" and the description focuses on signal acquisition and recording, not analysis using AI/ML.

No
The device is described as a "Sleep Diagnostic System" intended to "record the physiological data required for EEG and sleep studies" and acts as a "diagnostic aid," not for treatment.

Yes

The "Intended Use / Indications for Use" section explicitly states that the data recorded by the device "may be used by clinicians in Sleep Disorders, Epilepsies and other disorders as a diagnostic aid."

No

The device description explicitly states it consists of an "amplifier box (head box) and main interface unit," which are hardware components.

Based on the provided information, the PSG-1100 Sleep Diagnostic System is not an In Vitro Diagnostic (IVD) device.

Here's why:

  • IVD Definition: In Vitro Diagnostics are medical devices used to examine specimens taken from the human body, such as blood, urine, or tissue, to provide information for diagnosis, monitoring, or screening.
  • PSG-1100 Function: The PSG-1100 records physiological data directly from the patient's body (EEG and other bio-potential signals) through sensors attached to the skin. It does not analyze specimens taken from the body.
  • Intended Use: The intended use describes recording physiological data for diagnostic aid, not analyzing biological samples.

Therefore, the PSG-1100 falls under the category of a physiological monitoring and recording device, not an IVD.

N/A

Intended Use / Indications for Use

The PSG-1100 Sleep Diagnostic System is intended to record the physiological data required for EEG and sleep studies (Polysomnography or PSG). These data may be used by clinicians in Sleep Disorders, Epilepsies and other disorders as a diagnostic aid. This device is intended for use by medical personnel and will be available for use within a medical facility or outside of a medical facility under direct supervision of a medical professional.

Product codes

GWQ, OLV

Device Description

The PSG-1100 Sleep Diagnostic System is a digital PSG amplifier intended to record the electrical activity of the brain (EEG) and other bio-potential signals and to record physiological data required for sleep studies.

The device consists of an amplifier box (head box) and main interface unit. The head box operates with commercially available sensors and interfaces with a main unit which connects to and communicates with computer hardware/ software via Ethernet connection.

The PSG-1100 head box provides the SpO2 capability of monitoring through SpO2 probe, internal module is a standard feature. ETCO2 is an optional feature and can be added via TG-970P or TG-920P ETCO2 module. Airflow monitoring can be measured through the internal pressure transducer by connecting commercially available filtered airflow cannulas via the built in luer lock connector. As with the existing device, the operator performs an impedance check and runs the calibration program. Electrodes and/or sensors are attached to the patient and connect to the corresponding jacks on the junction box, which is optically isolated via the main unit to ensure electrical safety. Skin-electrode impedance check is performed to verify surface electrode connection and impedance levels. The operator then begins recording waveform data.

The analog bio-potential signals applied to the electrode junction box are digitized. The DSP (digital signal processor) in combination with the device software reproduces the waveforms.

Mentions image processing

Not Found

Mentions AI, DNN, or ML

Not Found

Input Imaging Modality

Not Found

Anatomical Site

Brain (EEG), general physiological data for sleep studies

Indicated Patient Age Range

Not Found

Intended User / Care Setting

medical personnel; within a medical facility or outside of a medical facility under direct supervision of a medical professional.

Description of the training set, sample size, data source, and annotation protocol

Not Found

Description of the test set, sample size, data source, and annotation protocol

Not Found

Summary of Performance Studies (study type, sample size, AUC, MRMC, standalone performance, key results)

Testing of the Nihon Kohden the PSG-1100A was performed in compliance with Nihon Kohden resting of the Mirror Control process. The testing showed PSG-1100A met equivalent acceptance Corporation abolgh our reveal and was shown to be equivalent in safety and effectiveness to the predicate devices

