Continuous monitoring with wearables in multiple sclerosis reveals an association of cardiac autonomic dysfunction with disease severity

Hilty, Marc; Oldrati, Pietro; Barrios, Liliana; Müller, T; Blumer, Claudia; Foege, Magdalena; consortium, PHRT; Holz, Christian; Lutterotti, Andreas

doi:10.1177/20552173221103436

Cited by 10 publications

(6 citation statements)

References 61 publications

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“…109 . Hilty et al found an association between heart rate variability and disease severity in PwMS through 24-hour monitoring with a wearable device 110 . During a virtual peg insertion test, smoothness and grip force measured with a haptic device were altered in PwMS compared to HC and showed higher sensitivity than its clinical counterparts 111 .…”

Section: Other Wearablesmentioning

confidence: 99%

Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

Specht,

Jager,

Garbaya

et al. 2023

Preprint

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In recent times, we have unequivocally witnessed a push towards digitising the healthcare system. Topics such as remote patient monitoring (RPM), digital health, and their use to monitor neurological disease progression have gained momentum and popularity. Notwithstanding the considerable advances that have been made in adopting such technologies and using them in the context of mental health or even a few neurodegenerative disease monitoring, they have not been widely used in the context of remote management and treatment of multiple sclerosis MS. In the same vein, given that (MS) is a very individualized disease to manage, there are numerous challenges yet opportunities associated with using digital health technologies for remote MS monitoring. This paper reviews the different research work and clinical attempts performed over the last decade (both home & hospital-based monitoring) en route to using digital health for MS monitoring and management. Similarly, this systematic review discusses the main challenges and barriers to translating that research from clinics into homes and highlights the opportunities in that context. Throughout this extensive review, we shine a light on various monitoring methods that hold the potential to be measured in a home environment, including electroencephalography (EEG) and evoked potentials (e.g., motor evoked potential (MEP), somatosensory evoked potentials (SSEP), and visual evoked potential (VEP)), electromyography (EMG), inertial measurement unit (IMU), and speech analysis. Combining such digital biomarkers could pave the way for developing a more personalised treatment for MS patients, thereby stopping its progression and avoiding silent MS disability. Adopting digital health for remote monitoring and management could also chart a route ahead for a new era of personalised medicine for MS patients and potentially other brain disorder patients.

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Section: Other Wearablesmentioning

confidence: 99%

Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

Specht,

Jager,

Garbaya

et al. 2023

Preprint

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“…In addition to being less cumbersome than Holter monitors, these chest-worn sensors may be easier to apply in remote settings compared to a sacral sensor when used for movement analysis. Cardiac measures, such as heart rate, have been shown to relate to disease severity and fatigue in PwMS [26] and may inform new measures of fatiguability [27]. Wide adoption of these devices, which often include accelerometers, may also provide an opportunity for expanding our ability to capture measures of postural sway using these devices, but chest-worn accelerometers have not yet been validated for this purpose.…”

Section: Introductionmentioning

confidence: 99%

Chest-Based Wearables and Individualized Distributions for Assessing Postural Sway in Persons With Multiple Sclerosis

Meyer

Cohen

Donahue

et al. 2023

IEEE Trans. Neural Syst. Rehabil. Eng.

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Typical assessments of balance impairment are subjective or require data from cumbersome and expensive force platforms. Researchers have utilized lower back (sacrum) accelerometers to enable more accessible, objective measurement of postural sway for use in balance assessment. However, new sensor patches are broadly being deployed on the chest for cardiac monitoring, opening a need to determine if measurements from these devices can similarly inform balance assessment. Our aim in this work is to validate postural sway measurements from a chest accelerometer. To establish concurrent validity, we considered data from 16 persons with multiple sclerosis (PwMS) asked to stand on a force platform while also wearing sensor patches on the sacrum and chest. We found five of 15 postural sway features derived from the chest and sacrum were significantly correlated with force platform-derived features, which is in line with prior sacrum-derived findings. Clinical significance was established using a sample of 39 PwMS who performed eyes-open, eyes-closed, and tandem standing tasks. This cohort was stratified by fall status and completed several patient-reported measures (PRM) of balance and mobility impairment. We also compared sway features derived from a single 30-second period to those derived from a oneminute period with a sliding window to create individualized distributions of each postural sway feature (ID method). We find traditional computation of sway features from the chest is sensitive to changes in PRMs and task differences. Distribution characteristics from the ID method establish additional relationships with PRMs, detect differences in more tasks, and distinguish between fall status groups. Overall, the chest was found to be a valid location to monitor postural sway and we recommend utilizing the ID method over single-observation analyses.

