by Windy Cadiam, RN MSN St.
Glebonie Canono, RN MSN St.
May Ann Chozas, RN MSN St.
Sherna Mae Fernandez, RN MSN St.
Roison Andro Narvaez, MSN RN CMCS CLDP LGBH PhD St.

Citation: Cadiam, W., Canono, G., Chozas, M.A., Fernandez, S.M., & Narvaez, R. A. (2024). Effectiveness of wearable devices on the quality of sleep in the adult population: An integrative review. Canadian Journal of Nursing Informatics, 19(2). https://cjni.net/journal/?p=13114

Abstract

Background: Major public health problems include sleep disturbances. Consumers have access to a wide variety of wearable devices for tracking and monitoring sleep, but only a small number of studies have been done to evaluate how effective they are in promoting sleep quality in the adult population.

Aim: To evaluate and identify the efficacy of wearable devices in the adult population quality of sleep.

Design: Integrative literature review

Results: Nine studies met the inclusion criteria. There is growing interest in using wearable technology to measure sleep, according to this review. Overall, this analysis demonstrates that wearable technology can be used to monitor and evaluate sleep, but its effectiveness in raising sleep quality is not widely acknowledged. As seen by the high level of wearable technology adoption we found, wearable technologies may be appealing to both health practitioners and patients. This acceptability has a big impact on how well ecological sleep monitoring strategies work in the chosen studies. 

Conclusions: Wearables offer acceptable sleep monitoring tools, but their effectiveness in improving sleep quality is not widely recognized. To demonstrate the effectiveness of wearable technology more clearly in improving sleep quality, future studies should make use of larger sample groups and longer study periods. The viability and efficacy of wearable technology require further study, particularly in the adult population.

Implication for practice: Wearable devices are a great help to the nurse in the reliable measurement and recording of quantitative data. These devices provide accurate and timely data which could be very helpful in the decision-making process. Some of the devices also help to track the performance of adults.

Keywords: “wearable devices in healthcare”, “quality of sleep in the adult population”, “effectiveness of wearable devices in the quality of sleep-in adult population”, “wearable technology” and “usefulness of wearables in adult’s sleep” 

What is known about the topic

1. The widespread usage of wearable technology in the healthcare setting has grown over time, but is currently being constrained by a number of issues.

2. Our healthcare system greatly benefits from wearable technology. If healthcare professionals can overcome the obstacles blocking future deployment, they will be able to provide patients with better care and treatment.

What this review adds

1. Most studies that the researchers reviewed concentrate on wearable technology’s capacity to track activities as well as evaluate and monitor sleep quality. Its ability to enhance and promote better sleep is not primarily acknowledged.

2. The effectiveness of wearable technology on the adult population sleep quality has only been the subject of a small number of research studies.

Background

Sleep is a key process that aids in the recovery of mental and physical health so the body can be awake, refreshed, and alert. Lack of sleep impairs the brain’s ability to function properly and productively. Sleep disorder issues tend to decrease the ability to concentrate, think accurately, and process memories (De Fazio et al., 2022). One of the changes most people experience associated with aging is having a harder time falling asleep or having a sleep disorder. This is a common but under-recognized health problem. In a study on sleep, it was revealed that 50% of the adult population has insomnia. Patients assume that it is part of the aging process, so most sleep disorders remain untreated due to poor self-reporting (Marasinghe, 2014).

Mobile devices’ growing popularity and usage are rapidly increasing and has been directed to the development of smart wearable technologies. In many fields, including healthcare and biomedical monitoring systems, wearable technology is now widely used. This enables continuous measurement of important biomarkers for physiological health monitoring and assessment. Wearable technology has developed gradually over time in a variety of forms, including accessories, body attachments, body inserts, and integrated clothing. Seniors and also young people currently utilize these sophisticated wearable devices often. Users can monitor and track their physical activity, health records, nutrition, and sleep patterns using devices like smartwatches, wristbands, Fitbit, etc. (Faerman et al., 2020; Farivar et al., 2020; Guk et al., 2019).

