The Case for Low-Friction High-Adherence Passive Sleep-Tracking Devices in Longitudinal Monitoring of Neurodegenerative Disease

Digital health technologies are playing an increasingly important role in patient monitoring, able to capture longitudinal data to supplement scheduled episodic evaluations conducted by clinicians. Rapid advances in sensors and data processing algorithms have resulted in some highly sophisticated systems capable of monitoring and tracking numerous symptoms with high levels of sensitivity and specificity. These approaches, however, often require active engagement with the patient, potentially increasing burden in a clinical trial and often resulting in diminishing adherence over time. In the case of slow-progressing neurodegenerative diseases, this may become an obstacle, as often very subtle changes in symptoms are typically monitored over a multi-year period. Accordingly, there is evident interest in passive monitoring solutions which have minimal burden on patients. Smart ring technologies are one such solution, with appealing form factors, low engagement requirements and increasing intervals before device recharging is required. While newer devices are capable of tracking sleep function with increasing levels of accuracy, they are unable to offer the precision afforded by gold standard sleep analysis such as electroencephalography (EEG), polysomnography (PSG) and sleep laboratory protocols. Prompted by a recent study which highlighted the reduced accuracy of consumer-based sleep devices compared with conventional approaches, we posit that the benefits of such devices may offset the constraints of measurement accuracy. Furthermore, any accuracy–adherence trade-offs would be compensated by long-term statistical benefits derived from detecting within-person changes and reducing measurement noise through enhanced sampling frequencies. In this perspective, we highlight their potential utility in tracking Parkinson’s disease patients longitudinally, where compromised sleep architectures are associated with multiple symptoms and continuous monitoring could offer myriad patient benefits.