scholarly journals Accuracy of Wristband Fitbit Models in Assessing Sleep: Systematic Review and Meta-Analysis (Preprint)

2019 ◽  
Author(s):  
Shahab Haghayegh ◽  
Sepideh Khoshnevis ◽  
Michael H Smolensky ◽  
Kenneth R Diller ◽  
Richard J Castriotta

BACKGROUND Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living conditions in a cost-efficient way. OBJECTIVE We conducted a systematic review of publications reporting on the performance of wristband <italic>Fitbit</italic> models in assessing sleep parameters and stages. METHODS In adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we comprehensively searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, MEDLINE, PubMed, PsycINFO, and Web of Science databases using the keyword <italic>Fitbit</italic> to identify relevant publications meeting predefined inclusion and exclusion criteria. RESULTS The search yielded 3085 candidate articles. After eliminating duplicates and in compliance with inclusion and exclusion criteria, 22 articles qualified for systematic review, with 8 providing quantitative data for meta-analysis. In reference to polysomnography (PSG), nonsleep-staging <italic>Fitbit</italic> models tended to overestimate total sleep time (TST; range from approximately 7 to 67 mins; effect size=-0.51, <italic>P</italic>&lt;.001; heterogenicity: I<sup>2</sup>=8.8%, <italic>P</italic>=.36) and sleep efficiency (SE; range from approximately 2% to 15%; effect size=-0.74, <italic>P</italic>&lt;.001; heterogenicity: I<sup>2</sup>=24.0%, <italic>P</italic>=.25), and underestimate wake after sleep onset (WASO; range from approximately 6 to 44 mins; effect size=0.60, <italic>P</italic>&lt;.001; heterogenicity: I<sup>2</sup>=0%, <italic>P</italic>=.92) and there was no significant difference in sleep onset latency (SOL; <italic>P</italic>=.37; heterogenicity: I<sup>2</sup>=0%, <italic>P</italic>=.92). In reference to PSG, nonsleep-staging <italic>Fitbit</italic> models correctly identified sleep epochs with accuracy values between 0.81 and 0.91, sensitivity values between 0.87 and 0.99, and specificity values between 0.10 and 0.52. Recent-generation <italic>Fitbit</italic> models that collectively utilize heart rate variability and body movement to assess sleep stages performed better than early-generation nonsleep-staging ones that utilize only body movement. Sleep-staging <italic>Fitbit</italic> models, in comparison to PSG, showed no significant difference in measured values of WASO (<italic>P</italic>=.25; heterogenicity: I<sup>2</sup>=0%, <italic>P</italic>=.92), TST (<italic>P</italic>=.29; heterogenicity: I<sup>2</sup>=0%, <italic>P</italic>=.98), and SE (<italic>P</italic>=.19) but they underestimated SOL (<italic>P</italic>=.03; heterogenicity: I<sup>2</sup>=0%, <italic>P</italic>=.66). Sleep-staging <italic>Fitbit</italic> models showed higher sensitivity (0.95-0.96) and specificity (0.58-0.69) values in detecting sleep epochs than nonsleep-staging models and those reported in the literature for regular wrist actigraphy. CONCLUSIONS Sleep-staging <italic>Fitbit</italic> models showed promising performance, especially in differentiating wake from sleep. However, although these models are a convenient and economical means for consumers to obtain gross estimates of sleep parameters and time spent in sleep stages, they are of limited specificity and are not a substitute for PSG.

10.2196/16273 ◽  
2019 ◽  
Vol 21 (11) ◽  
pp. e16273 ◽  
Author(s):  
Shahab Haghayegh ◽  
Sepideh Khoshnevis ◽  
Michael H Smolensky ◽  
Kenneth R Diller ◽  
Richard J Castriotta

