Home-Use Impact and Effectiveness of Cloud 9

This is an interventional study in which patients with a history of habitual snoring use the
Cloud9™ Continuous Positive Airway Pressure (CPAP) device that delivers a low level of
continuous nasal air pressure between 2 cm H2O and 4 cm H2O, for about four weeks at their
home. This study is designed to document the adherence of the snorer, the acceptance and
comfort of the therapy, and bed partners' subjective report of improvement in sleep quality,
and/or reduction or elimination of snoring.

Study Procedures

Study Procedures

Baseline Assessment: The study begins with a baseline assessment to determine whether each
participant meets the entry criteria for the study. After consent, participant snorers will
have a history and physical exam to confirm entry criteria and answer questionnaires: Epworth
Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), Snore Outcomes Survey (SOS),
and Stanford Sleepiness Scale (SSS) to assess their sleepiness and snoring. In a second step,
snoring participants who initially meet the entry criteria will receive a full night Home
Sleep Test (HST) to confirm snoring and to rule out sleep apnea or any other sleep related
disorder. Participants who already performed a full night polysomnography (PSG) as a part of
the earlier sleep lab study for the Cloud9 device (Treatment of Snoring NA_00073250) do not
have to be re-screened, if the earlier PSG is not older than 36 months, and the participant's
BMI remains within 3 kg/m2 of its original value. In parallel, the snorer's bed-partner will
be asked to complete baseline questionnaires: ESS, PSQI, Spouse/Bed-partner Survey (SBPS),
and supplement, SSS, and snore assessment according to Visual Analog Scale (VAS).

Baseline Week: Snorers and bed-partners will be asked to wear Actigraphy watches for
approximately one-week prior to the initiation of treatment at home with the study device.

Home-Trial: At the end of the baseline week, snoring participants will be asked to use the
device at home for 4 weeks. Usage data will be recorded by a power logger and read when
returned to the study site at the end of study. Snoring participants will receive a study
coordinator call on the day after night 1 of the home trial. Additionally, snoring
participants will receive a coordinator call weekly thereafter, to assess the user experience
with the device. Snorers and bed-partners will continue to wear Actigraphy monitors
throughout the home-trial.

Final Visit: At the end of the 4 weeks of home use, participants will return all study
equipment to the sleep lab. Usage data from the data logger will be read for compliance
rates. Snoring participants and their bed partners will also complete a final set of
questionnaires as before (ESS, PSQI, SOS, SBPS and supplement. Bed partners will rate snoring
using VAS. Snorers will also be asked to complete a Comfort and Acceptability Survey and the
Sleep Apnea Quality of Life Index (SAQLI) Treatment related questions.

Inclusion Criteria:

- Patient is > 18 years of age.

- Patient is willing and able to provide written Informed Consent utilizing a Patient
Information and Consent form that has been reviewed and approved by a governing
Institutional Review Board (IRB).

- Patient has a bed partner willing to participate in the study

- Patient has a history of habitual snoring (almost every night or every night) as
determined by a bed-partner; bed-partner subjectively reports that snoring is a
considerable burden for her/him.

- Patient has been pre-screened and demonstrates an Epworth Questionnaire (an assessment
of daytime sleepiness; high number = greater sleepiness) score of less than 11, no
history of witnessed apneas or nocturnal gasping/choking episodes and a BMI ≤ 35, or
subjects with a BMI >35 who have no significant sleep apnea already documented on an
overnight sleep study.

Exclusion Criteria: (For subjects recruited from the previous inSleep protocol, the BMI
must be in a range of ±3 kg/m2 of the earlier recorded value)

- Patient has been diagnosed with Chronic Obstructive Pulmonary Disease (COPD), asthma,
emphysema or chronic bronchitis.

- Patient has a history of heart disease, heart attack or stroke.

- Patient has uncontrolled or poorly controlled hypertension.

- Patient has been diagnosed with Obstructive Sleep Apnea (OSA), defined as
Apnea-Hypopnea Index (AHI) ≥ 15. Hypopnea is defined as a discernible reduction in
flow that is associated with a greater than or equal to 4% desaturation.

- Pregnancy of the snoring participant, by self-report. If there is any doubt concerning
status, a urine pregnancy test will be performed.

- Patient is currently participating in another clinical study for which follow-up is
ongoing.