Search Results (24)

Heart rate variability (HRV) is widely recognized as an indicator of general health, particularly time domain measures like the root mean square of successive differences (RMSSD) between consecutive heartbeats. Consumer wearables measuring HRV have potential for wide accessibility meaning that their broad use to capture HRV as a health biomarker is possible. Our objective was to investigate the validity of HRV measured by wearables as a general health indicator. We examined whether resting HRV assessed by wearables across five studies—two using smartwatches, two using heart rate chest straps, and one using a smartring—exhibited expected associations with diverse health domains, including mental, physical, behavioral, functional, and physiological. We focused on resting HRV measures recorded while in primarily stationary conditions, either upon waking or while sleeping, because such measures would theoretically reduce the effects of potential confounders such as movement artifacts, daytime caffeine intake, and postural changes. Wearables measured resting HRV had small-to-moderate associations with more clinically oriented and trait-like (or slow-changing) health measures like Hba1c (average blood glucose, r = −0.21, p = 0.014), depressive symptoms (r = −0.22, p = 0.024), and sleep difficulty (r = −0.11, p = 0.003). Wearable-measured resting HRV can potentially serve as a health biomarker, but further research is needed. Full article

Background: Rapid-eye-movement (REM) sleep disinhibition—shorter REM latency and a larger nightly REM fraction—is a well-described laboratory correlate of major depression. Whether the same pattern can be captured efficiently with consumer wearables in everyday settings remains unclear. We therefore quantified REM latency and proportion of REM sleep out of total sleep duration (labeled “REM sleep coefficient”) from Apple Watch recordings and examined their association with depressive symptoms. Methods: 191 adults wore an Apple Watch for 15 consecutive nights while a custom iOS app streamed raw accelerometry and heart-rate data. Sleep stages were scored with a neural-network model previously validated against polysomnography. REM latency and REM sleep coefficient were averaged per participant. Depressive severity was assessed twice with the Beck Depression Inventory and averaged. Descriptive statistics, normality tests, Spearman correlations, and ordinary-least-squares regressions were performed. Results: Mean ± SD values were BDI 13.52 ± 6.79, REM sleep coefficient 24.05 ± 6.52, and REM latency 103.63 ± 15.44 min. REM latency correlated negatively with BDI (Spearman ρ = −0.673, p < 0.001), whereas REM sleep coefficient correlated positively (ρ = 0.678, p < 0.001). Combined in a bivariate model, the two REM metrics explained 62% of variance in depressive severity. Conclusions: Wearable-derived REM latency and REM proportion jointly capture a large share of depressive-symptom variability, indicating their potential utility as accessible digital biomarkers. Larger longitudinal and interventional studies are needed to determine whether modifying REM architecture can alter the course of depression. Full article

The home is an ideal setting for long-term sleep monitoring. This review explores a range of home-based sleep monitoring technologies, including smartphone apps, smartwatches, and smart mattresses, to assess their accuracy, usability, limitations, and how well they integrate with existing healthcare systems. This review evaluates 21 smartphone apps, 16 smartwatches, and nine smart mattresses through systematic data collection from academic literature, manufacturer specifications, and independent studies. Devices were assessed based on sleep-tracking capabilities, physiological data collection, movement detection, environmental sensing, AI-driven analytics, and healthcare integration potential. Wearables provide the best balance of accuracy, affordability, and usability, making them the most suitable for general users and athletes. Smartphone apps are cost-effective but offer lower accuracy, making them more appropriate for casual sleep tracking rather than clinical applications. Smart mattresses, while providing passive and comfortable sleep tracking, are costlier and have limited clinical validation. This review offers essential insights for selecting the most appropriate home sleep monitoring technology. Future developments should focus on multi-sensor fusion, AI transparency, energy efficiency, and improved clinical validation to enhance reliability and healthcare applicability. As these technologies evolve, home sleep monitoring has the potential to bridge the gap between consumer-grade tracking and clinical diagnostics, making personalized sleep health insights more accessible and actionable. Full article