Polysomnography (PSG) can be used to assess the quality of sleep. Like other chronic conditions, sleeping disorders require a protracted course of treatment. As a result, there is a growing need for technology that can monitor and diagnose these conditions. Mobile medical technology can thereby lower treatment costs and enhance therapeutic outcomes.(Mantua et al., 2017; Sun et al., 2016). Contrarily, consumer sleep monitoring gadgets like fitness trackers assert to measure the amount of time their users spend sleeping, as well as in some cases, to assess the quality of their users’ sleep and wake them up from light slumber, potentially leading to an improvement in their users’ overall sleep (Kolla et al., 2016). Research has also shown that wearable devices with auditory stimulations promote sleeping patterns in the adult population and induce good sleep, particularly in patients with insomnia. Digital therapeutics too are used as a sleeping aid (Yoon et al., 2022). Meanwhile, the level of sleep using wearable devices determines the pattern of sleep and activity level of the user.

Many studies regarding wearable technology on other aspects such as tracker of nutrition, blood pressure, vital signs, steps, and physical activity are still insufficient when it comes to the concept of wearable technology used in the adult population. This study emphasizes the need for a study encompassing an exploration of the literature regarding wearable devices focused on the adult population. Thus, the purpose of this literature review was to identify scientific evidence based on the benefits and efficiency of wearable technology in improving sleep quality in the adult population.

Aim/Research Questions

This review was conducted to provide a comprehensive literature review on the effectiveness of wearable devices in the quality of sleep in the adult population. More specifically, this study was done to seek answers for the following questions:

• What are wearable devices?
• What are the advantages of wearable devices?
• How effective are wearable devices in supporting adult population sleeping patterns?
• What are the experiences of the adult population in using these devices?
• What is the implication of the use of wearable devices in the quality of sleep in the adult population to nursing education, research, and practice?

Methodology 

The five-stage integrative review process used consisted of: (1) problem formulation, (2) collection of data, (3) data evaluation, (4) analysis of data, and (5) interpretation of results and presentation of results. Whittemore and Knafl’s (2005) was used because it allowed a combination of diverse methodologies and integrative literature reviews to be included in the process.

Search Strategy

A systematic literature search was conducted using electronic reference databases such as SAGE, CINAHL, Google Scholar, Pubmed, and ScienceDirect to search for relevant articles from November to December 2022. Searches were conducted using the following keywords: “wearable devices in healthcare”, “quality of sleep in the adult population”, “effectiveness of wearable devices in the quality of sleep in the adult population”, “wearable technology” and “usefulness of wearables in adult’s sleep”. As shown in Figure 1, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram shows that by study title, 1345 total results were filtered. Then, 321 abstracts were selected and reviewed. 50 of these were included for full-text evaluation. Nine (9) articles from the final sample that met the inclusion and exclusion requirements were kept for data extraction and analysis.

Figure 1.

PRISMA Flow Diagram of the search done to address the effectiveness of wearable devices in the quality of sleep in the adult population.

Inclusion and Exclusion Criteria

The search included studies that discussed health-related wearable devices, and their usage and effectiveness in supporting the quality of sleep of adults as the outcome. Articles with the adult population as participants and published from 2015 up to the present were involved because they derived updated research, with the latest, relevant and on trend technologies. Peer-reviewed studies (in English) on how wearable technology affect adult population sleep quality were considered if they were qualitative, mixed-method studies, mainly quantitative, case control or cohort studies, controlled trials without randomization, and randomized controlled trials. Articles not related to wearable devices and non-wearable devices were eliminated. Studies that were not in English, outside of the time range, did not have an adult population emphasis, and all forms of article reviews were disqualified. Articles with other device foci such as taking vital signs, physical activity trackers, step trackers and fall detection were disregarded.

Data Evaluation/Quality Appraisal

Numerous studies were reviewed to find eligible papers. Two of the researchers performed the initial result search, while the other two completed the screening. Using the search terms and the inclusions and exclusions criteria, the researchers discovered potential publications during the identification search. Only nine articles ultimately met all inclusion/exclusion requirements as an outcome. A table matrix tool by Sparbel and Anderson (2000) was used to extract the data with the following information: First Author, Year, Country, Service Area Offered/Data Range of Collection, Sample, Sample Size and Setting, Wearable Devices used, and Level of Evidence (LOE) as illustrated in Table 1. The researchers used the Critical Appraisal Skills Programme (CASP) (2018) Checklist to appraise the studies and to evaluate the outcome and reliability of published articles. In addition, Melnyk and Fineout-Overholt (2022) levels of evidence were also used to determine the design in the included study.

