Automatic event detector from smartphone accelerometry: Pilot mHealth study for obstructive sleep apnea monitoring at home

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Obstructive sleep apnea (OSA) is a common disorder with a low diagnosis ratio, leaving many patients undiagnosed and untreated. In the last decades, accelerometry has been found to be a feasible solution to obtain respiratory activity and a potential tool to monitor OSA. On the other hand, many smartphone-based systems have already been developed to propose solutions for OSA monitoring and treatment. The objective of this work was to develop an automatic event detector based on smartphone accelerometry and pulse oximetry, and to assess its ability to detect thoracic movements. It was validated with a commercial OSA monitoring system at home. Results of this preliminary pilot study showed that the proposed event detector for accelerometry signals is a feasible tool to detect abnormal respiratory events, such as apneas and hypopneas, and has potential to be included in smartphone-based systems for OSA assessment.Postprint (published version

Entropy analysis of acoustic signals recorded with a smartphone for detecting apneas and hypopneas: A comparison with a commercial system for home sleep apnea diagnosis

Obstructive sleep apnea (OSA) is a prevalent disease, but most patients remain undiagnosed and untreated. Here we propose analyzing smartphone audio signals for screening OSA patients at home. Our objectives were to: (1) develop an algorithm for detecting silence events and classifying them into apneas or hypopneas; (2) evaluate the performance of this system; and (3) compare the information provided with a type 3 portable sleep monitor, based mainly on nasal airflow. Overnight signals were acquired simultaneously by both systems in 13 subjects (3 healthy subjects and 10 OSA patients). The sample entropy of audio signals was used to identify apnea/hypopnea events. The apnea-hypopnea indices predicted by the two systems presented a very high degree of concordance and the smartphone correctly detected and stratified all the OSA patients. An event-by-event comparison demonstrated good agreement between silence events and apnea/hypopnea events in the reference system (Sensitivity = 76%, Positive Predictive Value = 82%). Most apneas were detected (89%), but not so many hypopneas (61%). We observed that many hypopneas were accompanied by snoring, so there was no sound reduction. The apnea/hypopnea classification accuracy was 70%, but most discrepancies resulted from the inability of the nasal cannula of the reference device to record oral breathing. We provided a spectral characterization of oral and nasal breathing to correct this effect, and the classification accuracy increased to 82%. This novel knowledge from acoustic signals may be of great interest for clinical practice to develop new non-invasive techniques for screening and monitoring OSA patients at homePeer ReviewedPostprint (published version

A New Multidisciplinary Home Care Telemedicine System to Monitor Stable Chronic Human Immunodeficiency Virus-Infected Patients: A Randomized Study

BACKGROUND: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. METHODOLOGY: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. FINDINGS: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4+ T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels >90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. CONCLUSIONS: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection. TRIAL REGISTRATION: Clinical-Trials.gov: NCT01117675

Analysis of Smartphone Triaxial Accelerometry for Monitoring Sleep-Disordered Breathing and Sleep Position at Home

Obstructive sleep apnea (OSA) is a sleep disorder in which repetitive upper airway obstructive events occur during sleep. These events can induce hypoxia, which is a risk factor for multiple cardiovascular and cerebrovascular diseases. OSA is also known to be position-dependent in some patients, which is referred to as positional OSA (pOSA). Screening for pOSA is necessary in order to design more personalized and effective treatment strategies. In this article, we propose analyzing accelerometry signals, recorded with a smartphone, to detect and monitor OSA at home. Our objectives were to: (1) develop an algorithm for detecting thoracic movement associated with disordered breathing events; (2) compare the performance of smartphones as OSA monitoring tools with a type 3 portable sleep monitor; and (3) explore the feasibility of using smartphone accelerometry to retrieve reliable patient sleep position data and assess pOSA. Accelerometry signals were collected through simultaneous overnight acquisition using both devices with 13 subjects. The smartphone tool showed a high degree of concordance compared to the portable device and succeeded in estimating the apnea-hypopnea index (AHI) and classifying the severity level in most subjects. To assess the agreement between the two systems, an event-by-event comparison was performed, which found a sensitivity of 90% and a positive predictive value of 80%. It was also possible to identify pOSA by determining the ratio of events occurring in a specific position versus the time spent in that position during the night. These novel results suggest that smartphones are promising mHealth tools for OSA and pOSA monitoring at home.Peer ReviewedPostprint (published version

