Publications

Patients with spinal cord injury (SCI) have an increased risk of sleep-disordered breathing (SDB), which can lead to serious comorbidities and impact patients’ recovery and quality of life. However, sleep tests are rarely performed on SCI patients, given their multiple health needs and the cost and complexity of diagnostic equipment. The objective of this study was to use a novel smartphone system as a simple non-invasive tool to monitor SDB in SCI patients. We recorded pulse oximetry, acoustic, and accelerometer data using a smartphone during overnight tests in 19 SCI patients and 19 able-bodied controls. Then, we analyzed these signals with automatic algorithms to detect desaturation, apnea, and hypopnea events and monitor sleep position. The apnea–hypopnea index (AHI) was significantly higher in SCI patients than controls (25 ± 15 vs. 9 ± 7, p < 0.001). We found that 63% of SCI patients had moderate-to-severe SDB (AHI ? 15) in contrast to 21% of control subjects. Most SCI patients slept predominantly in supine position, but an increased occurrence of events in supine position was only observed for eight patients. This study highlights the problem of SDB in SCI and provides simple cost-effective sleep monitoring tools to facilitate the detection, understanding, and management of SDB in SCI patients.

JTD Keywords: apnea syndrome, biomedical signal processing, individuals, mhealth, monitoring, nasal resistance, people, position, prevalence, questionnaire, sample, sleep apnea, sleep position, sleep-disordered breathing, smartphone, time, Apnea-hypopnea indices, Biomedical signal processing, Biomedical signals processing, Cost effectiveness, Diagnosis, Mhealth, Monitoring, Noninvasive medical procedures, Oximeters, Oxygen-saturation, Patient rehabilitation, Simple++, Sleep apnea, Sleep position, Sleep research, Sleep-disordered breathing, Smart phones, Smartphone, Smartphones, Spinal cord injury, Spinal cord injury patients

Objective. Impaired trunk stability is frequent in spinal cord injury (SCI), but there is a lack of quantitative measures for assessing trunk function. Our objectives were to: (a) evaluate trunk muscle activity and movement patterns during a reaching task in SCI patients, (b) compare the impact of cervical (cSCI) and thoracic (tSCI) injuries in trunk function, and (c) investigate the effects of a startling acoustic stimulus (SAS) in these patients. Approach. Electromyographic (EMG) and smartphone accelerometer data were recorded from 15 cSCI patients, nine tSCI patients, and 24 healthy controls, during a reaching task requiring trunk tilting. We calculated the response time (RespT) until pressing a target button, EMG onset latencies and amplitudes, and trunk tilt, lateral deviation, and other movement features from accelerometry. Statistical analysis was applied to analyze the effects of group (cSCI, tSCI, control) and condition (SAS, non-SAS) in each outcome measure. Main results. SCI patients, especially those with cSCI, presented significantly longer RespT and EMG onset latencies than controls. Moreover, in SCI patients, forward trunk tilt was accompanied by significant lateral deviation. RespT and EMG latencies were remarkably shortened by the SAS (the so-called StartReact effect) in tSCI patients and controls, but not in cSCI patients, who also showed higher variability. Significance. The combination of EMG and smartphone accelerometer data can provide quantitative measures for the assessment of trunk function in SCI. Our results show deficits in postural control and compensatory strategies employed by SCI patients, including delayed responses and higher lateral deviations, possibly to improve sitting balance. This is the first study investigating the StartReact responses in trunk muscles in SCI patients and shows that the SAS significantly accelerates RespT in tSCI, but not in cSCI, suggesting an increased cortical control exerted by these patients.

JTD Keywords: accelerometer, electromyography, impairment, individuals, movements, postural stability, reaction-time, reliability, sitting balance, smartphone, spinal cord injury, startle, startreact, strategies, stroke, trunk, Accelerometer, Electromyography, Sitting balance, Smartphone, Spinal cord injury, Startreact, Trunk

Poor sleep quality or disturbed sleep is associated with multiple health conditions. Sleep position affects the severity and occurrence of these complications, and positional therapy is one of the less invasive treatments to deal with them. Sleep positions can be self-reported, which is unreliable, or determined by using specific devices, such as polysomnography, polygraphy or cameras, that can be expensive and difficult to employ at home. The aim of this study is to determine how smartphones could be used to monitor and treat sleep position at home. We divided our research into three tasks: (1) develop an Android smartphone application (‘SleepPos’ app) which monitors angle-based high-resolution sleep position and allows to simultaneously apply positional treatment; (2) test the smartphone application at home coupled with a pulse oximeter; and (3) explore the potential of this tool to detect the positional occurrence of desaturation events. The results show how the ‘SleepPos’ app successfully determined the sleep position and revealed positional patterns of occurrence of desaturation events. The ‘SleepPos’ app also succeeded in applying positional therapy and preventing the subjects from sleeping in the supine sleep position. This study demonstrates how smartphones are capable of reliably monitoring high-resolution sleep position and provide useful clinical information about the positional occurrence of desaturation events.