Background Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living conditions in a cost-efficient way. Objective We conducted a systematic review of publications reporting on the performance of wristband Fitbit models in assessing sleep parameters and stages. Methods In adherence with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we comprehensively searched the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane, Embase, MEDLINE, PubMed, PsycINFO, and Web of Science databases using the keyword Fitbit to identify relevant publications meeting predefined inclusion and exclusion criteria. Results The search yielded 3085 candidate articles. After eliminating duplicates and in compliance with inclusion and exclusion criteria, 22 articles qualified for systematic review, with 8 providing quantitative data for meta-analysis. In reference to polysomnography (PSG), nonsleep-staging Fitbit models tended to overestimate total sleep time (TST; range from approximately 7 to 67 mins; effect size=-0.51, P<.001; heterogenicity: I2=8.8%, P=.36) and sleep efficiency (SE; range from approximately 2% to 15%; effect size=-0.74, P<.001; heterogenicity: I2=24.0%, P=.25), and underestimate wake after sleep onset (WASO; range from approximately 6 to 44 mins; effect size=0.60, P<.001; heterogenicity: I2=0%, P=.92) and there was no significant difference in sleep onset latency (SOL; P=.37; heterogenicity: I2=0%, P=.92). In reference to PSG, nonsleep-staging Fitbit models correctly identified sleep epochs with accuracy values between 0.81 and 0.91, sensitivity values between 0.87 and 0.99, and specificity values between 0.10 and 0.52. Recent-generation Fitbit models that collectively utilize heart rate variability and body movement to assess sleep stages performed better than early-generation nonsleep-staging ones that utilize only body movement. Sleep-staging Fitbit models, in comparison to PSG, showed no significant difference in measured values of WASO (P=.25; heterogenicity: I2=0%, P=.92), TST (P=.29; heterogenicity: I2=0%, P=.98), and SE (P=.19) but they underestimated SOL (P=.03; heterogenicity: I2=0%, P=.66). Sleep-staging Fitbit models showed higher sensitivity (0.95-0.96) and specificity (0.58-0.69) values in detecting sleep epochs than nonsleep-staging models and those reported in the literature for regular wrist actigraphy. Conclusions Sleep-staging Fitbit models showed promising performance, especially in differentiating wake from sleep. However, although these models are a convenient and economical means for consumers to obtain gross estimates of sleep parameters and time spent in sleep stages, they are of limited specificity and are not a substitute for PSG.


2021 ◽  
pp. 1-13
Author(s):  
Darin Pauley ◽  
Pim Cuijpers ◽  
Davide Papola ◽  
Clara Miguel ◽  
Eirini Karyotaki

Abstract Background Digital interventions for anxiety disorders are a promising solution to address barriers to evidence-based treatment access. Precise and powerful estimates of digital intervention effectiveness for anxiety disorders are necessary for further adoption in practice. The present systematic review and meta-analysis examined the effectiveness of digital interventions across all anxiety disorders and specific to each disorder v. wait-list and care-as-usual controls. Methods A systematic search of bibliographic databases identified 15 030 abstracts from inception to 1 January 2020. Forty-seven randomized controlled trials (53 comparisons; 4958 participants) contributed to the meta-analysis. Subgroup analyses were conducted by an anxiety disorder, risk of bias, treatment support, recruitment, location and treatment adherence. Results A large, pooled effect size of g = 0.80 [95% Confidence Interval: 0.68–0.93] was found in favor of digital interventions. Moderate to large pooled effect sizes favoring digital interventions were found for generalized anxiety disorder (g = 0.62), mixed anxiety samples (g = 0.68), panic disorder with or without agoraphobia (g = 1.08) and social anxiety disorder (g = 0.76) subgroups. No subgroups were significantly different or related to the pooled effect size. Notably, the effects of guided interventions (g = 0.84) and unguided interventions (g = 0.64) were not significantly different. Supplemental analysis comparing digital and face-to-face interventions (9 comparisons; 683 participants) found no significant difference in effect [g = 0.14 favoring digital interventions; Confidence Interval: −0.01 to 0.30]. Conclusion The precise and powerful estimates found further justify the application of digital interventions for anxiety disorders in place of wait-list or usual care.


Author(s):  
Brendan J Nolan ◽  
Bonnie Liang ◽  
Ada S Cheung

Abstract Context Preclinical data has shown progesterone metabolites improve sleep parameters through positive allosteric modulation of the γ-aminobutyric acid type A receptor. We undertook a systematic review and meta-analysis of randomized controlled trials to assess micronized progesterone treatment on sleep outcomes. Evidence Acquisition Using preferred reporting items for systematic review and meta-analysis guidelines, we searched MEDLINE, Embase, PsycInfo, and the Cochrane Central Register of Controlled Trials for randomized controlled trials of micronized progesterone treatment on sleep outcomes up to March 31, 2020. This study is registered with the International Prospective Register of Systematic Reviews, number CRD42020165981. A random effects model was used for quantitative analysis. Evidence Synthesis Our search strategy retrieved 9 randomized controlled trials comprising 388 participants. One additional unpublished trial was found. Eight trials enrolled postmenopausal women. Compared with placebo, micronized progesterone improved various sleep parameters as measured by polysomnography, including total sleep time and sleep onset latency, though studies were inconsistent. Meta-analysis of 4 trials favored micronized progesterone for sleep onset latency (effect size, 7.10; confidence interval [CI] 1.30, 12.91) but not total sleep time (effect size, 20.72; CI -0.16, 41.59) or sleep efficiency (effect size, 1.31; CI -2.09, 4.70). Self-reported sleep outcomes improved in most trials. Concomitant estradiol administration and improvement in vasomotor symptoms limit conclusions in some studies. Conclusions Micronized progesterone improves various sleep outcomes in randomized controlled trials, predominantly in studies enrolling postmenopausal women. Further research could evaluate the efficacy of micronized progesterone monotherapy using polysomnography or validated questionnaires in larger cohorts.