Table 1

Included Articles Characteristics

Results

As shown in Table 1, the nine articles included in this review used different designs. Three used randomized trial study, one quasi-experimental, two used qualitative study, two utilized comparative analysis and the final study was a cohort. Most of the research employed questionnaire and interview methods to gather information about attitudes and views regarding the use of wearable technology in improving the quality of sleep in the adult population. A range of 16 to 1141 respondents participated in the studies. The majority of the studies (n=7) were carried out in the USA, while the remaining (n=2) were carried out in Spain. Papers studied were classified according to Level of Evidence. LOE II applied to three of the studies, LOE IV to another three, LOE VI to another two studies and LOE III to one of the articles reviewed for this study.

The objectives, findings, and wearable technology used in the included research are discussed in Table 2. The nine articles’ goals were to test and evaluate the effectiveness of the devices in improving adult population sleep quality. Wearable devices used in the studies varied. Wrist actigraphy and the Fitbit Flex 2, Strap 2.0 WHOOP, Xiaomi Mi Band 2, PSG, Electrocardiography, Jawbone UP 3, Fitbit charge HR, Garmin Vivosmart, Basis and Misfit Withings were the types of wearable technology applied. Most of the results (7) showed that there is insufficient proof that these devices influence sleep quality, which is in contrast to two (2) findings that showed wearable technology can enhance high-quality sleep.

Table 2

Aims and findings of the included studies

Discussion

Wearable devices including smartphones, in-bed sensors, contactless sensors, and wearable sleep trackers such as wristbands, armbands, smartwatches, and sensor clips are some of the devices that are commercially accessible. Their availability, usability, and novelty have made them popular and helped raise people’s awareness of how important sleep is in general. The nine included articles in this study aimed to assess and evaluate the effectiveness of wearable devices particularly in assessing, and monitoring sleep, and their efficacy to improve sleep quality in the adult population.

Baron et al. (2019) and Berryhill et al. (2020) signified the efficiency of wearables through their functions as they give precise, appropriate readings, and have an impact on health among adult’s lives. The interventions provided by wearables can help lower blood pressure, enhance sleep quality and degree of dependence to enhance daytime function, cognitive function, and quality of life.

Faerman et al., (2020), Melton et al., (2018), Concheiro-Moscoso et al., (2022) and Mantua et al., (2016) showed that wearables are not good predictors of subjective sleep quality. Polysomnography (PSG), electrocardiography, and actigraphy sensors are usually used for sleep measurements. In contrast to other studies, there are no differences and substantial association between total sleep time and there is no evidence to support initial efficacy of wearables as standalone aids in enhancing sleep and physical activities among adults.

Poor sleep quality is often associated with other health concerns. Lee et al., (2018) and Nieto-Riveiro et al., (2018) highlighted that unfavorable sleep features such as erratic sleep patterns, brief sleep durations and poor sleep quality have been associated with being overweight. Integration of wearable devices in adult lives can focus on sleep disorders, as well as urinary incontinence, and risk for falls. Teo et al., (2019) additionally showed that consumer wearables can indicate cardiovascular disease risks during the sleep period. Wearables can help since they provide potential alarms and notifications related to a user, then counseling can be organized. Developing a patient monitoring system using personal health data from wearables reinforces the essence of nursing informatics in the healthcare system.

There is growing interest in using wearable technology to measure sleep, according to this review. Overall, our analysis demonstrated that wearable technology can be used to monitor and evaluate sleep, but its effectiveness in raising sleep quality is not widely acknowledged. As seen by the high level of wearable technology adoption we found, wearable technologies may be appealing to both health practitioners and patients. This acceptability has a big impact on how well ecological sleep monitoring strategies worked in the chosen studies.

In terms of its usefulness in improving the calibre of adult sleep with some significant limits such as scientific validity and short-term clinical trials, these devices cannot be used in the current clinical environment and it may be too soon to recommend them. Given the rapid advancement of technology, it does not seem implausible to believe that more thorough and confirmed devices will be accessible soon. 