Automatic event detector from smartphone accelerometry: Pilot mHealth study for obstructive sleep apnea monitoring at home

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Obstructive sleep apnea (OSA) is a common disorder with a low diagnosis ratio, leaving many patients undiagnosed and untreated. In the last decades, accelerometry has been found to be a feasible solution to obtain respiratory activity and a potential tool to monitor OSA. On the other hand, many smartphone-based systems have already been developed to propose solutions for OSA monitoring and treatment. The objective of this work was to develop an automatic event detector based on smartphone accelerometry and pulse oximetry, and to assess its ability to detect thoracic movements. It was validated with a commercial OSA monitoring system at home. Results of this preliminary pilot study showed that the proposed event detector for accelerometry signals is a feasible tool to detect abnormal respiratory events, such as apneas and hypopneas, and has potential to be included in smartphone-based systems for OSA assessment

La evaluación del aprendizaje de la composición escrita en situación escolar

Diseñar, experimentar y evaluar un modelo de enseñanza y aprendizaje de la composición escrita que tenga en cuenta las situaciones sociales del uso de la lengua y los contenidos lingüístico-textuales y discursivos. Planteamiento de hipótesis. 114 alumnos, de 8õ de EGB a 2õ de BUP o 4õ de ESO, repartidos en cuatro grupos de cuatro centros públicos de Barcelona. Se presenta un marco teórico sobre la evaluación formativa de la composición escrita, analizando el proceso de escritura y su enseñanza. Se procede a la presentación de diversos modelos de secuencia didáctica para la enseñanza de la composición escrita, los elementos que los constituyen y el papel de la evaluación formativa en los mismos. Se desarrollan siete sesiones de seminario entre los miembros del equipo investigador en las que se elabora una secuencia didáctica sobre el texto argumentativo en la etapa de Educación Secundaria. Esta secuencia es aplicada en el aula por el profesor y un investigador, registrando su desarrollo en soporte audio y procediendo a su transcripción y a la de los textos elaborados por el alumnado. Se presenta un nuevo concepto de evaluación formativa de la composición escrita definida como la regulación o autorregulación de este proceso y de la enseñanza-aprendizaje. La evaluación formativa es un momento privilagiado del proceso de aprendizaje en el que el alumnado se apropia de los contenidos trabajados sobre la composición escrita. El diseño del marco didáctico de enseñanza incide en el modo en que el alumnado usa los contenidos de aprendizaje. Se observa que la actividad metalingüística está presente en el proceso de composición escrita y está relacionada con los componentes de la secuencia didáctica. Cada grupo de alumnos emplea los materiales previstos en la secuencia de forma diferente, según sean sus características. La investigación, que propone conocer lo que tiene lugar cuando los alumnos construyen sus conocimientos sobre la escritura, abre un campo nuevo muy fructífero para mejorar las prácticas educativas en las aulas.Ministerio Educación CIDEBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín, 5 - 3 Planta; 28014 Madrid; Tel. +34917748000; Fax +34917748026; [email protected]

Characterizing the spectrum of right ventricular remodelling in response to chronic training

Background: The significance and spectrum of reduced right ventricular (RV) deformation, reported in endurance athletes, is unclear. Purpose: to comprehensively analyze the cardiac performance at rest of athletes, especially focusing on integrating RV size and deformation to unravel the underlying triggers of this ventricular remodelling. Methods: 100 professional male athletes and 50 sedentary healthy males of similar age were prospectively studied. Conventional echocardiographic parameters of all 4 chambers were obtained, as well as 2D echo-derived strain (2DSE) in the left (LV) and in the RV free wall with separate additional analysis of the RV basal and apical segments. Results: Left and right-sided dimensions were larger in athletes than in controls, but with a disproportionate RA enlargement. RV global strain was lower in sportsmen (-26.8 ± 2.8 vs -28.5 ± 3.4%, p<0.001) due to a decrease in the basal segment (-22.8 ± 3.5 vs -25.8 ± 4.0%, p<0.001) resulting in a marked gradient of deformation from the RV inlet towards the apex. By integrating size, deformation and stroke volume, we observed that the LV working conditions were similar in all sportsmen while a wider variability existed in the RV. Conclusions: Cardiac remodelling in athletes is more pronounced in the right heart cavities with specific regional differences within the right ventricle, but with a wide variability among individuals. The large inter-individual differences, as well as its acute and chronic relevance warrant further investigation.This work was partially funded by grants from the Fundació Clinic (premio Emili Letang, B. Merino), Generalitat de Catalunya (FI-AGAUR 2014-2017 (RH 040991, M. Sanz), and from the Spanish Society of Cardiology (Fundación Española del Corazón Investigación Clínica 2012), the Spanish Government (Plan Nacional I+D+i, Ministerio de Innovación y Ciencia DEP 2011-2013 (DEP 2010-20565); Intensificación Actividad Investigadora, Instituto de Salud Carlos III (M Sitges; PI11/01709); Plan Nacional I+D, Ministerio de Economia y Competitividad DEP2013-44923-P, TIN2014-52923-R and FEDER

