IoT in Sleep Apnea diagnosis using smartphone apps :Assessing

effectiveness and addressing challenges.

Prepared by the students :

Bodoor al -Qutob Fatima Jamous Rania Hasan

8230672 8230655 8230842

Course Name

Business telecommunications and Networks

Course Instructor

Dr. Mohammad Alnawaiseh

Table of Content

Topic Page number

1. Abstract 4

2. Introduction 5

3. Problem Statement 6

3.1 The purpose of the study 6

3.2 Research questions 6-7

4. Literature review 7-9

5. Research methodology 10

5.1 Measurement and Data Collection Method 10

5.2 Sample and Study Population 10

5.2.1 Type of the study 10

5.2.2 The Sampling Design 10

5.2.3 Data Analysis 11

6. Ethics Statement 11

7. The limitations of the study 12

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8. Conclusion 12

9. Time frame 13

10. Funding 14

11. References 15

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 Internet of Things IoT in Sleep Apnea diagnosis using smartphone
apps :Assessing effectiveness and addressing challenges.

1. Abstract

With the prevalence of Obstructive Sleep Apnea (OSA) on the rise and its continued challenge to
individuals' sleep quality and overall health, this research seeks to unravel key insights and
solutions to mitigate its impact and enhance sleep related outcomes. The purpose of this study is
to investigate the use of the Internet of Things (IoT) and smartphone applications in the
diagnosis of OSA. It will assess the efficacy of this method while identifying and addressing
related challenges. The methodology will use a combination of quantitative and qualitative
methods, targeting health mobile app users and health sleep specialists. As for the analysis, a
quantitative method provides statistical data and numerical insights into usage patterns,
effectiveness, and trends among health mobile app users and sleep specialists. The qualitative
method, on the other hand, offers in depth exploration of motivations, perceptions, experiences,
and challenges faced by these groups, providing rich contextual understanding.

This paper will assess the reliability of a non clinical OSA monitoring system using smartphone
applications compared with traditional expensive polysomnography (PSG) for the diagnosis and
evaluation of OSA. Note that all participants' consent will be obtained to assure their privacy and
the use of their responses.

Keywords: IoT, Obstructive Sleep Apnea, OSA, Smartphone application, Polysomnography,

PSG, Real time monitoring.

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 2. Introduction

OSA, a chronic sleep disease marked by periodic breathing pauses or shallow breathing while
sleeping, affects millions of people worldwide. OSA consists of the obstruction or partial
occlusion of the upper respiratory tract lasting at least 10 seconds that hinders normal
oxygenation of the blood (Strohl et al.,1996). Untreated, OSA can cause a slew of health issues,
including cardiovascular disease, high blood pressure, and daily lethargy.

Polysomnography (PSG) has long been considered the gold standard for diagnosing OSA. This
sophisticated method necessitates an overnight stay in a sleep lab under constant medical
surveillance, where several sensors capture physiological data and record it, which is deemed
intrusive and, therefore, may disturb sleep. While PSG is very accurate, its expense, difficulty,
and restricted availability can hinder access to prompt diagnosis.

Recent advances in smartphone technology and the IoT present a potentially transformative
approach to OSA detection. Smartphone applications with built in sensors can collect sleep data
from the comfort of a user's own home. This technique has the potential to transform OSA
diagnosis by providing a more accessible, user friendly, and perhaps less expensive alternative to
PSG. However, the usefulness and limitations of this strategy are still being investigated.

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 3. Problem Statement

3.1 The purpose of the study

This study investigates the possibilities of IoT powered smartphone apps for OSA diagnosis. We
aim to gain insight into the app system's accuracy in detecting OSA by comparing it to
traditional PSG methods. We will also investigate the user experience, usability, and adherence
related to utilizing the app system.

This study aims to examine the effectiveness of smartphone apps as a tool for diagnosing OSA,
while also addressing the challenges associated with this approach. Our findings can help to
develop more accessible and user friendly ways for diagnosing and treating OSA, hence
improving public health outcomes.