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“…Commercially available wearable devices (wearables) and contactless technologies (nearables) are increasingly used for home monitoring and have the potential to enable remote health monitoring and promote independent living [11][12][13][14][15][16][17][18]. These technologies offer secure digital infrastructure that allows reliable and seamless transfer of collected data to cloud servers and can facilitate long term remote monitoring opportunities for healthcare.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Wearables are widely used for continuous, community monitoring of heart rate and some have been evaluated in clinical settings although predominantly in younger age groups [17–25]. Although several wearables have been shown to be acceptable for older adults, lower technology adoption rate, user comfort trade off, and burden of maintenance (removal during some daily activities such as showers, periodic recharging, and mobile application use) may make them unsuitable for long term use in PLWD due to their associated behavioural and psychological symptoms [23, 26].…”

Section: Introductionmentioning

confidence: 99%

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Reliable Contactless Monitoring of Heart Rate, Breathing Rate and Breathing Disturbance During Sleep in Aging: A Digital Health Technology Evaluation Study

Ravindran,

della Monica,

Atzori

et al. 2023

Preprint

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Introduction: Longitudinal monitoring of vital signs provides a method for identifying changes to general health in an individual and particularly so in older adults. The nocturnal sleep period provides a convenient opportunity to assess vital signs. Contactless technologies that can be embedded into the bedroom environment are unintrusive and burdenless and have the potential to enable seamless monitoring of vital signs. To realise this potential, these technologies need to be evaluated against gold standard measures and in relevant populations. Methods: We evaluated the accuracy of heart rate and breathing rate measurements of three contactless technologies (two under-mattress trackers: Withings sleep analyser (WSA) and Emfit QS (Emfit) and a bedside radar: Somnofy) in a sleep laboratory environment and assessed their potential to capture vital signs (heart rate and breathing rate) in a real-world setting. Data were collected in 35 community dwelling older adults aged between 65 and 83 years (mean ± SD: 70.8 ± 4.9; 21 men) during a one-night clinical polysomnography (PSG) in a sleep laboratory, preceded by 7 to 14 days of data collection at-home. Several of the participants had health conditions including type-2 diabetes, hypertension, obesity, and arthritis and ≈ 49% (n = 17) had moderate to severe sleep apnea while ≈ 29% (n = 10) had periodic leg movement disorder. The under-mattress trackers provided estimates of both heart rate and breathing rate while the bedside radar provided only breathing rate. The accuracy of the heart rate and breathing rate estimated by the devices was compared to PSG electrocardiogram (ECG) derived heart rate (beats per minute, bpm) and respiratory inductance plethysmography thorax (RIP thorax) derived breathing rate (cycles per minute, cpm). We also evaluated breathing disturbance indices of snoring and the apnea-hypopnea index (AHI) available from the WSA. Results: All three contactless technologies provided acceptable accuracy in estimating heart rate [mean absolute error (MAE) < 2.2 bpm and mean absolute percentage error (MAPE) < 5%] and breathing rate (MAE ≤ 1.6 cpm and MAPE < 12%) at 1 minute resolution. All three contactless technologies were able to capture changes in heart rate and breathing rate across the sleep period. The WSA snoring and breathing disturbance estimates were also accurate compared to PSG estimates (R-squared: WSA Snore: 0.76, p < 0.001; WSA AHI: 0.59, p < 0.001). Conclusion: Contactless technologies offer an unintrusive alternative to conventional wearable technologies for reliable monitoring of heart rate, breathing rate, and sleep apnea in community dwelling older adults at scale. They enable assessment of night-to-night variation in these vital signs, which may allow the identification of acute changes in health, and longitudinal monitoring which may provide insight into health trajectories.

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Continuous monitoring with wearables in multiple sclerosis reveals an association of cardiac autonomic dysfunction with disease severity

Cited by 10 publications

References 61 publications

Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

Multiple Sclerosis in the Digital Health Age: Challenges and Opportunities - A Systematic Review

Chest-Based Wearables and Individualized Distributions for Assessing Postural Sway in Persons With Multiple Sclerosis

Reliable Contactless Monitoring of Heart Rate, Breathing Rate and Breathing Disturbance During Sleep in Aging: A Digital Health Technology Evaluation Study

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