Testing included:
User needs / Intended use/Functional: Confirmed by verification/validation testing in compliance with the Design Control requirements. User need and intended use was shown to be equivalent in safety and effectiveness to the predicate devices. The modifications do not alter the fundamental scientific technology of the device
Chassis: Confirmed by verification/validation testing in compliance with the Design Control requirements. The Chassis was shown to be equivalent to the predicate devices
Labeling: Confirmed by verification/validation testing in compliance with the Design Control requirements. Labeling was shown to be equivalent to the predicate devices
Operating environment [temperature and humidity, EMC and EMI]: Confirmed by verification/validation testing in compliance with the Design Control requirements. The Operating environment was shown to be equivalent to the predicate devices
Storage environment: Confirmed by verification/validation testing in compliance with the Design Control requirements. Storage environment was shown to be equivalent to the predicate devices
Condition for transport: Confirmed by verification/validation testing in compliance with the Design Control requirements. Codition of transport was shown to be equivalent in safety and effectiveness to the predicate devices
Risk analysis: Based on risk analysis the new device was shown to be equivalent in safety and effectiveness to the predicate devices no new questions were raised.

Key Metrics (Sensitivity, Specificity, PPV, NPV, etc.)

Not Found

Predicate Device(s)

KO22121, K080546, K050833, K062943

Reference Device(s)

Not Found

Predetermined Change Control Plan (PCCP) - All Relevant Information

Not Found

§ 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).

0

K120888

510(k) Summary

NOV 9 2012

Company Name:Nihon Kohden Corporation
90 Icon Street
Foothill Ranch, CA 92610
Device Name:Nihon Kohden PSG-1100 Sleep Diagnostic System
510(k) Sponsor, Contact:Nihon Kohden America, Inc.
90 Icon Street
Foothill Ranch, CA 92610
Steve Geerdes
Director Quality Assurance and Regulatory Affairs
Phone: (949) 580-1555 Ext. 3325
Fax: (949) 580-1550
Summary Date:Revised 11/7/2012
Common Name:Electroencephalograph amplifier (EEG Amplifier)

·

Classification Names:

Electroencephalograph882.1400GWQ
Standard Polysomnograph with
Electroencephalograph882.1400OLV

.

Predicate Device

• Nihon Kohden JE-912A PSG Input BoxKO22121
-----------------------------------------------

Additional predicates

Nihon Kohden EEG-1200A Series NeurofaxK080546
Nihon Kohden JE-921A junction BoxK050833
Neurotronics PolysmithK062943

1

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------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
1----------------------------------------------------------
-----CAR

Description of Device 1.0

The PSG-1100 Sleep Diagnostic System is a digital PSG amplifier intended to record the electrical activity of the brain (EEG) and other bio-potential signals and to record physiological data required for sleep studies.

The device consists of an amplifier box (head box) and main interface unit. The head box operates with commercially available sensors and interfaces with a main unit which connects to and communicates with computer hardware/ software via Ethernet connection.

Intended Use of Device 2.0

The PSG-1100 Sleep Diagnostic System is intended to record the physiological data required for EEG and sleep studies (Polysomnography or PSG). These data may be used by clinicians in Sleep Disorders, Epilepsies and other disorders as a diagnostic aid. This device is intended for use by medical personnel and will be available for use within a medical facility or outside of a medical facility under direct supervision of a medical professional.

3.0 Technical Characteristics

The PSG-1100 head box provides the SpO₂ capability of monitoring through SpO₂ probe, internal module is a standard feature. ETCO₂ is an optional feature and can be added via TG-970P or TG-920P ETCO2 module. Airflow monitoring can be measured through the internal pressure transducer by connecting commercially available filtered airflow cannulas via the built in luer lock connector. As with the existing device, the operator performs an impedance check and runs the calibration program. Electrodes and/or sensors are attached to the patient and connect to the corresponding jacks on the junction box, which is optically isolated via the main unit to ensure electrical safety. Skin-electrode impedance check is performed to verify surface electrode connection and impedance levels. The operator then begins recording waveform data.

The analog bio-potential signals applied to the electrode junction box are digitized. The DSP (digital signal processor) in combination with the device software reproduces the waveforms.