OSA is a common sleep disorder characterized by frequent breathing pauses or shallow

breathing while sleeping. Traditional diagnosis is based on polysomnography (PSG), a
complicated and expensive treatment that necessitates an overnight stay in a sleep lab. This
reduces diagnostic accessibility, potentially leading to underdiagnosis and untreated OSA, which
can have major health repercussions. Recent advances in smartphone technology and the IoT
provide a promising option for detecting OSA. Smartphone apps can collect sleep data using the
phone's built-in capabilities such as sound recorder.

3.2 Research questions

However, the efficacy and limits of this method for detecting OSA remain unknown. This study
intends to solve this knowledge gap by asking the following research questions:

1. How accurate are smartphone apps at diagnosing OSA as compared to clinical diagnostic
techniques?
2. What impressions do patients have about the ease of use and practicality of smartphone
apps for diagnosing OSA?
3. What is the medical professionals feedback on the effectiveness and dependability of
smartphone apps in supporting OSA diagnosis?

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 4. What are the top benefits and challenges of using health smartphone apps for long term
monitoring and management of OSA?

4. Literature Review
Sleep medicine is becoming increasingly important as more individuals focus on sleep problems
and sleep disorders. Not all concerns about sleep difficulties necessitate prompt treatment from a
sleep physician, including diagnostic investigations and therapeutic approaches. However,
appropriate information for primary care physicians can assist them in determining which
complaints deserve more attention and which can be addressed with knowledge and behavioral
guidance (Penzel et al.,2018).
Focusing on the scope of understanding common sleep disorder related to Obstructive sleep
apnea (OSA) mostly in the adult population, the most suitable standard for the diagnosing of
OSA is polysomnography (PSG). OSA can cause intellectual impairment, poor psychomotor
performance, behavioral problems and personality issues. Consequently, real-time monitoring of
this condition is a critical need in healthcare systems (Al-Mardini et al.,2014;Yacchirema et
al.,2018). Unfortunately PSG requires an expensive attended uncomfortable overnight stay at the
sleep center having the patient wired with systems to record his biological insights. In addition to
the fact that PSG is costly it is also limited to short term sleep sensing since it is performed in a
lab and thus may not be an accurate representation of a patient’s typical sleep habits. A previous
study investigated having a more affordable and convenient portable device that allows users to
apply the OSA test at home rather than sleep centers to provide a natural and comfortable
environment for the user (Al-Mardini et al.,2014;Chiu et al.,2017;Sattar et al.,2019;Baptista et
al.,2022).
Patients' quality of life can be improved with the use of IoT(Dhanvijay & Patil,2019). The Internet
of Things IoT is widely utilized in an array of areas, including remote patient monitoring and
collecting data about a patient's health and lifestyle habits that can be used to personalize
treatment plans and provide more proactive care (Zhang et al.,2017;Ma et al.,2018;Ma et
al.,2020). Furthermore, combining IoT, cloud computing, and machine learning has
demonstrated efficacy for accurate, real time sleep apnea detection and diagnosis (Ma et
al.,2020).