Characterizing the spectrum of right ventricular remodelling in response to chronic training

Background: The significance and spectrum of reduced right ventricular (RV) deformation, reported in endurance athletes, is unclear. Purpose: to comprehensively analyze the cardiac performance at rest of athletes, especially focusing on integrating RV size and deformation to unravel the underlying triggers of this ventricular remodelling. Methods: 100 professional male athletes and 50 sedentary healthy males of similar age were prospectively studied. Conventional echocardiographic parameters of all 4 chambers were obtained, as well as 2D echo-derived strain (2DSE) in the left (LV) and in the RV free wall with separate additional analysis of the RV basal and apical segments. Results: Left and right-sided dimensions were larger in athletes than in controls, but with a disproportionate RA enlargement. RV global strain was lower in sportsmen (-26.8 ± 2.8 vs -28.5 ± 3.4%, p<0.001) due to a decrease in the basal segment (-22.8 ± 3.5 vs -25.8 ± 4.0%, p<0.001) resulting in a marked gradient of deformation from the RV inlet towards the apex. By integrating size, deformation and stroke volume, we observed that the LV working conditions were similar in all sportsmen while a wider variability existed in the RV. Conclusions: Cardiac remodelling in athletes is more pronounced in the right heart cavities with specific regional differences within the right ventricle, but with a wide variability among individuals. The large inter-individual differences, as well as its acute and chronic relevance warrant further investigation.This work was partially funded by grants from the Fundació Clinic (premio Emili Letang, B. Merino), Generalitat de Catalunya (FI-AGAUR 2014-2017 (RH 040991, M. Sanz), and from the Spanish Society of Cardiology (Fundación Española del Corazón Investigación Clínica 2012), the Spanish Government (Plan Nacional I+D+i, Ministerio de Innovación y Ciencia DEP 2011-2013 (DEP 2010-20565); Intensificación Actividad Investigadora, Instituto de Salud Carlos III (M Sitges; PI11/01709); Plan Nacional I+D, Ministerio de Economia y Competitividad DEP2013-44923-P, TIN2014-52923-R and FEDER

A new multidisciplinary home care telemedicine system to monitor stable chronic human immunodeficiency virus-infected patients: a randomized study

Background: Antiretroviral therapy has changed the natural history of human immunodeficiency virus (HIV) infection in developed countries, where it has become a chronic disease. This clinical scenario requires a new approach to simplify follow-up appointments and facilitate access to healthcare professionals. Methodology: We developed a new internet-based home care model covering the entire management of chronic HIV-infected patients. This was called Virtual Hospital. We report the results of a prospective randomised study performed over two years, comparing standard care received by HIV-infected patients with Virtual Hospital care. HIV-infected patients with access to a computer and broadband were randomised to be monitored either through Virtual Hospital (Arm I) or through standard care at the day hospital (Arm II). After one year of follow up, patients switched their care to the other arm. Virtual Hospital offered four main services: Virtual Consultations, Telepharmacy, Virtual Library and Virtual Community. A technical and clinical evaluation of Virtual Hospital was carried out. Findings: Of the 83 randomised patients, 42 were monitored during the first year through Virtual Hospital (Arm I) and 41 through standard care (Arm II). Baseline characteristics of patients were similar in the two arms. The level of technical satisfaction with the virtual system was high: 85% of patients considered that Virtual Hospital improved their access to clinical data and they felt comfortable with the videoconference system. Neither clinical parameters [level of CD4 + T lymphocytes, proportion of patients with an undetectable level of viral load (p = 0.21) and compliance levels 90% (p = 0.58)] nor the evaluation of quality of life or psychological questionnaires changed significantly between the two types of care. Conclusions: Virtual Hospital is a feasible and safe tool for the multidisciplinary home care of chronic HIV patients. Telemedicine should be considered as an appropriate support service for the management of chronic HIV infection