Obstructive Sleep Apnea (OSA) is a prevalent chronic sleep-related breathing disorder characterized by partial or complete airway obstruction. The expensive, time-consuming, and labor-intensive nature of the gold-standard approach, polysomnography (PSG), and the lack of regular monitoring of patients’ daily lives with existing solutions motivates the development of clinical support for enhanced prognosis. In this study, we utilize image representations of sleep stages and contextual patient-specific data, including medical history and stage durations, to investigate the use of wearable devices for OSA screening and comorbid conditions. For this purpose, we leverage the publicly available Wisconsin Sleep Cohort (WSC) dataset. Given that wearable devices are adept at detecting sleep stages (often using proprietary algorithms), and medical history data can be efficiently captured through simple binary (yes/no) responses, we seek to explore neural network models with this. Without needing access to the raw physiological signals and using epoch-wise sleep scores and demographic data, we attempt to validate the effectiveness of screening capabilities and assess the interplay between sleep stages, OSA, insomnia, and depression. Our findings reveal that sleep stage representations combined with demographic data enhance the precision of OSA screening, achieving F1 scores of up to 69.40. This approach holds potential for broader applications in population health management as a plausible alternative to traditional diagnostic approaches. However, we find that purely modality-agnostic sleep stages for a single night and routine lifestyle information by themselves may be insufficient for clinical utility, and further work accommodating individual variability and longitudinal data is needed for real-world applicability. Full article

Background: Obstructive sleep apnea is a sleep disorder that is linked to many health complications and can even be lethal in its severe form. Overnight polysomnography is the gold standard for diagnosing apnea, which is expensive, time-consuming, and requires manual analysis by a sleep expert. Artificial intelligence (AI)-embedded wearable device as a portable and less intrusive monitoring system is a highly desired alternative to polysomnography. However, AI models often require substantial storage capacity and computational power for edge inference which makes it a challenging task to implement the models in hardware with memory and power constraints. Methods: This study demonstrates the implementation of depth-wise separable convolution (DSC) as a resource-efficient alternative to spatial convolution (SC) for real-time detection of apneic activity. Single lead electrocardiogram (ECG) and oxygen saturation (SpO₂) signals were acquired from the PhysioNet databank. Using each type of convolution, three different models were developed using ECG, SpO₂, and model fusion. For both types of convolutions, the fusion models outperformed the models built on individual signals across all the performance metrics. Results: Although the SC-based fusion model performed the best, the DSC-based fusion model was 9.4, 1.85, and 11.3 times more energy efficient than SC-based ECG, SpO₂, and fusion models, respectively. Furthermore, the accuracy, precision, and specificity yielded by the DSC-based fusion model were comparable to those of the SC-based individual models (~95%, ~94%, and ~94%, respectively). Conclusions: DSC is commonly used in mobile vision tasks, but its potential in clinical applications for 1-D signals remains unexplored. While SC-based models outperform DSC in accuracy, the DSC-based model offers a more energy-efficient solution with acceptable performance, making it suitable for AI-embedded apnea detection systems. Full article

This study investigates the correlation between REM sleep patterns, as measured by the Apple Watch, and depressive symptoms in an undiagnosed population. Employing the Apple Watch for data collection, REM sleep duration and frequency were monitored over a specified period. Concurrently, participants’ depressive symptoms were evaluated using standardized questionnaires. The analysis, primarily using Spearman’s correlation, revealed noteworthy findings. A significant correlation was observed between an increased REM sleep proportion and higher depressive symptom scores, with a correlation coefficient of 0.702, suggesting a robust relationship. These results highlight the potential of using wearable technology, such as the Apple Watch, in early detection and intervention for depressive symptoms, suggesting that alterations in REM sleep could serve as preliminary indicators of depressive tendencies. This approach offers a non-invasive and accessible means to monitor and potentially preempt the progression of depressive disorders. This study’s implications extend to the broader context of mental health, emphasizing the importance of sleep assessment in routine health evaluations, particularly for individuals exhibiting early signs of depressive symptoms. Full article