2021 ◽  
Vol 12 ◽  
Author(s):  
Joakim H. Kristensen ◽  
Ståle Pallesen ◽  
Daniel L. King ◽  
Mari Hysing ◽  
Eilin K. Erevik

Problematic gaming has been linked to poor sleep outcomes; however, these associations have not yet been synthesized quantitatively. This review employed a meta-analysis to investigate the relationship between problematic gaming and sleep-related outcomes. A search of Medline, Embase, Web of Science, PsycINFO, and Google Scholar identified a total of 763 studies, including 34 studies (n = 51,901 participants) eligible for inclusion. Papers were included if available in any European language, addressed problematic gaming, contained original data, and provided sufficient data for calculation of effect sizes. Two researchers independently extracted data using pre-defined fields including quality assessment. Sleep-related outcomes were meta-analyzed for sleep parameters that were reported by 5 or more papers. Significant overall effects were found for sleep duration (g = −0.238, 95% CI = −0.364, −0.112), poor sleep quality (OR = 2.02, 95% CI = 1.47, 2.78), daytime sleepiness (OR = 1.57, 95% CI = 1.00, 2.46) and sleep problems (OR = 2.60, 95% CI = 1.94, 3.47). Between-study heterogeneity was detected for all meta-analyses. Subgroup analyses showed a higher inverse effect size for adolescent samples compared to adult or non-specific age samples in terms of sleep duration. For daytime sleepiness, a larger effect size was found for studies based on single-item sleep measures compared to multi-item sleep measures. For sleep problems, the subgroup analysis showed the opposite with a higher effect size for studies based on single-item sleep measures than multi-item sleep measures. Across all sleep parameters, problematic gamers consistently reported a more adverse sleep status than non-problematic gamers.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/; record ID: CRD42020158955.


2018 ◽  
Vol 31 (11) ◽  
pp. 1627-1633 ◽  
Author(s):  
Shinji Matsunaga ◽  
Hiroshige Fujishiro ◽  
Hajime Takechi

ABSTRACTObjective:The efficacy and tolerability of idalopirdine, a selective 5-hydroxytryptamine6 receptor antagonist, in patients with Alzheimer’s disease (AD) is uncertain. A systematic review and meta-analysis of randomized controlled trials (RCTs) testing idalopirdine for patients with AD was performed.Methods:We included RCTs of idalopirdine for patients with AD and used Alzheimer’s Disease Assessment Scale-cognitive subscale (ADAS-cog) scores as a primary measure.Results:Four RCTs with 2,803 patients with AD were included. There was no significant difference in ADAS-cog between the idalopirdine and placebo groups [mean difference (MD) = −0.41,P= 0.32,I2= 62%]. However, significant heterogeneity remained. Sensitivity analysis revealed that idalopirdine was more effective than placebo for ADAS-cog in the high dose and moderate AD subgroups (high dose subgroup: MD = −2.15,P= 0.005, moderate AD subgroup: MD = −2.15,P= 0.005). Moreover, meta-regression analysis showed that idalopirdine effect size for ADAS-cog was associated with mean dose (coefficient, −0.0289), ADAS-cog at baseline (coefficient, −0.9519), and proportion of male participants (coefficient, 0.2214). For safety outcomes, idalopirdine was associated with a higher incidence of at least one adverse event and increased γ-glutamyltransferase, alanine aminotransferase, aspartate aminotransferase, and vomiting than placebo. There were no significant differences in other secondary outcomes between both treatments.Conclusions:Idalopirdine is not effective for AD patients and is associated with a risk of elevated liver enzymes and vomiting. Although idalopirdine might be more effective at high doses and in moderate AD subgroups, the effect size is small and may be limited.