JTD Keywords: accelerometry, android, apnea patients, app, association, biomedical signal processing, management, mhealth, monitoring, pathophysiology, pilot mhealth, questionnaire, sleep position, smartphone, supine position, time, Accelerometry, Android, App, Biomedical signal processing, Mhealth, Monitoring, Sleep position, Smart-phone, Smartphone, Tennis ball technique

Poor sleep quality is a risk factor for multiple mental, cardiovascular, and cerebrovascular diseases. Certain sleep positions or excessive position changes can be related to some diseases and poor sleep quality. Nevertheless, sleep position is usually classified into four discrete values: supine, prone, left and right. An increase in sleep position resolution is necessary to better assess sleep position dynamics and to interpret more accurately intermediate sleep positions. This research aims to study the feasibility of smartphones as sleep position monitors by (1) developing algorithms to retrieve the sleep position angle from smartphone accelerometry; (2) monitoring the sleep position angle in patients with obstructive sleep apnea (OSA); (3) comparing the discretized sleep angle versus the four classic sleep positions obtained by the video-validated polysomnography (PSG); and (4) analyzing the presence of positional OSA (pOSA) related to its sleep angle of occurrence. Results from 19 OSA patients reveal that a higher resolution sleep position would help to better diagnose and treat patients with position-dependent diseases such as pOSA. They also show that smartphones are promising mHealth tools for enhanced position monitoring at hospitals and home, as they can provide sleep position with higher resolution than the gold-standard video-validated PSG.

JTD Keywords: accelerometry, actigraphy, association, biomedical signal processing, index, latency, mhealth, monitoring, pathophysiology, quality, questionnaire, score, sleep apnea, sleep position, smartphone, time, Accelerometry, Biomedical signal processing, Mhealth, Monitoring, Sleep apnea, Sleep position, Smartphone, Supine position

Obstructive sleep apnea (OSA) is a sleep disorder in which repetitive upper airway obstructive events occur during sleep. These events can induce hypoxia, which is a risk factor for multiple cardiovascular and cerebrovascular diseases. OSA is also known to be position-dependent in some patients, which is referred to as positional OSA (pOSA). Screening for pOSA is necessary in order to design more personalized and effective treatment strategies. In this article, we propose analyzing accelerometry signals, recorded with a smartphone, to detect and monitor OSA at home. Our objectives were to: (1) develop an algorithm for detecting thoracic movement associated with disordered breathing events; (2) compare the performance of smartphones as OSA monitoring tools with a type 3 portable sleep monitor; and (3) explore the feasibility of using smartphone accelerometry to retrieve reliable patient sleep position data and assess pOSA. Accelerometry signals were collected through simultaneous overnight acquisition using both devices with 13 subjects. The smartphone tool showed a high degree of concordance compared to the portable device and succeeded in estimating the apnea-hypopnea index (AHI) and classifying the severity level in most subjects. To assess the agreement between the two systems, an event-by-event comparison was performed, which found a sensitivity of 90% and a positive predictive value of 80%. It was also possible to identify pOSA by determining the ratio of events occurring in a specific position versus the time spent in that position during the night. These novel results suggest that smartphones are promising mHealth tools for OSA and pOSA monitoring at home.

JTD Keywords: Accelerometry, Biomedical signal processing, mHealth, Monitoring, Sleep apnea, Sleep position, Smartphone

