Physical Activity, Sleep, and Quality of Life in Pulmonary Arterial Hypertension: Novel Insights From Wearable Devices

Reduced functional capacity and poor sleep quality are common in pulmonary arterial hypertension (PAH). Wearable devices are an emerging, user-friendly tool to capture activity and sleep information. We aimed to determine whether Fitbit-derived activity and sleep trends provide clinically meaningful information in patients with PAH. Our prospective observational study recruited patients with PAH from across the United States using remote enrollment strategies and in-person efforts. Participants wore a Fitbit device for 12 weeks at baseline and a subgroup with 1-year follow-up. A matched control cohort was generated from the <i>All of Us</i> Research Program and we evaluated changes in patients with PAH compared to matched controls. Among 110 patients with baseline monitoring, average daily steps correlated with 6MWD (<i>r</i> = 0.61, <i>p</i> < 0.001) and percent rapid eye movement (REM) sleep (<i>r</i> = 0.28, <i>p</i> = 0.008). In 44 PAH participants who completed baseline and 1-year monitoring, there was a group-time interaction for percent light sleep (<i>p</i> = 0.024) and percent REM sleep (<i>p</i> = 0.034), which demonstrated that sleep quality worsened in patients with PAH over 1 year compared to matched controls. Average daily steps decreased in patients with PAH from 5200 [IQR 3212-7458] at baseline to 4651 [IQR 2912-6827] at 1 year (<i>p</i> = 0.008). In conclusion, our study demonstrated the potential clinical value of wearable devices by showing that activity and sleep quality are reduced in PAH compared to matched controls and these measures decline over time. Future studies should investigate if monitoring these health behaviors detects early functional decline and whether targeted interventions may improve outcomes.