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A study on IoT using wearable respiratory sensors proved that it can provide high accuracy
results on sleep monitoring to detect OSA and monitor all breathing features but it needs more
support to these sensors as there are few systems functioning for it (Zhang et al., 2023).
Having sleep monitored is not only to detect OSA but also will help the patients to detect other
sleeping disorders as well.And sharing these sets of data with a specialist will ease the job in
providing accurate solutions as a result for the patients (Dhruba et al.,2021).
The reason that modern applications are involved in remote monitoring is to support the patients
who need intensive daily examinations and virtual monitoring can ease the examination in the
cases of patients with chronic diseases.Virtual examination will help the patients from physical
presence and save their time (Dhanvijay & Patil,2019).
The solution was implemented in developing a mobile application that can track the biomedical
reading from patients and succeeded to have close results almost accurate to PSG results for
OSA diagnosed patients (Al-Mardini et al.,2014). And to detect OSA,IoT real-time data should
be captured.The development of having mobile applications with IoT allowed the user to be
notified when issues occurred during sleeping. The data captured consists of heart rate range,
pulse rate range and analog sensors used as well to detect sounds.The test was applied on
different people and the developed application results displayed on the app dashboard easily
(Chowdhury et al.,2021). Although there are multiple mobile applications in Android’s Google
Play Store and Apple’s AppStore that support health tracking and fitness, few of them are
specifically concerned with Sleep monitoring and even fewer of them don’t require extra devices
beside the smart phone which work standalone, without requiring any other sensor except
smartphone sensors (Cay et al.,2022). Camcı et al.2017 developed a system that is able to detect
OSA disorders, Which collects data from the built in sensors of the smartphone while sleeping.
The system shows that sleep apnea detection is doable using smartphones. However, the
performance of the system wasn't evaluated with actual OSA patients.
By the time sleep studies arise and developing applications are also targeting the health industry,
these apps helped sleep self management and increased the awareness of healthy sleep habits. It
made it easy for the patients to get benefits from using Smartphone technology in treatment
engagement (Saleem et al.,2020;Baptista et al.,2022).Baptista and colleagues conducted a
systematic review in February 2022, analyzing study data for ten consumer direct smartphone
apps designed to diagnose, monitor, and treat sleep disordered breathing. These researchers

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concluded that the apps are generally not as accurate as traditional options and lack scientific
validation.
Even with the usage of mobile phones and modern smartwatches as medical sensors, errors still
appear in addition to daily issues related to battery power and differences between specific
physical traits and environmental variables (Alshehri et al.,2020).
Furthermore, common issues in developing Mobile apps related to security, database
technologies and data privacy will arise as the most important condition for the patient is to
protect his identity and personal data from being leaked or shared without their consent The
other concern related to data as well where it can be captured, kept and managed to be process
into useful insights. To accomplish these goals, the apps were developed with Artificial
intelligence AI which will have a significant part in relating data to meaningful insights
(Dhanvijay & Patil,2019). ِAI, was also a good player in adding more value to the data collated
remotely for OSA diagnosis. It was used to measure many metrics such as accuracy and
sensitivity by using different AI techniques and integrating them with IoT sensors(Abdel-Basset
et al.,2020).
As for the results when comparing different electrocardiograms (ECG) from wearable devices
with minimal differences when measuring metrics of accuracy and sensitivity per second which
can be considered as suboptimal for OSA detection(John et al.2021). Another study also shows
that the results when comparing PSG with other smartphone sleep apps were quite similar with
taking in coseration incorrect results for some users which were omitted due to sleep disorders in
which they took longer time to get in sleep than normal people (cho et al.,2020).

Although many studies have focused on developing systems to monitor sleep apnea using
smartphone applications, these studies have not assessed the reliability of a non-clinical OSA
monitoring system using smartphone applications compared with traditional expensive
polysomnography (PSG) for the diagnosis and evaluation of OSA. Therefore, our research aims
to cover this gap in making it reliable as much as traditional PGS.

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5. The Methodology

5.1 Measurement and Data Collection Method

There are two main resources for data collection will be used:

- First: Primary data collection (gathering the raw data)

For this study, the researcher will use the following tools:

A self-administered structured questionnaire and interviews will be used. The questionnaire will
be translated into Arabic and will contain a set of items for the constructs with Likert scale as
well as the interview will be also transcript to be analyzed.

- Second: Secondary data collection (already available data)

The researcher will provide public reviews on the smartphone application and if possible having
access to registered data from the sleep center.

5.2 Sample and Study Population

5.2.1 Type of the study

The type of the study is exploratory in nature to discover the challenges and benefits of using IoT
for smartphone apps in health. It's also descriptive as this research will rely on reviews and
surveys with different users and interviews with specialists.