More and more people quantify their sleep using wearables and are becoming obsessed in their pursuit of optimal sleep (“orthosomnia”). However, it is criticized that many of these wearables are giving inaccurate feedback and can even lead to negative daytime consequences. Acknowledging these facts, we here optimize our previously suggested sleep classification procedure in a new sample of 136 self-reported poor sleepers to minimize erroneous classification during ambulatory sleep sensing. Firstly, we introduce an advanced interbeat-interval (IBI) quality control using a random forest method to account for wearable recordings in naturalistic and more noisy settings. We further aim to improve sleep classification by opting for a loss function model instead of the overall epoch-by-epoch accuracy to avoid model biases towards the majority class (i.e., “light sleep”). Using these implementations, we compare the classification performance between the optimized (loss function model) and the accuracy model. We use signals derived from PSG, one-channel ECG, and two consumer wearables: the ECG breast belt Polar® H10 (H10) and the Polar® Verity Sense (VS), an optical Photoplethysmography (PPG) heart-rate sensor. The results reveal a high overall accuracy for the loss function in ECG (86.3 %, $\kappa$ = 0.79), as well as the H10 (84.4%, $\kappa$ = 0.76), and VS (84.2%, $\kappa$ = 0.75) sensors, with improvements in deep sleep and wake. In addition, the new optimized model displays moderate to high correlations and agreement with PSG on primary sleep parameters, while measures of reliability, expressed in intra-class correlations, suggest excellent reliability for most sleep parameters. Finally, it is demonstrated that the new model is still classifying sleep accurately in 4-classes in users taking heart-affecting and/or psychoactive medication, which can be considered a prerequisite in older individuals with or without common disorders. Further improving and validating automatic sleep stage classification algorithms based on signals from affordable wearables may resolve existing scepticism and open the door for such approaches in clinical practice. Full article

A hypoglossal nerve stimulator (HGNS) is an invasive device that is used to treat obstructive sleep apnea (OSA) through electrical stimulation. The conventional implantable HGNS device consists of a stimuli generator, a breathing sensor, and electrodes connected to the hypoglossal nerve via leads. However, this implant is bulky and causes significant trauma. In this paper, we propose a minimally invasive HGNS based on an electrocardiogram (ECG) sensor and wireless power transfer (WPT), consisting of a wearable breathing monitor and an implantable stimulator. The breathing external monitor utilizes an ECG sensor to identify abnormal breathing patterns associated with OSA with 88.68% accuracy, achieved through the utilization of a convolutional neural network (CNN) algorithm. With a skin thickness of 5 mm and a receiving coil diameter of 9 mm, the power conversion efficiency was measured as 31.8%. The implantable device, on the other hand, is composed of a front-end CMOS power management module (PMM), a binary-phase-shift-keying (BPSK)-based data demodulator, and a bipolar biphasic current stimuli generator. The PMM, with a silicon area of 0.06 mm${}^2$ (excluding PADs), demonstrated a power conversion efficiency of 77.5% when operating at a receiving frequency of 2 MHz. Furthermore, it offers three-voltage options (1.2 V, 1.8 V, and 3.1 V). Within the data receiver component, a low-power BPSK demodulator was ingeniously incorporated, consuming only 42 $\mathsf{\mu }$W when supplied with a voltage of 0.7 V. The performance was achieved through the implementation of the self-biased phase-locked-loop (PLL) technique. The stimuli generator delivers biphasic constant currents, providing a 5 bit programmable range spanning from 0 to 2.4 mA. The functionality of the proposed ECG- and WPT-based HGNS was validated, representing a highly promising solution for the effective management of OSA, all while minimizing the trauma and space requirements. Full article

Effective monitoring of respiratory disturbances during sleep requires a sensor capable of accurately capturing chest movements or airflow displacement. Gold-standard monitoring of sleep and breathing through polysomnography achieves this task through dedicated chest/abdomen bands, thermistors, and nasal flow sensors, and more detailed physiology, evaluations via a nasal mask, pneumotachograph, and airway pressure sensors. However, these measurement approaches can be invasive and time-consuming to perform and analyze. This work compares the performance of a non-invasive wearable stretchable morphic sensor, which does not require direct skin contact, embedded in a t-shirt worn by 32 volunteer participants (26 males, 6 females) with sleep-disordered breathing who performed a detailed, overnight in-laboratory sleep study. Direct comparison of computed respiratory parameters from morphic sensors versus traditional polysomnography had approximately 95% (95 ± 0.7) accuracy. These findings confirm that novel wearable morphic sensors provide a viable alternative to non-invasively and simultaneously capture respiratory rate and chest and abdominal motions. Full article