The researchers recommend more studies should be evaluated and the tremendous boom of wearable technology must develop a wide scope of research reinforcement to see the advantages and disadvantages of these technologies. Collaboration with sleep scientists and clinicians that promote sleep programs may be included to facilitate educational learning on how to promote sleep, interactive discussions, and management of efficient sleep time periods for adults.

Implications for nursing practice

The following technological advances are of great help to the nursing practice. These devices can aid nurses in the reliable measurement and recording of quantitative sleep data. This could make way for the formulation of proper nursing interventions and suitable management of patients. These devices provide accurate and timely data which could be very helpful in the decision-making process and help nurses monitor their patients. Some of the devices also help track the performance of adults, allowing them to quickly assess and evaluate their performance; this allows practitioners to help patients in directing their activities toward the attainment of specific health-related objectives such as deep restful sleep. Some of these devices are designed to measure vital signs and other health indicators at a certain degree of accuracy, thereby offering a better understanding of the patient’s health situation, especially in the study of sleep accuracy, time, and quality. This allows health professionals to plan better care for patients while giving the necessary assistance to facilitate immediate and faster recovery through adequate sleep.

Limitations and recommendations

Based on the findings, most reviewed papers claimed that wearable technology is a reliable tool for tracking and evaluating sleep, however, the effect on sleep quality was not extensively covered and no deeper investigations were conducted. The fact that all the studies were conducted in high-income nations like the USA and Spain is another common constraint among the studies. It is challenging to draw a broad conclusion due to the variability of the population examined in this review. The wide range of wearable technology’s utility in the area of sleep is reflected in our analysis. Last but not least, it should be noted that this review of the literature does not provide any information on the long-term use of these devices because the studies included were primarily short-term clinical trials with devices that may have problems with data collection due to, for example, a limited battery life.

Future researchers should concentrate on the effectiveness of wearable technology in improving sleep quality mainly in the adult population, as our review reveals that there are very few studies available in this field. In order to compare whether there is a substantial difference when the setting is in high wealth countries, it is also advised that future researchers conduct the study in low income countries that have access to wearable devices. The popularity of wearable technology is rising. It can be very expensive. Healthcare policy makers and executives need to keep an eye out for wearable technology as consumers continue to utilize it. When it comes to wearable technology, they must have thorough and reliable criteria for usage.

Additionally, the instructions for these wearable devices must be user-friendly for both customers and health professionals. Creation of specialized sleep monitoring wearables that offer higher-quality sleep must be developed. The majority of wearables that are now on the market were created for activity tracking. The usefulness of sleep monitoring in enhancing sleep quality is frequently touted as a supplemental feature of the devices. Although certain specific sleep-monitoring technologies already exist, further development and assessment of devices aiming to specifically improve and enhance sleep quality are needed. Additionally, these gadgets ought to make better use of already-available health features, such as goal-based gaming, ongoing feedback, and social support to promote healthy sleeping habits.

Conclusion 

This integrated review shows an increased interest in new technologies as well as their wide application. Based on our research, most devices were deemed to be comfortable, simple to use, and capable of providing an affordable and precise method for sleep monitoring and assessment, making them suitable for home monitoring and user-friendly use. The use of wearable devices can aid with screening and prevention of disease. Given many advantages, wearable devices’ effectiveness in the quality of sleep was not mainly discussed or focused on in the reviewed studies.  Researchers should consider the prevalent shortcomings mentioned in this study when they conduct future studies in this area.

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Author Notes

Windy Cadiam, RN MSN St.  https://orcid.org/0000-00015-1796-596 

Glebonie Canono, RN MSN St.  https://orcid.org/0000-0002-3967-2520 

May Ann  Chozas, RN MSN St.  https://orcid.org/0000-0003-2358-66X

Sherna Mae Fernandez, RN MSN St. https://orcid.org/0000-0001-8095-9649

Roison Andro Narvaez, MSN RN? CMCS CLDP LGBH PhD St.

https://orcid.org/0000-0001-7555-5420    

Correspondence concerning this article should be addressed to Roison Andro Narvaez, Professor, St. Paul University Philippines, rnarvaez@spup.edu.ph