Volunteer Info

If you have been diagnosed with COPD or any heart disease, have shortness of breath, chest pains, or blood pressure that is not under control, had a stroke, use O2, or are aware of any reason why you should not participate in this test – please close this page.

If you are willing to proceed, you will be requested to provide the information detailed below when the testing begins, and agree to keep our work confidential.

 1.  Profile Information-

  • Gender: Male __    Female ___
  • Age: _______
  • Height: ______
  • Weight: ______
  • Shirt collar size: _____
  • Has it been suggested by a physician that you use nPAP to treat Obstructive Sleep Apnea (OSA)? Yes ___    No ___
  • OSA Severity as diagnosed? (Mild, Moderate, Severe) and/or Apnea Hypopnea Index (AHI) ______________ ; AHI: ________
  • When were you diagnosed with OSA? ___________________
  • As part of the diagnosis was any mention made of Central and/or Mixed Apneas? Yes ____   No ____
  • If so, what was said? ______________________________________________________

________________________________________________________________________

  • How many hours per night do you use nPAP? ___________
  • How many nights per week do you use nPAP? __________
  • What kind of PAP do you use? CPAP, BiPAP, APAP ____________
  • Have you tried Mandibular Advancement Devices (MAD)? Yes _____ No _____ Date began _______.    Are you still using  your MAD?  ______

2.  Identifying Information-

  • Name: __________________________________________
  • Address: _________________________________________
  • Phone: ____________________
  • Email: ___________________________________________
  • Date: ___________________________________________
  • ID number (this is assigned): ________________________

Note: WhisperSom would only ever share Profile Information with another party for sleep disordered breathing research, diagnosis and treatment development. Not Identifying Information.

I agree to keep the work of WhisperSom confidential.  I will not disclose anything about my participation as a volunteer unless requested by WhisperSom, and agreed to by me.

I affirm that WhisperSom has not made any representations to me that their product either diagnoses or treats obstructive sleep apnea, or that it should be used in place of any treatment that a doctor may prescribe for me – or against a doctor’s advice.

The above information and representations are true and complete to the best of my knowledge and belief.

Volunteer Signature:                   Date:

__________________________________      _________________

__________________________________

Print Name

 

  • A suitable volunteer will be asked to fill out an information form and an initial Epworth Sleepiness Scale (ESS) form.
  • Volunteers will undergo two (2) nights of evaluation with the test equipment in the “passive” and “record” mode, wherein no audio stimulus it delivered.  We do this to establish baselines of physiological data.  In particularly, we are recording the number and length of apneas and blood oxygen saturation levels, to which we can compare the efficacy of the test equipment in the “active” mode, wherein stimuli may be delivered.  For this reason, the pulse oximeter must be worn throughout the test nights.
  • The next three consecutive nights will have the volunteer use the test equipment in its’ active mode and of course, wearing the pulse oximeter.
  • Each morning, volunteers fill out a very simple log of how they slept that night.
  • At the end of the test week volunteers will be asked to fill out another ESS form.

If you are still interested please let me know by contacting me at dgoldstein@whispersom.com (preferred) or by calling me at 978-877-1145 and leave a voice mail message with your phone number.

Thank you.

David B. Goldstein