Obstructive sleep apnea (OSA) is a prevalent disease, but most patients remain undiagnosed and untreated. Here we propose analyzing smartphone audio signals for screening OSA patients at home. Our objectives were to: (1) develop an algorithm for detecting silence events and classifying them into apneas or hypopneas; (2) evaluate the performance of this system; and (3) compare the information provided with a type 3 portable sleep monitor, based mainly on nasal airflow. Overnight signals were acquired simultaneously by both systems in 13 subjects (3 healthy subjects and 10 OSA patients). The sample entropy of audio signals was used to identify apnea/hypopnea events. The apnea-hypopnea indices predicted by the two systems presented a very high degree of concordance and the smartphone correctly detected and stratified all the OSA patients. An event-by-event comparison demonstrated good agreement between silence events and apnea/hypopnea events in the reference system (Sensitivity = 76%, Positive Predictive Value = 82%). Most apneas were detected (89%), but not so many hypopneas (61%). We observed that many hypopneas were accompanied by snoring, so there was no sound reduction. The apnea/hypopnea classification accuracy was 70%, but most discrepancies resulted from the inability of the nasal cannula of the reference device to record oral breathing. We provided a spectral characterization of oral and nasal breathing to correct this effect, and the classification accuracy increased to 82%. This novel knowledge from acoustic signals may be of great interest for clinical practice to develop new non-invasive techniques for screening and monitoring OSA patients at home.

JTD Keywords: Sleep apnea, Acoustics, Monitoring, Entropy, Sensors, Microphones, Acoustics, Biomedical signal processing, mHealth, Monitoring, Sleep apnea, Smartphone

Mobile applications based on gas sensing present new opportunities for low-cost air quality monitoring, safety, and healthcare. Metal oxide semiconductor (MOX) gas sensors represent the most prominent technology for integration into portable devices, such as smartphones and wearables. Traditionally, MOX sensors have been continuously powered to increase the stability of the sensing layer. However, continuous power is not feasible in many battery-operated applications due to power consumption limitations or the intended intermittent device operation. This work benchmarks two low-power, duty-cycling, and on-demand modes against the continuous power one. The duty-cycling mode periodically turns the sensors on and off and represents a trade-off between power consumption and stability. On-demand operation achieves the lowest power consumption by powering the sensors only while taking a measurement. Twelve thermally modulated SB-500-12 (FIS Inc. Jacksonville, FL, USA) sensors were exposed to low concentrations of carbon monoxide (0–9 ppm) with environmental conditions, such as ambient humidity (15–75% relative humidity) and temperature (21–27 ◦C), varying within the indicated ranges. Partial Least Squares (PLS) models were built using calibration data, and the prediction error in external validation samples was evaluated during the two weeks following calibration. We found that on-demand operation produced a deformation of the sensor conductance patterns, which led to an increase in the prediction error by almost a factor of 5 as compared to continuous operation (2.2 versus 0.45 ppm). Applying a 10% duty-cycling operation of 10-min periods reduced this prediction error to a factor of 2 (0.9 versus 0.45 ppm). The proposed duty-cycling powering scheme saved up to 90% energy as compared to the continuous operating mode. This low-power mode may be advantageous for applications that do not require continuous and periodic measurements, and which can tolerate slightly higher prediction errors.

JTD Keywords: Smartphone, Metal-oxide semiconductor, Gas sensor, Low power, Temperature-modulation, Interferences

Introduction: Continuous positive airway pressure (CPAP) is the first-choice treatment for obstructive sleep apnoea (OSA), but adherence is frequently suboptimal. Innovative, patient-centred interventions are, therefore, needed to enhance compliance. Due to its low cost and ubiquity, mobile health (mHealth) technology seems particularly suited for this purpose. We endeavoured to develop an mHealth application called “APPnea,” aimed at promoting patient self-monitoring of CPAP treatment. We then assessed the feasibility and acceptability of APPnea in a group of OSA patients. Methods: Consecutive OSA patients used APPnea for six weeks. APPnea gave patients daily reminders to answer three questions about their OSA treatment (CPAP use, physical activity, and diet) and prompted them to upload their body weight weekly. Answers were saved to a secure server for further analysis. After completing the study, patients gave their anonymous opinions about APPnea. Results: We enrolled 60 patients with OSA receiving CPAP treatment. The mean age was 56 ± 10 years and the apnoea–hypopnea index was 47 ± 25 events/hour. In total, 63% of participants completed the daily questionnaire for more than 66% of the study period. Objective CPAP compliance was generally high (5.3 ± 1.6 hours/night). In a subset of 38 patients naïve to CPAP, those who used APPnea regularly had significantly higher CPAP compliance. Satisfaction levels were high for the majority of users. Conclusion: This mHealth intervention is not only feasible but also satisfactory to patients. Although larger randomized trials and cost-effectiveness studies should be performed, this study shows that APPnea could promote participation and improve compliance among patients with OSA, thereby improving outcomes.

JTD Keywords: CPAP, MHealth, Sleep apnoea, Smartphone application