Past, Present, and Future of Multisensory Wearable Technology to Monitor Sleep and Circadian Rhythms

Matthew R Lujan, Ignacio Perez-Pozuelo, Michael A Grandner, Matthew R Lujan, Ignacio Perez-Pozuelo, Michael A Grandner

Abstract

Movement-based sleep-wake detection devices (i.e., actigraphy devices) were first developed in the early 1970s and have repeatedly been validated against polysomnography, which is considered the "gold-standard" of sleep measurement. Indeed, they have become important tools for objectively inferring sleep in free-living conditions. Standard actigraphy devices are rooted in accelerometry to measure movement and make predictions, via scoring algorithms, as to whether the wearer is in a state of wakefulness or sleep. Two important developments have become incorporated in newer devices. First, additional sensors, including measures of heart rate and heart rate variability and higher resolution movement sensing through triaxial accelerometers, have been introduced to improve upon traditional, movement-based scoring algorithms. Second, these devices have transcended scientific utility and are now being manufactured and distributed to the general public. This review will provide an overview of: (1) the history of actigraphic sleep measurement, (2) the physiological underpinnings of heart rate and heart rate variability measurement in wearables, (3) the refinement and validation of both standard actigraphy and newer, multisensory devices for real-world sleep-wake detection, (4) the practical applications of actigraphy, (5) important limitations of actigraphic measurement, and lastly (6) future directions within the field.

Keywords: actigraphy; heart rate; photoplethysmography; validation; wearables.

Conflict of interest statement

MG reports grants in the past 12 months from Jazz Pharmaceuticals, Kemin Foods, and CeraZ Technologies. He has received consulting fees from Fitbit, Casper, Athleta, Natrol, and Idorsia. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Lujan, Perez-Pozuelo and Grandner.

Figures

Figure 1
Figure 1
Timeline of major developments in wearable technology.
Figure 2
Figure 2
Schematic of Piezoelectric accelerometry.
Figure 3
Figure 3
Summary of EBE analysis of standard actigraphic devices. Accuracy measures the overall ability of a device to correctly classify epochs as either sleep or wake, sensitivity measures ability to classify sleep epochs, and specificity measures ability to correctly classify wake epochs.
Figure 4
Figure 4
(A) Conduction system of the heart. (B) Schematic for ECG recording of electrical activity. (C) High vs. low heart rate variability (HRV). (D) Schematic depicting various factors influencing HR and HRV. (E) Correlation between R-R interval from ECG trace to P-P interval from PPG trace.
Figure 5
Figure 5
Summary of EBE analysis for Fitbit, Apple Watch, and Oura Ring devices.
Figure 6
Figure 6
Summary of EBE analysis for other consumer sleep technologies.
Figure 7
Figure 7
Sleep staging validation for wearables and non-wearables from Chinoy et al. (58).
Figure 8
Figure 8
(A) Ceiling effect in accuracy with wearable devices using PPG technology. (B) Potential novel metrics for sleep and wake measurement. (C) Strengths and weaknesses of consumer sleep technology.

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