Sleep is a physiological process that has been shown to impact both physical and psychological heath of individuals when compromised; hence, it has the potential to be used as an indicator of animal welfare. Nonetheless, evaluating sleep in non-human species normally involves manipulation of the subjects (i.e., placement of electrodes on the cranium), and most studies are conducted in a laboratory setting, which limits the generalisability of information obtained, and the species investigated. In this study, we evaluated an alternative method of assessing sleep behaviour in domestic dogs, using a wearable sensor, and compared the measurements obtained to behavioural observations to evaluate accuracy. Differences between methods ranged from 0.13% to 59.3% for diurnal observations and 0.1% to 95.9% for nocturnal observations for point-by-point observations. Comparisons between methods showed significant differences in certain behaviours, such as inactivity and activity for diurnal recordings. However, total activity and total sleep recorded did not differ statistically between methods. Overall, the wearable technology tested was found to be a useful, and a less-time consuming, tool in comparison to direct behavioural observations for the evaluation of behaviours and their indication of wellbeing in dogs. The agreement between the wearable technology and directly observed data ranged from 75% to 99% for recorded behaviours, and these results are similar to previous findings in the literature. Full article

Sleep staging based on polysomnography (PSG) performed by human experts is the de facto “gold standard” for the objective measurement of sleep. PSG and manual sleep staging is, however, personnel-intensive and time-consuming and it is thus impractical to monitor a person’s sleep architecture over extended periods. Here, we present a novel, low-cost, automatized, deep learning alternative to PSG sleep staging that provides a reliable epoch-by-epoch four-class sleep staging approach (Wake, Light [N1 + N2], Deep, REM) based solely on inter-beat-interval (IBI) data. Having trained a multi-resolution convolutional neural network (MCNN) on the IBIs of 8898 full-night manually sleep-staged recordings, we tested the MCNN on sleep classification using the IBIs of two low-cost (<EUR 100) consumer wearables: an optical heart rate sensor (VS) and a breast belt (H10), both produced by POLAR®. The overall classification accuracy reached levels comparable to expert inter-rater reliability for both devices (VS: 81%, $\kappa$ = 0.69; H10: 80.3%, $\kappa$ = 0.69). In addition, we used the H10 and recorded daily ECG data from 49 participants with sleep complaints over the course of a digital CBT-I-based sleep training program implemented in the App NUKKUAA™. As proof of principle, we classified the IBIs extracted from H10 using the MCNN over the course of the training program and captured sleep-related changes. At the end of the program, participants reported significant improvements in subjective sleep quality and sleep onset latency. Similarly, objective sleep onset latency showed a trend toward improvement. Weekly sleep onset latency, wake time during sleep, and total sleep time also correlated significantly with the subjective reports. The combination of state-of-the-art machine learning with suitable wearables allows continuous and accurate monitoring of sleep in naturalistic settings with profound implications for answering basic and clinical research questions. Full article

The primary aim of this study was to examine the validity of six commonly used wearable devices, i.e., Apple Watch S6, Garmin Forerunner 245 Music, Polar Vantage V, Oura Ring Generation 2, WHOOP 3.0 and Somfit, for assessing sleep. The secondary aim was to examine the validity of the six devices for assessing heart rate and heart rate variability during, or just prior to, night-time sleep. Fifty-three adults (26 F, 27 M, aged 25.4 ± 5.9 years) spent a single night in a sleep laboratory with 9 h in bed (23:00–08:00 h). Participants were fitted with all six wearable devices—and with polysomnography and electrocardiography for gold-standard assessment of sleep and heart rate, respectively. Compared with polysomnography, agreement (and Cohen’s kappa) for two-state categorisation of sleep periods (as sleep or wake) was 88% (κ = 0.30) for Apple Watch; 89% (κ = 0.35) for Garmin; 87% (κ = 0.44) for Polar; 89% (κ = 0.51) for Oura; 86% (κ = 0.44) for WHOOP and 87% (κ = 0.48) for Somfit. Compared with polysomnography, agreement (and Cohen’s kappa) for multi-state categorisation of sleep periods (as a specific sleep stage or wake) was 53% (κ = 0.20) for Apple Watch; 50% (κ = 0.25) for Garmin; 51% (κ = 0.28) for Polar; 61% (κ = 0.43) for Oura; 60% (κ = 0.44) for WHOOP and 65% (κ = 0.52) for Somfit. Analyses regarding the two-state categorisation of sleep indicate that all six devices are valid for the field-based assessment of the timing and duration of sleep. However, analyses regarding the multi-state categorisation of sleep indicate that all six devices require improvement for the assessment of specific sleep stages. As the use of wearable devices that are valid for the assessment of sleep increases in the general community, so too does the potential to answer research questions that were previously impractical or impossible to address—in some way, we could consider that the whole world is becoming a sleep laboratory. Full article