2020 ◽  
Vol 7 (1) ◽  
pp. e000437 ◽  
Author(s):  
Jing Liu ◽  
Min Cui ◽  
Tao Yang ◽  
Ping Yao

ObjectiveTo study the correlation between gastrointestinal (GI) symptoms and disease severity in patients with COVID-19.DesignWe searched six databases including three Chinese and three English databases for all the published articles on COVID-19. Studies were screened according to inclusion and exclusion criteria. The relevant data were extracted and all the statistical analyses were performed using Revman5.3.ResultIn a meta-analysis of 9 studies, comprising 3022 patients, 479 patients (13.7%, 95% CI 0.125 to 0.149) had severe disease and 624 patients (14.7%, 95% CI 0.136 to 0.159) had GI symptoms. Of 624 patients with GI symptoms, 118 patients had severe disease (20.5%, 95% CI 0.133 to 0.276) and of 2397 cases without GI symptoms, 361 patients had severe disease (18.2%, 95% CI 0.129 to 0.235). Comparing disease severity of patients with and without GI symptoms, the results indicated: I²=62%, OR=1.21, 95% CI 0.94 to 1.56, p=0.13; there was no statistically significant difference between the two groups. The funnel plot was symmetrical with no publication bias.ConclusionCurrent results are not sufficient to demonstrate a significant correlation between GI symptoms and disease severity in patients with COVID-19.


2021 ◽  
Author(s):  
Salah Eddine Oussama Kacimi ◽  
Elona Greca ◽  
Mohamed Amine Haireche ◽  
Ahmed Sallam ElHawary ◽  
Mounir Ould Setti ◽  
...  

Background: Fluvoxamine is a selective serotonin reuptake inhibitor that is known to be used as antidepressant. Repurposing of Fluvoxamine for the treatment of COVID-19 is theorized to help in the prevention of the clinical deterioration of SARS CoV-2 patients. In our systematic review and meta-analysis, we aim to assess the safety and efficacy of the drug under study in terms of its effect on the mortality and the risk of hospitalization and mechanical ventilation in non-critically ill COVID-19 patients. Methods: We performed a systematic search of seven electronic databases. The search results were screened based on the previously determined inclusion and exclusion criteria. We determined the data related to our objectives. The mortality rates, rates of hospitalization, risk of mechanical ventilation and serious side effects were extracted from the studies that successfully met our inclusion and exclusion criteria. Then, the extracted data from the included studies was included in the meta-analysis. Results: Three studies, two randomized clinical trials and one observational cohort study, with 1762 patients, were the final outcome of our search and screening processes. Among all participants, 886 patients received Fluvoxamine while 876 were controls. Follow up periods ranged from 7 days to 28 days. There was no significant difference in the intention-to-treat mortality rates between the two groups (RR = 0.66; 95% CI: 0.36 - 1.21, p-value = 0.18; I2 = 0%). However, Fluvoxamine decreased the per-protocol mortality compared to both placebo alone or placebo/standard care (RR = 0.09; 95% CI: 0.01 - 0.64, p-value = 0.02; I2 = 0% and RR = 0.09; 95% CI: 0.01 - 0.72, respectively). As compared to placebo or standard care, the all-cause hospitalization was significantly reduced in the fluvoxamine group (RR = 0.71; 95% CI: 0.54 - 0.93, p-value = 0.01; I2 = 61%). This risk reduction was not significant when compared to placebo alone (RR = 0.76; 95% CI: 0.57 - 1.00; p-value = 0.051; I2 = 48%). Furthermore, the risk of mechanical ventilation was not improved in the fluvoxamine group as compared to placebo (RR = 0.71; 95% CI: 0.43 - 1.16, p-value = 0.17; I2 = 0%). The serious adverse effects were almost the same in the treatment group and the control (13% and 12% respectively). Conclusion: Fluvoxamine does not significantly reduce the mortality rates or the risk of mechanical ventilation in SARS CoV-2 patients. Nonetheless, it was found to have a good impact on reducing all cause hospitalization among patients with COVID-19 disease. Therefore, further clinical studies are needed to determine the effectiveness of the drug and its mechanisms of action.


2019 ◽  
Author(s):  
Li Wang ◽  
Fu Sun ◽  
Siyang Liu ◽  
Hongyi Zhang ◽  
Bo Lu ◽  
...  

