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First Sleep Apnea App

University of Washington team introduces first-ever smartphone app to monitor breathing patterns during sleep.

While Americans have been obsessed with their number of daily steps and sleep quality as reported by the Fitbit, a team at University of Washington has been developing the first contactless smartphone app to offer insight into possible sleep apnea.

Nathaniel F. Watson, MD, professor of neurology and co-director of the University of Washington Medicine Sleep Center and co-author of the ApneaApp, stresses that the Android app in development isn't a diagnostic tool but will drive people into the treatment pipeline.

Reported accuracy rates of 95- 99% compared to the test currently done at hospitals prompted Watson and his collaborators from the computer science department to begin the process of seeking FDA approval. To date, 300 hours of testing have already been completed at Harborview Medical Center.

"Doctors diagnose sleep apnea and we are still working towards FDA approval," he explained. "The ApneaApp can be utilized for insight into breathing patterns during sleep. There's a massive unmet diagnostic and treatment burden that affects 25 million Americans, with 20 million still not diagnosed. Many physicians are still not educated, or minimally educated, about sleep apnea and there's a finite number of sleep specialists who are not evenly distributed throughout the country."

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ApneaApp uses sonar technology to track breathing patterns without a person having to sleep amidst a tangle of wires and sensors, as is necessary for a center-based or home sleep study.

ApneaApp sends inaudible sound waves from the phone's speaker that bounce off people in their sleep to track miniscule changes in their breathing pattern. The returning sound waves are then picked up by the phone's microphone. Currently, ApneaApp operates off the Android platform but the development team is researching iOS features and considering adding functionality to assess sleep time,

"It's similar to the way bats navigate," said Watson. "They send out sound signals that hit a target, and when those signals bounce back they know something is there. It tracks chest and abdominal movement and, in doing so, can assess how effectively a person is breathing."

Since sound wave patterns can change due to distance, the app is able to distinguish between the breathing patterns of two different people sleeping side by side. It efficiently traces breathing patterns from distances up to three feet, so users can place their smartphones at their bedside tables, as they normally would. Regardless of one's sleeping position, ApneaApp can track breathing patterns-even when the person is underneath a blanket.

The high frequency of the app's emitted sound waves, which adults cannot hear, means that other audible sounds, such as talking, fans and street noise aren't picked up by the microphone. And while children may hear ApneaApp's high-pitched sound waves, researchers are developing a newer version with sound waves that will be inaudible to all humans.

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The app can be utilized over a period of several days to accurately gauge breathing patterns. Just as with the home sleep test, there's no clinical standard for the time point at which accuracy is maximized and using for more nights would not be effective.

"Simply put, collecting more data is better," remarked Watson. "If the user is traveling across time zones or their usual sleep patterns are disrupted, the data may not represent their true sleep patterns. The issue has of multiple nights of sleep apnea tests is also still unresolved for the home sleep tests currently on the market."

Insurance companies will typically pay for only one trip to the doctor to diagnose sleep apnea, so there's commonly a concern that the data from a hospital sleep test may be inaccurate as well.

According to Watson, ApneaApp has been in the works since last fall. He hopes it can be released within a year. The price is yet to be determined and many questions will be answered once FDA approval is granted or denied.

Raising Sleep Apnea Awareness
Gaining FDA approval is an onerous tasks and Watson speculated that ApneaApp would fall into the "entertainment device category if it is not approved. Even in that scenario, he's passionate that it would fill a critical void in the diagnosis and treatment arena.

"ApneaApp would identify a person with a breathing pattern at risk of sleep apnea or hypopnea," he clarified. "It's our hope that they'd see their data and raise concerns with their primary care physician and get a referral to a sleep physician in an AASM-accredited lab."

"ApneaApp can track breathing patterns even when the person is sleeping underneath a blanket."

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One of Watson's goals in creating ApneaApp was to give patients a tool to better communicate the possibility of sleep apnea with their physician. Even when a patient mentions sleep issues to his doctor, it's common for both the patient and provider to incorrectly identify symptoms.

"People are not bringing their concerns to their primary care provider in a way that triggers suggestion of sleep apnea," he noted. "They may say they're fatigued or irritable during the day. Then, it results in a referral and a possible diagnosis of depression."

Robin Hocevar is on staff at ADVANCE. Contact rhocevar@advanceweb.com

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