Nowadays, self-tracking and optimization are widely spread. As sleep is essential for well-being, health, and peak performance, the number of available consumer technologies to assess individual sleep behavior is increasing rapidly. However, little is known about the consumer wearables’ usability and reliability for sleep tracking. Therefore, the aim of the present study was to compare the sleep measures of wearable devices with a standardized sleep diary in young healthy adults in free-living conditions. We tracked night sleep from 30 participants (19 females, 11 males; 24.3 ± 4.2 years old). Each wore three wearables and simultaneously assessed individual sleep patterns for four consecutive nights. Wearables and diaries correlated substantially regarding time in bed (Range CCC_Lin: 0.74–0.84) and total sleep time (Range CCC_Lin: 0.76–0.85). There was no sufficient agreement regarding the measures of sleep efficiency (Range CCC_Lin: 0.05–0.34) and sleep interruptions (Range CCC_Lin: −0.02–0.10). Finally, these results show wearables to be an easy-to-handle, time- and cost-efficient alternative to tracking sleep in healthy populations. Future research should develop and empirically test the usability of such consumer sleep technologies. Full article

Global demand for sleep-tracking wearables, or consumer sleep technologies (CSTs), is steadily increasing. CST marketing campaigns often advertise the scientific merit of devices, but these claims may not align with consensus opinion from sleep research experts. Consensus opinion about CST features has not previously been established in a cohort of sleep researchers. This case study reports the results of the first survey of experts in real-world sleep research and a hypothetical purchase task (HPT) to establish economic valuation for devices with different features by price. Forty-six (N = 46) respondents with an average of 10 ± 6 years’ experience conducting research in real-world settings completed the online survey. Total sleep time was ranked as the most important measure of sleep, followed by objective sleep quality, while sleep architecture/depth and diagnostic information were ranked as least important. A total of 52% of experts preferred wrist-worn devices that could reliably determine sleep episodes as short as 20 min. The economic value was greater for hypothetical devices with a longer battery life. These data set a precedent for determining how scientific merit impacts the potential market value of a CST. This is the first known attempt to establish a consensus opinion or an economic valuation for scientifically desirable CST features and metrics using expert elicitation. Full article

Ventricular arrhythmia (VA) is a leading cause of sudden death and health deterioration. Recent advances in predictive analytics and wearable technology for behavior assessment show promise but require further investigation. Yet, previous studies have only assessed other health outcomes and monitored patients for short durations (7–14 days). This study explores how behaviors reported by a consumer wearable can assist VA risk prediction. An exploratory observational study was conducted with participants who had an implantable cardioverter-defibrillator (ICD) and wore a Fitbit Alta HR consumer wearable. Fitbit reported behavioral markers for physical activity (light, fair, vigorous), sleep, and heart rate. A case-crossover analysis using conditional logistic regression assessed the effects of time-adjusted behaviors over 1–8 weeks on VA incidence. Twenty-seven patients (25 males, median age 59 years) were included. Among the participants, ICDs recorded 262 VA events during 8093 days monitored by Fitbit (median follow-up period 960 days). Longer light to fair activity durations and a higher heart rate increased the odds of a VA event (p < 0.001). In contrast, lengthier fair to vigorous activity and sleep durations decreased the odds of a VA event (p < 0.001). Future studies using consumer wearables in a larger population should prioritize these outcomes to further assess VA risk. Full article