5.2.2 The Sampling Design

- Purposive Sampling for Health Specialists: Purposive sampling would be appropriate

for interviews with health specialists to better understand their needs in terms of
smartphone app OSA diagnosis applications and IoT supporting technologies. Purposive
sampling allows us to choose individuals who have knowledge or experience relevant to
our study objectives. Identify and approach health specialists (e.g., sleep specialists,

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 pulmonologists, or other professionals) who can provide useful insights regarding the
usage of these applications and IoT technologies in OSA detection.
- Convenience Sampling for Health Mobile Application Users: Convenience sample
may be appropriate for our study because it focuses on smartphone OSA diagnosis
application users. Convenience sampling selects participants who are easily accessible or
available for the study. We can find health mobile application users through online
forums, social media groups, or health-related communities where people share their
experiences and reviews of such apps. While convenience sampling may introduce some
bias, it can swiftly and efficiently gather insights from a wide spectrum of consumers.

5.2.3 Data Analysis

Using a combination of quantitative and qualitative methods; quantitative by survey used with
the application users to get their experience feedback and qualitative by using purposive
sampling for interviews with health specialists and convenience sampling for health mobile
application users allows you to gather comprehensive data from different perspectives. Purposive
sampling ensures that you obtain in-depth insights from experts in the field, while convenience
sampling allows reaching a broader user base and capturing varied experiences and reviews of
smartphone app OSA diagnosis applications and IoT supportive technologies using sound
detectors.

6. Ethics Statement

● All participants in this study will be told about the nature, purpose, and benefits of the
study prior to participation, and their privacy and confidentiality will be rigorously
respected. Any data collected will be anonymized and securely stored, with access
limited to authorized persons. Personal information will be kept confidential and used
only for research purposes.
● The research methodology, findings, and conclusions will all be presented in a clear and
open manner. Any conflicts of interest or prejudices will be revealed to ensure the study's
integrity.

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 ● We accept and understand that the statistics we want are the property of the Sleep Center.
Before accessing and using the data, we will seek and get all relevant approvals and
authorizations from those responsible. The data obtained will be utilized exclusively for
the indicated research purposes and will be carefully kept throughout the study process to
ensure accuracy and prevent any manipulation or misrepresentation that could lead to
inaccurate research conclusions.

7. The limitations of the study:

● The study was made on one application that could be applied on other mobile apps.
● Lack of awareness on smartphone health applications to detect OSA.

8. Conclusion

In conclusion, this study will provide critical insights on the potential of smartphone apps in
improving the diagnosis of OSA. Our Study suggests that these technologies hold promise in
providing a convenient and cost-effective means of detecting OSA, with comparable accuracy to
standard diagnostic methods.

However, several challenges must be addressed to fully realize the benefits of IoT in OSA
diagnosis. Overall, the integration of smartphone apps into OSA diagnosis has the potential to
revolutionize the field, offering patients a more accessible and efficient means of managing their
condition.

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9. Time frame

Approximately 3 months to study the data from several hotels in Jordan and to include the
needed data. It will be scheduled as below in table 1;

Table 1. 2-month research time frame.

Research Phase Objective Duration

I.Study the background ● To make sure all related previous studies were 1 week
and literature review on checked and to stress on the gap the research will
the topic fill
● Prepare theoretical framework

II.Prepare the research ● Select the sampling method and calculate sample 1 weeks
design size.
● Prepare questionnaire and interview transcripts
used with data statics to be exported for testing.

III. Data collection ● Select a volunteer team. 3 weeks

phase ● Share the questionnaire with participants.
● Start having structured interviews with sleep
specialists to collect data from them.
● Start collection reviews from the OSA mobile apps
public reviews.
● Coding and data cleansing to be ready for analysis.

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 IV. Data Analysis phase ● Analyze data from surveys, interviews and other 2 weeks
statistics.
● Results drafting and conclusion points.
● Prepare Discussion writing.

V.Writing completion- ● Finish the research writing including all 1 week

final research writing details ,tables and figures.

10. Funding

This study got no explicit funding from any government, commercial, or non-profit organization.

11. References:

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