InSleep46: Deployment of a remote monitoring device for the detection and monitoring of dementia risk in older adult populations: a feasibility study

Background

Improvements in health technology offer opportunities for remote disease screening, diagnosis and monitoring. The Withings Sleep Analyzer (WSA), an under mattress ballistocardiograph sensor able to detect body movement, breathing, and cardiac ejection is a promising technology for the non-invasive detection and monitoring of neurodegenerative diseases. InSleep46 aims to evaluate whether the WSA is able to detect preclinical Alzheimer’s disease in members of the 1946 British Birth cohort, now in their late 70s.

Objectives

To assess feasibility of deployment of a remote sleep, circadian and physiological monitoring device in a population of older adults.

Participants

356 participants from the Insight 46 neuroimaging sub-study (1946 British Birth Cohort), all born in one week in March 1946.

Methods

We describe remote recruitment, device installation, and troubleshooting protocols. Feasibility analysis examined participant characteristics associated with recruitment and successful device setup using logistic regression. Troubleshooting events for device installation and maintenance were recorded over a mean 14-month follow-up period.

Results

During the feasibility analysis period, 263 (74%) participants, mean (SD) age 77 years (0.47) agreed to take part, of whom 245 (93%) successfully set up the WSA. Recruitment and successful set up of the WSA were not dependent on cognitive ability, socioeconomic position, or educational attainment. 162 (62%) of recruited individuals required ≥1 troubleshooting call (mean 2.3 per participant, range 0-16). 603 calls were required in total.

Conclusion

Deployment of a remote sleep and physiological monitoring device in an older adult population is feasible. Most participants required individualised assistance to set up the device. For the technology to be widely implemented, the set up must be accessible, with dedicated support available.

STRENGTHS AND LIMITATIONS OF THIS STUDY

• The Withings Sleep Analyzer, a ballistocardiographic under-mattress sensor, enables passive collection of sleep, circadian, and physiological data in participants’ own homes, maximising ecological validity with minimal demand on research participants.

• Study participants are from the world’s longest continuously running birth cohort, with extensive longitudinal data available, collected over 27-waves of data collection from birth to age 80, including cognitive, imaging and fluid biomarkers for neurodegenerative disease.

• This is a nationally representative cohort of participants who are all the same age. However, reflecting the population of post-war Britain at its inception, the cohort is not ethnically diverse and thus findings may not be generalisable to all ethnic groups. Furthermore, as those invited have/expect to attend a two-day clinic visit, the cohort is likely to consist of more willing and able participants than the general population.

• This study prospectively collected data on the feasibility of deployment and set up of a remote sleep monitoring device, enabling understanding of potential barriers to widescale deployment of remote digital biomarkers.

• We provide a practical framework for the successful deployment and maintenance of a remote digital monitoring device.