Feeling validated yet? A scoping review of the use of consumer-targeted wearable and mobile technology to measure and improve sleep

Summary

The objectives of this review were to evaluate the use of consumer-targeted wearable and mobile sleep monitoring technology, identify gaps in the literature and determine the potential for use in behavioral interventions. We undertook a scoping review of studies conducted in adult populations using consumer-targeted wearable technology or mobile devices designed to measure and/or improve sleep. After screening for inclusion/exclusion criteria, data were extracted from the articles by two co-authors. Articles included in the search were using wearable or mobile technology to estimate or evaluate sleep, published in English and conducted in adult populations. Our search returned 3897 articles and 43 met our inclusion criteria. Results indicated that the majority of studies focused on validating technology to measure sleep (n = 23) or were observational studies (n = 10). Few studies were used to identify sleep disorders (n = 2), evaluate response to interventions (n = 3) or deliver interventions (n = 5). In conclusion, the use of consumer-targeted wearable and mobile sleep monitoring technology has largely focused on validation of devices and applications compared with polysomnography (PSG) but opportunities exist for observational research and for delivery of behavioral interventions. Multidisciplinary research is needed to determine the uses of these technologies in interventions as well as the use in more diverse populations including sleep disorders and other patient populations.

Introduction

Consumer-targeted fitness devices, most of them containing sleep monitoring capabilities, are rapidly growing in their popularity. Sales of these devices nearly doubled from 2014 to 2015 and grew by 67% in the first quarter of 2016, compared to the previous year [1]. In addition, 72% of U.S. adult consumers report owning a smartphone [2]. Given that sleep monitoring smartphone applications are a top selling category [3], nearly 3 of 4 U.S. consumers have access to a device with the potential to record sleep. Despite most consumer-targeted wearable and mobile sleep tracking technologies being classified as low risk fitness devices rather than medical devices by the Federal Drug Administration (FDA) [4], surveys suggest that sleep is reported as the most interesting health measure to automatically track [5]. Previous reviews have comprehensively evaluated the types of devices, web and mobile applications aimed at consumer sleep [6] as well as the evidence for the validity for monitoring sleep [7] and applications for sleep disorders screening [8]. These reviews demonstrate the large number of devices aimed at estimating sleep and screening for sleep disorders and consistently found relatively sparse published validity data. In many cases, claims of these sleep tracking devices and applications outweigh the evidence to support them.

In this review, we investigate the research literature to determine how these technologies were being used and whether they used as intervention tools for sleep behavior change. We chose to use a scoping review methodology to map and summarize the evidence. Scoping reviews are a type of systematic qualitative review that consists of formalized methods for “mapping” the research in a field. The process includes a well-defined and in depth search strategy as well as processes to identify areas of emphasis and analytical interpretation [9]. This is an appropriate review methodology for a diverse area with insufficient studies to conduct a quantitative review.