Sleep is fundamental for both health and wellness. Its poor quality is linked to increased risk of mood disorders, erectile dysfunction, cardiovascular diseases, diabetes, obesity, and mortality.1,2 Sleep disorders span all economic and racial spectrums globally which increases the research and development of sleep health technology with a corresponding surge in new mobile electronic diagnostic and therapeutic options.

Sleep Disordered Breathing (SDB) are varied with many diverse etiologies, each requiring expertise and thoughtful evaluation for proper diagnosis. Until recently, testing could only be performed in dedicated sleep labs at significant time and cost. A gold standard sleep lab study requires patients to spend 12–24 h hard-wired to sensors in a closed room under constant observation by specialist technicians.3–6 Expensive, labor-intensive, and with very low patient turnover, sleep labs are unable to keep up with demand, often booked out six months or more.

Patients, especially those with mild disease, may be reluctant to devote the time and expense needed for this level of evaluation. Facility backlog and patient inconvenience, combined with the advent of “on a chip” and “smartphone” technologies, have created an explosion of inexpensive, at-home applications and devices specifically addressing sleep health.7 Patients avidly embrace alternatives to traditional sleep labs, and physicians must stay up to date and preferably lead in this new era.8

Dozens/Hundreds9,10 of sleep-related smartphone Applications (Apps) are easily downloaded from internet marketplaces offering diagnosis, management, and treatment of a variety of sleep disorders, mainly. These span from simple white-noise generators to sophisticated trackers of sleep time and quality utilizing phones internal motion sensors and gravimeters. Linked devices, such as wearable sleep trackers, provide additional home-based options offering even further data collection and disease management.11 These have not been chosen in this paper except does that are linked to CPAP use.

New technology requires both a learning curve and a review of reliability, quality and validity.12–15

Health care providers and healthcare organizations are needed to help evaluate and provide guidance on utility, accuracy, and place in the treatment spectrum.

This paper provides a scientific literature review of consumer-direct apps and devices for the diagnosis, monitoring, and treatment of SDB.

The authors searched for relevant apps pertaining to sleep apnea in both the Google Play store and Apple App Store. The keywords used were: “snoring”, “sleep apnea”, “Obstructive Sleep Apnea Syndrome” (OSAS) for the category of sleep medicine. A systematic review from PubMed, Scopus and mobile device app marketplaces (Apple Store and Google Play Store) was performed.

A comprehensive literature search was conducted in MEDLINE (OVID), EMBase, ISI web of science and Scopus for English and Spanish language citations published from January 1, 2008 (considering that the first mobile phone app store was started in mid-2008) to September 1, 2020. A Boolean search strategy using key words related to “mobile health applications” (e.g., mHealth apps OR mobile health applications OR mobile medical applications OR medical smartphone applications) and keywords “sleep apnea”, “sleep tracker devices’, “sleep monitoring”, “snoring”, “obstructive sleep apnea”, “sleep related breathing disorders” “myofunctional therapy for OSA apps” “CPAP treatment apps”. Please see detailed including a list of selected manuscripts (Table 1).

Sleep apnea apps that had published literature or apps that could be used in a clinical setting were included in this systematic review, while apps not relevant to the scope of this research and/or duplicates, educational or divulgation apps, apps promoting a business or individual, apps requiring specific hardware that had to be purchased separately, and apps in non-English languages were excluded. Furthermore, we searched the National Library of Medicine through PubMed for articles published from inception to a complete review of all apps that were related to the terms was done in Apple Store and Google’s store. Please see Prisma method of selection (Figs. 1 and 2).

Figure 1.

Summary of Apps evaluating for SBD.

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Figure 2.

Summary of scientific publications evaluating performance of Apps and devices for SBD.

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We found a total of 300 apps in Android and Apple store. Of those 44 were excluded for not being in English or were duplicates. A total of 256 were selected in depth for scrutiny (Fig. 1). Only 10 smartphone apps that met the inclusion criteria of having solid scientific data with publications (Table 2).

Daily internet use is a regular part of most people's lives with personal health, disease, and diagnosis searches rapidly increasing. Patients presenting for consult often arrive with information gleaned from the web, requesting doctors to now opine not just on basic health but new medical apps and devices. This poses a challenge for physicians who, in addition to disease, diagnosis, and management, must also now be fluent and up to date in unregulated direct to consumer electronic products.

The ubiquitous smartphone and their ever-increasing associated number of apps and linked devices has created a great promise for at home, patient-centric health. Direct to consumer diagnosis, monitoring, and treatment of SDB theoretically offers an inexpensive convenience for patients eager to engage with their own medical workup. Useful or merely creating an inaccurate distraction, unrivaled accessibility, and ever-expanding abilities of the all-pervasive smartphone is creating a patient-driven shift in diagnosis and treatment of SDB from clinic to home.

Smartphone apps are being developed at dizzying speed with new ones seemingly available each day. As with many consumer-oriented products, quality can vary greatly. In health care, this can and should be of great concern.34 While some work well and deliver on stated function, others may be inaccurate or too immature in their current technological development cycle for reliable use.

Sleep clinicians need to have an approach to the patient who recognizes the limitations of Consumer Sleep Technology (CST). The American Academy of Sleep Medicine published in 2018 an important paper to try to guide physicians on how to approach the patient, that has great interest in CST, recognizing the potential benefits of these, however, given the lack of scientific validation most CSTs cannot be utilized for the diagnosis and/or treatment of sleep disorders at this time. But CSTs may be utilized to enhance the patient-clinician interaction when presented in the context of an appropriate clinical evaluation.8

Peer-reviewed publications that summarize the performance of currently available CSTs compared with PSG remain limited.35–37 The importance of these apps come to surface especially during this hard year of the COVID-19 pandemic where there are restricted healthcare resources and sleep medicine services are advised to reduce in-house services, and to provide medical care by remote monitoring using phone, video calls and telemedicine solutions.38

Recently, we have seen the development of more complex technology with underpinning Software Development Kit (SDK), which utilizes advanced Digital Signal Processing (DSP) technology and Artificial Intelligence (AI) algorithms to identify detailed sleep stages, respiration rate, snoring, and OSA patterns seems to allow a higher degree of sensitivity and specificity.39

Consumer-targeted apps that support sleep self-management can raise awareness and promote healthy sleep habits. Smartphone technology provides potentially beneficial opportunities for increased patient interest and constructive treatment engagement. Increased patient enthusiasm encourages productive engagement and collaboration with clinicians in successfully developing and implementing treatment goals.

The use of new technologies for diagnosis, monitoring and treatment of SDB holds great promise but remains in the early stages of development. Smartphone apps and linked devices offer accessible, inexpensive, and continuous at home data monitoring but without proper testing, and validation may be unreliable. Serious concerns for ethical, security, privacy, and connectivity issues exist within the mHealth realm for Apps with unvalidated “cure “or “treat” claims.45 Until such time as validated accuracy is available, smart phone apps/devices for SDB should be used with caution as adjuncts, not replacement for formal sleep studies.

No Funding was received.

This article does not contain any studies with human participants or animals performed by any of the authors.

The authors declare no conflicts of interest.