Review and perspective on sleep-disordered breathing research and translation to clinics.

Sleep-disordered breathing, ranging from habitual snoring to severe obstructive sleep apnea, is a prevalent public health issue. Despite rising interest in sleep and awareness of sleep disorders, sleep research and diagnostic practices still rely on outdated metrics and laborious methods reducing the diagnostic capacity and preventing timely diagnosis and treatment. Consequently, a significant portion of individuals affected by sleep-disordered breathing remain undiagnosed or are misdiagnosed. Taking advantage of state-of-the-art scientific, technological, and computational advances could be an effective way to optimize the diagnostic and treatment pathways. We discuss state-of-the-art multidisciplinary research, review the shortcomings in the current practices of SDB diagnosis and management in adult populations, and provide possible future directions. We critically review the opportunities for modern data analysis methods and machine learning to combine multimodal information, provide a perspective on the pitfalls of big data analysis, and discuss approaches for developing analysis strategies that overcome current limitations. We argue that large-scale and multidisciplinary collaborative efforts based on clinical, scientific, and technical knowledge and rigorous clinical validation and implementation of the outcomes in practice are needed to move the research of sleep-disordered breathing forward, thus increasing the quality of diagnostics and treatment.

Multicentre sleep-stage scoring agreement in the Sleep Revolution project.

Determining sleep stages accurately is an important part of the diagnostic process for numerous sleep disorders. However, as the sleep stage scoring is done manually following visual scoring rules there can be considerable variation in the sleep staging between different scorers. Thus, this study aimed to comprehensively evaluate the inter-rater agreement in sleep staging. A total of 50 polysomnography recordings were manually scored by 10 independent scorers from seven different sleep centres. We used the 10 scorings to calculate a majority score by taking the sleep stage that was the most scored stage for each epoch. The overall agreement for sleep staging was κ = 0.71 and the mean agreement with the majority score was 0.86. The scorers were in perfect agreement in 48% of all scored epochs. The agreement was highest in rapid eye movement sleep (κ = 0.86) and lowest in N1 sleep (κ = 0.41). The agreement with the majority scoring varied between the scorers from 81% to 91%, with large variations between the scorers in sleep stage-specific agreements. Scorers from the same sleep centres had the highest pairwise agreements at κ = 0.79, κ = 0.85, and κ = 0.78, while the lowest pairwise agreement between the scorers was κ = 0.58. We also found a moderate negative correlation between sleep staging agreement and the apnea-hypopnea index, as well as the rate of sleep stage transitions. In conclusion, although the overall agreement was high, several areas of low agreement were also found, mainly between non-rapid eye movement stages.

A New Digital Health Program for Patients With Inflammatory Bowel Disease: Preliminary Program Evaluation.

BACKGROUND: Inflammatory bowel disease (IBD) causes chronic inflammation of the gastrointestinal tract. IBD is characterized by an unpredictable disease course that varies greatly between individuals and alternates between the periods of relapse and remission. A low energy level (fatigue) is a common symptom, whereas stress and reduced sleep quality may be the triggering factors. Therapeutic guidelines call for effective disease assessment, early intervention, and personalized care using a treat-to-target approach, which may be difficult to achieve through typical time- and resource-constrained standard care. Providing patients with a digital health program that incorporates helpful self-management features and patient support to complement standard care may be optimal for improving the disease course. OBJECTIVE: This study aimed to perform a preliminary program evaluation, analyzing engagement and preliminary effectiveness and the effect on participants' energy levels (fatigue), stress, and sleep quality, of a newly developed 16-week digital health program (SK-311 and SK-321) for patients with IBD. METHODS: Adults with IBD were recruited to participate in a real-world, live, digital health program via Finnish IBD patient association websites and social media. No inclusion or exclusion criteria were applied for this study. Baseline characteristics were entered by the participants upon sign-up. Platform engagement was measured by tracking the participants' event logs. The outcome measures of stress, energy levels (fatigue), and quality of sleep were reported by participants through the platform. RESULTS: Of the 444 adults who registered for the digital health program, 205 (46.2%) were included in the intention-to-treat sample. The intention-to-treat participants logged events on average 41 times per week (5.9 times per day) during the weeks in which they were active on the digital platform. More women than men participated in the intervention (126/205, 88.7%). The mean age of the participants was 40.3 (SD 11.5) years, and their mean BMI was 27.9 (SD 6.0) kg/m2. In total, 80 people provided the required outcome measures during weeks 12 to 16 (completers). Treatment completion was strongly predicted by the number of active days in week 1. Analysis of the completers (80/205, 39%) showed significant improvements for stress (t79=4.57; P<.001; percentage change=-23.26%) and energy levels (t79=-2.44; P=.017; percentage change=9.48%); however, no significant improvements were observed for quality of sleep (t79=-1.32; P=.19). CONCLUSIONS: These results support the feasibility of a digital health program for patients with IBD (SK-311 and SK-321) and suggest that treatment completion might have a substantial positive effect on patient-reported stress and energy levels in a real-world setting. These findings are promising and provide initial support for using the Sidekick Health digital health program to supplement standard care for patients with IBD.