Technical comparison

New PSG-1100AJE-921APSG Input Box
Junction BoxJE-912A

2

K050833/080546K022121
Number of
Channels(*)423234
Input Impedance100 M ohm100 M ohm100 M ohm
Calibration CheckStep square
50 uV (1 step)Step square or Sine
wave
2 to 1000 uV (9 steps)Step square or Sine
wave
2 to 1000 uV (9 steps)
Impedance CheckAll inputs with Screen
and Input box
readoutAll inputs with Screen
and Input box
readoutAll inputs with Screen
and Input box
readout
Common-Mode
Rejection Ratio
(CMRR)105 dB or more105 dB or more105 dB or more
Noise Level1/25)50 or 60 Hz (rejection
ratio > 1/25)50 or 60 Hz (rejection
ratio > 1/25)
SensitivityOFF, 0.1 to 200
uV/mm (20 steps)
DC: OFF, 10 to 200
mV/mm (10 steps)OFF, 1 to 200 uV/mm
(15 steps)
DC: OFF, 10 to 200
mV/mm (10 steps)OFF, 1 to 200 uV/mm
(15 steps)
DC: OFF, 10 to 200
mV/mm (10 steps)
A-D Conversion16 bits16 bits16 bits
SamplingAll channelsAll channelsAll channels
200, 250, 500, 1000,
2000 Hz100, 200, 500, 1000 Hz100, 200, 500 Hz
DisplayN/A
Resolution1600 x 12001600 x 1200N/A
Channels3264 + Mark ChannelN/A
Power100-240 V +/- 10%
50 / 60 Hz
42 VA (Main unit only)120 V +/- 10%
50 / 60 Hz
750 VA (including PC and display)N/A
Operating
EnvironmentTemperature: 10 to
35 degree C
Humidity: 30 to 80 %Temperature: 10 to
35 degree C
Humidity: 30 to 80 %Temperature: 10 to
35 degree C

ı

:

.

.

:

3

Data Summary 4.0

Testing of the Nihon Kohden the PSG-1100A was performed in compliance with Nihon Kohden resting of the Mirror Control process. The testing showed PSG-1100A met equivalent acceptance Corporation abolgh our reveal and was shown to be equivalent in safety and effectiveness to the predicate devices

Testing included:

| User needs /
Intended use/Functional | Confirmed by verification/validation testing in
compliance with the Design Control
requirements. User need and intended use
was shown to be equivalent in safety and
effectiveness to the predicate devices. The
modifications do not alter the fundamental
scientific technology of the device |

------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

4

| Chassis | Confirmed by verification/validation testing in
compliance with the Design Control
requirements. The Chassis was shown to be
equivalent to the predicate devices |
|---------------------------------------------------------------------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Labeling | Confirmed by verification/validation testing in
compliance with the Design Control
requirements. Labeling was shown to be
equivalent to the predicate devices |
| Operating environment
[temperature and humidity,
EMC and EMI] | Confirmed by verification/validation testing in
compliance with the Design Control
requirements. The Operating environment
was shown to be equivalent to the predicate
devices |
| Storage environment | Confirmed by verification/validation testing in
compliance with the Design Control
requirements. Storage environment was
shown to be equivalent to the predicate
devices |
| Condition for transport | Confirmed by verification/validation testing in
compliance with the Design Control
requirements. Codition of transport was
shown to be equivalent in safety and
effectiveness to the predicate devices |
| Risk analysis | Based on risk analysis the new device was
shown to be equivalent in safety and
effectiveness to the predicate devices no new
questions were raised. |


Medical Electrical Equipment

IEC 60601-1Part1: General requirements for safety 1998-12
IEC 60601-1, Amendment 1Part 1: General Requirements for safety, Amendment 1, 1991-11
IEC 60601-1, Amendment 2Part 1: General Requirements for safety, Amendment 2, 1995-03

