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University of Eastern Finland

Sleep disorders and lack of sleep are major global problems that lead to, for example, increased medical care costs and sick leave, and decreased quality of life. According to recent estimates, sleep apnea alone affects approximately 1 billion people worldwide, and as many as half of the world’s population suffers from insomnia at some stage in their lives. In Finland alone, it is estimated that sleep apnea affects the lives of nearly 1.5 million people, although most of them are still undiagnosed. There is an urgent need for simpler and more cost-effective methods to screen and diagnose sleep disorders.

A recent review by STAR, a sleep technology and analysis research group at the University of Eastern Finland, looked at future trends in sleep disorder measurement technology, with a focus on the possibility of measurement at home. Polysomnography currently performed in sleep laboratories of professional health care is the most comprehensive method for diagnosing sleep disorders. However, due to the high price and limited availability of polysomnography in the laboratory, other methods, such as simple self-application of family sleep records, can also be used to diagnose sleep apnea. Technical advances in measurement technology and analytical methods based on machine learning and artificial intelligence have made it possible to use simpler and more affordable measurements in hospital environments without compromising clinical accuracy. In research, many automated methods for analyzing sleep records have been developed, and introducing them into clinical practice can free up healthcare resources. In addition, simpler sensors can record multiple nights of sleep, thereby providing a more accurate picture of the natural structure of sleep. Although self-applied family sleep records cannot completely replace the comprehensive polysomnography performed in the sleep laboratory, their use will definitely increase in the future.

Using current home sleep recording technology for self-applied, determining the exact structure of sleep is challenging. Traditionally, sleep stages are determined based on electroencephalogram (EEG). However, EEG is usually not included in self-applied family sleep records, because current clinical electrodes require a lot of skin preparation before application and accurate placement on different areas of the head.

A recent study by the STAR team examined the electrical characteristics of new fabric dry electrodes and the quality of the EEG signals they capture. Studies have shown that compared to silver/silver chloride electrodes that are widely used in clinical practice, dry electrodes take longer to form a stable electrode-skin contact. However, in the measurement performed in the laboratory environment, it was found that the EEG signal captured by the textile electrode was in good agreement with the signal quality captured by the clinical electrode.

"Textile electrodes are easier to use and more patient-friendly, so they are a viable alternative to home sleep recording for self-application," said Matias Rusanen, an early researcher and lead author at the University of Eastern Finland.

Better quality home measurement methods may also help monitor the progress of sleep apnea, because the severity of the disease usually lasts for several years. The cessation of breathing in sleep apnea usually causes a temporary drop in blood oxygen saturation, which puts a lot of pressure on the patient's body at night. It has also been found that this so-called hypoxic load makes patients susceptible to many other diseases, such as diabetes and cardiovascular disease.

Another recent study by the STAR team examined how existing diseases affect the reverse causality of the development of hypoxic burden over the years. Studies have shown that patients with diabetes or cardiovascular disease have a significantly greater deterioration in the nighttime hypoxia load during the five-year follow-up period compared to patients without the comorbidities normally associated with sleep apnea.

"Our findings indicate that patients with diabetes or cardiovascular disease can benefit from screening, especially continuous monitoring of sleep apnea, and thus benefit from the necessary treatment," said Tuomas Karhu, an early researcher and lead author at the University of Eastern Finland. .

Since comprehensive polysomnography is an expensive and complicated measurement method, it is not suitable for continuous monitoring. One solution to this problem may be the method described above, where the patient's sleep is monitored by self-applied and reusable sensors in the home environment. Further explore the simple at-home assessment of sleep bruxism for more information: Henri Korkalainen et al., self-applied family sleep records, Sleep Medicine Clinic (2021). DOI: 10.1016/j.jsmc.2021.07.003

Matias Rusanen et al., Laboratory comparison of FocusBand EEG equipment and textile electrodes with medical grade systems and wet gel electrodes, IEEE Access (2021). DOI: 10.1109/access.2021.3113049

Tuomas Karhu et al. Diabetes and cardiovascular disease are associated with worsening of intermittent hypoxemia, Journal of Sleep Research (2021). DOI: 10.1111/jsr.13441

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