The quantification of vaccine uptake in the Nordic countries and impact on key indicators of COVID-19 severity and healthcare stress level via age range comparative analysis.

In this paper we analyze the impact of vaccinations on spread of the COVID-19 virus for different age groups. More specifically, we examine the deployment of vaccines in the Nordic countries in a comparative analysis where we focus on factors such as healthcare stress level and severity of disease through new infections, hospitalizations, intensive care unit (ICU) occupancy and deaths. Moreover, we analyze the impact of the various vaccine types, vaccination rate on the spread of the virus in each age group for Denmark, Finland, Iceland, Norway and Sweden from the start of the vaccination period in December 2020 until the end of September 2021. We perform a threefold analysis: (i) frequency analysis of infections and vaccine rates by age groups; (ii) rolling correlations between vaccination strategies, severity of COVID-19 and healthcare stress level and; (iii) we also employ the epidemic Renormalization Group (eRG) framework. The eRG is used to mathematically model wave structures, as well as the impact of vaccinations on wave dynamics. We further compare the Nordic countries with England. Our main results outline the quantification of the impact of the vaccination campaigns on age groups epidemiological data, across countries with high vaccine uptake. The data clearly shows that vaccines markedly reduce the number of new cases and the risk of serious illness.

The Sleep Revolution project: the concept and objectives.

Obstructive sleep apnea is linked to severe health consequences such as hypertension, daytime sleepiness, and cardiovascular disease. Nearly a billion people are estimated to have obstructive sleep apnea with a substantial economic burden. However, the current diagnostic parameter of obstructive sleep apnea, the apnea-hypopnea index, correlates poorly with related comorbidities and symptoms. Obstructive sleep apnea severity is measured by counting respiratory events, while other physiologically relevant consequences are ignored. Furthermore, as the clinical methods for analysing polysomnographic signals are outdated, laborious, and expensive, most patients with obstructive sleep apnea remain undiagnosed. Therefore, more personalised diagnostic approaches are urgently needed. The Sleep Revolution, funded by the European Union's Horizon 2020 Research and Innovation Programme, aims to tackle these shortcomings by developing machine learning tools to better estimate obstructive sleep apnea severity and phenotypes. This allows for improved personalised treatment options, including increased patient participation. Also, implementing these tools will alleviate the costs and increase the availability of sleep studies by decreasing manual scoring labour. Finally, the project aims to design a digital platform that functions as a bridge between researchers, patients, and clinicians, with an electronic sleep diary, objective cognitive tests, and questionnaires in a mobile application. These ambitious goals will be achieved through extensive collaboration between 39 centres, including expertise from sleep medicine, computer science, and industry and by utilising tens of thousands of retrospectively and prospectively collected sleep recordings. With the commitment of the European Sleep Research Society and Assembly of National Sleep Societies, the Sleep Revolution has the unique possibility to create new standardised guidelines for sleep medicine.

Collecting Data from a Mobile App and a Smartwatch Supports Treatment of Schizophrenia and Bipolar Disorder.

