Digital Health and Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

Rosa, Talita D’Aguiar; Bellardi, Kersti; Viana, Alonço; Ma, Yifei; Capasso, Robson

doi:10.5664/jcsm.7346

Cited by 19 publications

(19 citation statements)

References 30 publications

(45 reference statements)

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“…Additionally, a recent review exploring the use of electronical devices for the diagnosis of sleep-disordered breathing showed that most studies had quality issues, such as not reporting the sociodemographic characteristics of their samples. 20 Most devices that have been studied employ only acceleration (actigraphy) sensors to determine the sleep status, with the notable exceptions of the Fitbit Charge 2 (Fitbit, Inc., San Francisco, California, United States) 15 and the Withings Pulse O2. 19 Both the Fitbit Charge 2 and the Fitbit Alta HR can measure heart rate using photoplethysmogram (PPG) sensors.…”

Section: Introductionmentioning

confidence: 99%

Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea

Moreno-Pino

Porras-Segovia

López-Esteban³

et al. 2019

Journal of Clinical Sleep Medicine

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Study Objectives: Consumer wearable devices may be a helpful method of assessing sleep, but validation is required for their use in clinical practice. Our aim was to validate two models of Fitbit sleep trackers that rely on both accelerometer and heart rate sensors against polysomnography in participants with obstructive sleep apnea (OSA). Methods: Participants were adults presenting with symptoms of OSA and attending our outpatient sleep clinic. A polysomnography (PSG) was applied to all participants at the same time they were wearing a Fitbit sleep tracker. Using paired t tests and Bland-Altman plots, we compared the sleep measures provided by the wearable devices with those obtained by PSG. Since Fitbit devices' automatic detection of sleep start time can cause bias, we performed a correction using Huber loss function-based linear regression and a leave-one-out strategy. Results: Our sample consisted of 65 patients. Diagnosis of OSA was confirmed on 55 (84.6%). There were statistically significant differences between PSG and Fitbit measures for all sleep outcomes but rapid eye movement sleep. Fitbit devices overestimated total sleep time, and underestimated wake after sleep onset and sleep onset latency. After correction of bias, Fitbit-delivered measures of sleep onset latency did not significantly differ of those provided by PSG. Conclusions: Fitbit wearable devices showed an acceptable sensitivity but poor specificity. Consumer sleep trackers still have insufficient accuracy for clinical settings, especially in clinical populations. Solving technical issues and optimizing clinically-oriented features could make them apt for their use in clinical practice in a nondistant future.

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Section: Introductionmentioning

confidence: 99%

Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea

Moreno-Pino

Porras-Segovia

López-Esteban³

et al. 2019

Journal of Clinical Sleep Medicine

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“…While being obese, no sleep-related respiratory disorder was present in this patient. Nevertheless, her case may remember doctors to consider SAS when examining a patient for ECT, and to use ambulatory screening instruments ( Jonas et al, 2017 ; Rosa et al, 2018 ) to assess SAS if necessary.…”

Section: Discussionmentioning

confidence: 99%

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Hajak

Hajak²,

Ziegelmayer³

et al. 2021

Front. Psychol.

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Background: Extensive research has reported that electroconvulsive therapy (ECT) can be highly effective in approximately 80% of patients suffering from depression. Its clinical use is mainly limited by historical objections and the concern about unwanted adverse effects (AEs), including serious and potentially life-threatening adverse events (pLTAEs), induced either by ECT or by anesthesia. Objective risk estimation is, therefore, a decisive factor in determining an indication for ECT.Methods: This paper presents a retrospective analysis of 3-year safety protocols and patient files of 157 patients who received a total of 3,106 ECT applications in a psychiatric inpatient setting at a psychiatric community hospital. This patient group comprises 5.3% of inpatients admitted with comparable diagnoses. Adverse events were analyzed from standardized safety protocols and patient files with a focus on pLTAEs.Results: Adverse events were reported for 30 (19.1%) of the 157 participants during 39 (6.1%) of 641 hospital stays. Serious pLTAEs occurred during three electroconvulsive stimulations in three patients, who needed action through the administration of medication or mechanical respiration. No patient suffered permanent damage to health, and no patient died. The incidence of these and other AEs was independent of sex, age, and diagnosis of patients, and anesthesia medication. Minor AEs occurred more often with higher stimulus doses and an increasing number of treatments.Conclusion: The low incidence rate of 0.097% of serious pLTAEs that require medical action may allow the conclusion that ECT is a rather safe treatment when performed in a controlled setting. The beneficial risk profile of ECT performed in the standard care of psychiatric hospitals suggests a more generous indication of this treatment method. We recommend that ECT facilities collect individual safety data to allow a reliable judgment of their institutional ECT risk profile.

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“…Type 4 evaluations involve portable devices with one to two variables. In recent years, with the emergence of mobile technology, developers have been engineering novel tools and mobile device sensors that utilize motion/actigraphy measurements, and audiological and video recording ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Precision Medicine in Adult Obstructive Sleep Apnea and Home Diagnostic Testing: Caution in Interpretation of Home Studies Without Clinician Input Is Necessary

et al. 2022

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PurposeTo assess the validity of home sleep apnea test directed diagnosis and treatment of obstructive sleep apnea (OSA) in a real-life clinical setting and establish the extent to which clinical evaluation alters diagnosis and therapeutic intervention, in the context of the evolving realm of precision medicine.MethodsRetrospective consecutive cohort study of 505 patients referred to a single center between 15th September 2015 to 14th September 2016, multidisciplinary specialist sleep clinic presenting with a home sleep apnea test prior to referral. We evaluated the effect of sleep medicine practitioner (SMP) and ear, nose, and throat surgeon (ENTS) review on patient diagnoses, disease severity, and management options in OSA.ResultsHundred and fifteen patients were included. Repeat evaluation with in-lab polysomnogram (PSG) was required in 46/115 (40.0%) of patients, of which 20/46 (43.5%) had OSA severity changed. Sleep medicine practitioner review decreased the need for repeat testing with formal in-lab PSG (p < 0.05) and increased patient acceptance of continuous positive airway pressure (CPAP) as a long-term management option for OSA. Sleep medicine practitioner/ENTS review resulted in discovery of a non-OSA related sleep disorder or change in OSA severity in 47.8% (55/115). Ear, nose, and throat surgeon review resulted in additional or changed diagnosis in 75.7% (87/115) of patients.ConclusionIn the clinical assessment and diagnosis of OSA, patients should be reviewed by medical practitioners with an interest in sleep disorders to better navigate the complexities of assessment, as well as the identification of co-morbid conditions.

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Digital Health and Sleep-Disordered Breathing: A Systematic Review and Meta-Analysis

Abstract: This study evidenced the limitations and potential use of portable devices in screening patients for SDB. Additional research should evaluate the accuracy of devices when used at home.

Cited by 19 publications

References 30 publications

Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea

Validation of Fitbit Charge 2 and Fitbit Alta HR Against Polysomnography for Assessing Sleep in Adults With Obstructive Sleep Apnea

Risk Assessment of Electroconvulsive Therapy in Clinical Routine: A 3-Year Analysis of Life-Threatening Events in More Than 3,000 Treatment Sessions

Precision Medicine in Adult Obstructive Sleep Apnea and Home Diagnostic Testing: Caution in Interpretation of Home Studies Without Clinician Input Is Necessary

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