AbstractOBJECTIVESthe aim of this meta-analysis was pooled on the comprehensive information of the epidemiology of VZV infection and analyzed the seropositivity of VZV-IgG antibodies in different age groups in China, so as to arouse people’s attention on VZV.DESIGNSystematic reviewDATA SOURCESSources included on PubMed, the China National Knowledge Infrastructure (CNKI) database, WANFANG database and the Chinese Scientific Journals Full-Text Database (CQVIP) from 1997 to 2019.ELIGIBILITY CRITERIA(1) the Chinese and English literatures of study on varicella-zoster virus immunization epidemics in different regions of China; (2) The literature has obvious age stratification; (3) The subjects are general people; (4) VZV sero-prevalence in the population investigated by the literature research institute. Exclusion criteria: Any study that did not contain these information was excluded.DATA EXTRACTION AND SYNTHESISTwo evaluators independently retrieved documents and extracted data. Information about the study design, eligible population, age and gender distribution, inclusion and exclusion criteria were checked. When they disagreed, they could solve the problem by discussion or by soliciting opinions from third parties.RESULTSLiteratures were screened according to the inclusion criteria and 10 studies from 1997 to 2019 with a total of 11666 individuals were included. The overall VZV seroprevalence in the Chinese population was 65.80% (95% CI; 56.5% - 75.1%), and the peak prevalence was seen in the age 36-45 93.50% (95% CI; 0.917-0.953) while the VZV seroprevalence rate (82.20%, 95% CI: 0.544-1.099) was not increased in individuals of 45 and older.CONCLUSIONThe incidence of VZV increases with age, and there was no significant difference between different genders or regions. This results can provide epidemiological evidence for the prevention and treatment of VZV.Strengths and limitations of this studyA broad search strategy and systematic review methodology were used to generate this comprehensive review on advice for prevention and treatment of VZV.Every inclusion article was assessed with a risk of bias tool and/or a quality assessment tool.Because of relatively small sample size, the incomplete data, and the different research objects, there are some bias in the outcomes, which limits the ability to make discrete conclusions.There were not enough articles identified to perform a meta-analysis.


Author(s):  
Abdulmajeed Albalawi ◽  
Hasan Alabbadi ◽  
Tamim Almoqbell ◽  
Omar Alsayari ◽  
Abdulrahman Aljohani ◽  
...  

Mallory-Weiss syndrome (MWS), characterized by tearing and blood from mouth and stool, is a complication of gastro esophageal tract. The prevalence varies and there are a number of risk factors associated with MWS development. The present study is a systematic review and meta-analysis to determine the prevalence and various risk factors associated with Mallory-Weiss syndrome development. We systematically searched literature using specified keywords, reviewed it, and selected articles based on the inclusion and exclusion criteria. Qualitative data was presented in tables and the quantitative data was used to draw forest plots. Percentage was used to determine overall effect size for prevalence and OR and 95% CIs was used to determine overall effect size of risk factors. Our analysis of 21 studies showed that the overall effect size for prevalence was 15.46% with 95% CI of 13.63-17.29. The pooled effect size for hiatus hernia as risk factor was found to be OR 1.96 with 95% CI of 1.96 (1.73-2.22). The pooled effect size for alcohol as risk factor OR 0.81 with 95% CI of 1.96 (0.63-1.05). Finally, we found the pooled effect size for hiccups as risk factor OR 1.04 with 95% CI of 1.96 (0.78-1.39). Mallory-Weiss syndrome is not widely prevalent in various populations. There are a number of risk factors for MWS and hiatus hernia is most significant. Alcohol consumption is not strong predictor and hiccups are an emerging risk factor. There is a need for new studies with large number of subjects and controlled conditions. 


Author(s):  
Abdulmajeed Albalawi ◽  
Alanoud Alharbi ◽  
Hussain Alhasani ◽  
Amal Alharbi ◽  
Raghad Abdullah ◽  
...  

Keratoconus (KN), is an eye disorder, characterized by progressive thinning and protrusion of central cornea. A number of conditions such as such as allergy, asthma, eczema, and eye rubbing has been shown to be associated with the development of KN. However, there is a disagreement regarding some of risk factors and their strength so we conducted systematic review and meta-analysis to determine how strongly risk factors such as eye rubbing, and atopic triad associate with KN development and progression. We systematically searched the literature for related studies using specific keywords and key phrases. The studies were scrutinized based on inclusion and exclusion criteria. Finally, we extracted relevant qualitative and quantitate information from studies. For meta-analysis we used odds ratio (OR) and their 95% CI were used to draw forest plots. 35 studies were selected in final meta-analysis. Our meta-analysis yielded the combined effect of risk factors with OR of 2.20 and a 95% CI of 1.84–2.64. Furthermore, we found that eye rubbing-related studies had effect size of OR 2.09 with a 95% CI of 1.76–2.49 and a p value of 0.00001. For atopic triad (allergic rhinits, asthma and eczema) related studies, the meta-analysis yielded overall effect size of OR 2.34 with 95% CI of 2.06-2.66. Eye rubbing and atopic triad (allergic rhinitis, eczema, and asthma) are important risk factors for KC development with statistically strong association.


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