Mental disorders affect individuals and societies around the world negatively, with the health-related burden of 32,4% out of the overall disease burden. This large part of the overall burden underlines a growing need for innovation to support the treatment of mental disorders like schizophrenia and bipolar disorder. This empirical study features two groups of patients; a group of nine patients diagnosed with bipolar disorder and a group of twelve patients diagnosed with schizophrenia. The patients in the study carry a smartwatch for six weeks, continuously collecting data into a digital health platform. Additionally, they answer five daily wellbeing questions in a mobile app. To supplement that data, they also answer a questionnaire three times over the interval and at the end of the period they attend a semi-structured interview. We offer four main aspects to consider for PGHD in mental health: i) sharing data easily with healthcare professionals, ii) being able to engage with your own PGHD, iii) the watch use can help the patients regulate routine in their daily life, iv) tonality and phrasing.

Importance of Getting Enough Sleep and Daily Activity Data to Assess Variability: Longitudinal Observational Study.

BACKGROUND: The gold standard measurement for recording sleep is polysomnography performed in a hospital environment for 1 night. This requires individuals to sleep with a device and several sensors attached to their face, scalp, and body, which is both cumbersome and expensive. Self-trackers, such as wearable sensors (eg, smartwatch) and nearable sensors (eg, sleep mattress), can measure a broad range of physiological parameters related to free-living sleep conditions; however, the optimal duration of such a self-tracker measurement is not known. For such free-living sleep studies with actigraphy, 3 to 14 days of data collection are typically used. OBJECTIVE: The primary goal of this study is to investigate if 3 to 14 days of sleep data collection is sufficient while using self-trackers. The secondary goal is to investigate whether there is a relationship among sleep quality, physical activity, and heart rate. Specifically, we study whether individuals who exhibit similar activity can be clustered together and to what extent the sleep patterns of individuals in relation to seasonality vary. METHODS: Data on sleep, physical activity, and heart rate were collected over 6 months from 54 individuals aged 52 to 86 years. The Withings Aura sleep mattress (nearable; Withings Inc) and Withings Steel HR smartwatch (wearable; Withings Inc) were used. At the individual level, we investigated the consistency of various physical activities and sleep metrics over different time spans to illustrate how sensor data from self-trackers can be used to illuminate trends. We used exploratory data analysis and unsupervised machine learning at both the cohort and individual levels. RESULTS: Significant variability in standard metrics of sleep quality was found between different periods throughout the study. We showed specifically that to obtain more robust individual assessments of sleep and physical activity patterns through self-trackers, an evaluation period of >3 to 14 days is necessary. In addition, we found seasonal patterns in sleep data related to the changing of the clock for daylight saving time. CONCLUSIONS: We demonstrate that >2 months' worth of self-tracking data are needed to provide a representative summary of daily activity and sleep patterns. By doing so, we challenge the current standard of 3 to 14 days for sleep quality assessment and call for the rethinking of standards when collecting data for research purposes. Seasonal patterns and daylight saving time clock change are also important aspects that need to be taken into consideration when choosing a period for collecting data and designing studies on sleep. Furthermore, we suggest using self-trackers (wearable and nearable ones) to support longer-term evaluations of sleep and physical activity for research purposes and, possibly, clinical purposes in the future.

Social Network Analytics for Supervised Fraud Detection in Insurance.

Insurance fraud occurs when policyholders file claims that are exaggerated or based on intentional damages. This contribution develops a fraud detection strategy by extracting insightful information from the social network of a claim. First, we construct a network by linking claims with all their involved parties, including the policyholders, brokers, experts, and garages. Next, we establish fraud as a social phenomenon in the network and use the BiRank algorithm with a fraud-specific query vector to compute a fraud score for each claim. From the network, we extract features related to the fraud scores as well as the claims' neighborhood structure. Finally, we combine these network features with the claim-specific features and build a supervised model with fraud in motor insurance as the target variable. Although we build a model for only motor insurance, the network includes claims from all available lines of business. Our results show that models with features derived from the network perform well when detecting fraud and even outperform the models using only the classical claim-specific features. Combining network and claim-specific features further improves the performance of supervised learning models to detect fraud. The resulting model flags highly suspicions claims that need to be further investigated. Our approach provides a guided and intelligent selection of claims and contributes to a more effective fraud investigation process.