5

| IEC 60601-1-1 2nd edition | Part 1-1: General requirements for safety - Collateral standard.
Safety requirements for medical electrical systems, 2000-12 |
|-------------------------------------------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| IEC 60601-1-2 2nd edition | Part 1-2: General requirements for safety - Collateral
standard. Electromagnetic compatibility, 2001-09 |
| IEC 60601-1-2 2nd edition,
Amendment 1 | Part 1-2: General requirements for safety - Collateral
standard. Electromagnetic compatibility. Amendment 1, 2004 |
| IEC 60601-2-26 | Part 2-26: Particular Requirements for the safety of
electroencephalographs, 2002-11 |
| CAN/CSA-C22.2 No. 601.1-M90 | Medical electrical equipment, Part 1: General requirements for
safety. |
| CAN/CSA-C22.2 No. 601.1S1-94 | Supplement No. 1-94 to CAN/CSA-C22.2 No. 601-1-M90 Medical
Equipment- Part 1:General requirements for safety. |
| CAN/CSA-C22.2 No. 601.1B-90 | Amendment 2 to CAN/CSA-C22.2 No. 601.1-M90 Medical
equipment Part 1: General requirements for safety: 2002 |
| CAN/CSA-C22.2 No. 60601-1-1-02 | Medical electrical equipment, Part 1-1: General requirements
for safety- Collateral: Safety requirements for medical electrical
systems, 2006 |
| CAN/CSA-C22.2 No.60601-1-2-03 | Medical Electrical Equipment . Part 1-2: General Requirements
for Safety . Collateral Standard: Electromagnetic Compatibility .
Requirements and Tests (Adopted IEC 60601-1-2:2001, second
edition, 2001-09) |
| CAN/CSA C22.2 60601-2-26-04 | Medical Electrical Equipment part 2-26: Particular
requirements for the safety of Electroencephalographs,
adopted IEC 60601-2-26 Ed.2 (02). |

5.0 Conclusions

Based on the comparison information in the technical comparison chart above and confirmed by verification/validation testing in compliance with the Design Control requirements. The intended use and fundamental scientific technology of the device (Nihon Kohden PSG-1100 Sleep Diagnostic System) was shown to be equivalent in safety.and effectiveness to the predicate devices, JE-912A PSG Input Box K022121 and the JE-921A Junction Box K050833/K080546, No new questions of safety or effectiveness are raised.

6

DEPARTMENT OF HEALTH & HUMAN SERVICES

Image /page/6/Picture/1 description: The image shows the logo for the U.S. Department of Health and Human Services. The logo features a stylized caduceus, which is a symbol often associated with medicine and healthcare. The words "DEPARTMENT OF HEALTH & HUMAN SERVICES-USA" are arranged in a circular pattern around the caduceus. The logo is black and white.

Public Health Service

Food and Drug Administration 10903 New Hampshire Avenue Document Control Center - WO66-G609 Silver Spring, MD 20993-002

Nihon Kohden America, Inc. c/o Mr. Steve Geerdes 90 Icon Street Foothill Ranch, CA 92610

NOV

Re: K120888

Trade/Device Name: PSG-1100 Sleep Diagnostic System Regulation Number: 21 CFR 882.1400 Regulation Name: Electroencephalograph Regulatory Class: Class II Product Code: GWQ, OLV Dated: September 6, 2012 Received: September 7, 2012

Dear Mr. Geerdes:

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.

7

Page 2 - Mr. Steve Geerdes

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 (2) 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/Resourcesfor You/Industry/default.htm.

Sincerely yours,

Joyce M. Whanq

Victor Krauthamer, Ph.D. Acting Director Division of Neurological and Physical Medicine · Office of Device Evaluation Center for Devices and Radiological Health

Enclosure

8

Indications for Use Form

510(k) Number (if known): _k120888

Device Name: PSG-1100 Sleep Diagnostic System

Indications for Use:

The PSG-1100 Sleep Diagnostic System is intended to record the physiological data required for EEG and sleep studies (Polysomnography or PSG). These data may be used by clinicians in Sleep Disorders, Epilepsies and other disorders as a diagnostic aid. This device is intended for use by medical personnel and will be available for use within a medical facility or outside of a medical facility under direct supervision of a medical professional.

Prescription Use × (Part 21 CFR 801 Subpart D)

Over-The-Counter Use AND/OR (21 CFR 801 Subpart C)

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

Concurrence of CDRH, Office of In Vitro Diagnostic Devices (OIVD)

KRISTEN ROWSHER

(Division Sign-Off) (Division Sign-Off)
Division of Ophthalmic, Neurological and Ear,
Division of Ophthalmic, Neurological and Ear, Division St. Throat Devices

510(k) Number K120888