Strangely mined bitcoins: Empirical analysis of anomalies in the bitcoin blockchain transaction network.

The blockchain technology introduced by bitcoin, with its decentralised peer-to-peer network and cryptographic protocols, provides a public and accessible database of bitcoin transactions that have attracted interest from both economics and network science as an example of a complex evolving monetary network. Despite the known cryptographic guarantees present in the blockchain, there exists significant evidence of inconsistencies and suspicious behavior in the chain. In this paper, we examine the prevalence and evolution of two types of anomalies occurring in coinbase transactions in blockchain mining, which we reported on in earlier research. We further develop our techniques for investigating the impact of these anomalies on the blockchain transaction network, by building networks induced by anomalous coinbase transactions at regular intervals and calculating a range of network measures, including degree correlation and assortativity, as well as inequality in terms of wealth and anomaly ratio using the Gini coefficient. We obtain time series of network measures calculated over the full transaction network and three sub-networks. Inspecting trends in these time series allows us to identify a period in time with particularly strange transaction behavior. We then perform a frequency analysis of this time period to reveal several blocks of highly anomalous transactions. Our technique represents a novel way of using network science to detect and investigate cryptographic anomalies.

The Future of Sleep Measurements: A Review and Perspective.

This article provides an overview of the current use, limitations, and future directions of the variety of subjective and objective sleep assessments available. This article argues for various ways and sources of collecting, combining, and using data to enlighten clinical practice and the sleep research of the future. It highlights the prospects of digital management platforms to store and present the data, and the importance of codesign when developing such platforms and other new instruments. It also discusses the abundance of opportunities that data science and machine learning open for the analysis of data.

Impact of US vaccination strategy on COVID-19 wave dynamics.

We employ the epidemic Renormalization Group (eRG) framework to understand, reproduce and predict the COVID-19 pandemic diffusion across the US. The human mobility across different geographical US divisions is modelled via open source flight data alongside the impact of social distancing for each such division. We analyse the impact of the vaccination strategy on the current pandemic wave dynamics in the US. We observe that the ongoing vaccination campaign will not impact the current pandemic wave and therefore strict social distancing measures must still be enacted. To curb the current and the next waves our results indisputably show that vaccinations alone are not enough and strict social distancing measures are required until sufficient immunity is achieved. Our results are essential for a successful vaccination strategy in the US.

Interaction with Medical Venues in Megacities.

With the vast amounts of data that is being generated today, come new possibilities of understanding patient mobility. In this study, of urban mobility in ten mega cities worldwide, we try to understand the relationship between patients' environment and behaviour with regards to venues that provide some kind of medical care. We analyze longitudinal mobility data set from ten of the world's megacities and investigate urban dynamics and travel patterns in terms of interaction with medical centers. Our goal is to investigate universal patterns and gain an understanding of where people are coming from when they visit such venues and where they go afterwards as well how travel patterns progress throughout the day.

Profit-Based Model Selection for Customer Retention Using Individual Customer Lifetime Values.

The goal of customer retention campaigns, by design, is to add value and enhance the operational efficiency of businesses. For organizations that strive to retain their customers in saturated, and sometimes fast moving, markets such as the telecommunication and banking industries, implementing customer churn prediction models that perform well and in accordance with the business goals is vital. The expected maximum profit (EMP) measure is tailored toward this problem by taking into account the costs and benefits of a retention campaign and estimating its worth for the organization. Unfortunately, the measure assumes fixed and equal customer lifetime value (CLV) for all customers, which has been shown to not correspond well with reality. In this article, we extend the EMP measure to take into account the variability in the lifetime values of customers, thereby basing it on individual characteristics. We demonstrate how to incorporate the heterogeneity of CLVs when CLVs are known, when their prior distribution is known, and when neither is known. By taking into account individual CLVs, our proposed approach of measuring model performance gives novel insights when deciding on a customer retention campaign. The method is dependent on the characteristics of the customer base as is compliant with modern business analytics and accommodates the data-driven culture that has manifested itself within organizations.