Challenges and Opportunities for Applying Wearable Technology to Sleep

Psychophysiological stress response, emotion dysregulation and sleep parameters as predictors of psychopathology in adolescents and young adults

BACKGROUND

Increased emotional reactivity to stress, emotional dysregulation and sleep disturbances are interdependent trans-diagnostic processes that are present in internalising disorders such as depression and anxiety disorders. This study investigated which objective and subjective parameters of stress reactivity, sleep and emotional processing would predict symptoms of anxiety and depression in adolescents and young adults.

METHODS

Participants were adolescents and young adults between the ages of 14 to 21 (N = 106, 25[24 %] male, M age = 17.93). Heart rate, heart rate variability, and subjective stress levels were measured before, during and after a stress induction using the Trier Social Stress Test (TSST). Questionnaires on internalising symptoms, emotion dysregulation, and sleep quality were used. For seven consecutive nights, objective sleep parameters were measured with a wearable device.

RESULTS

Heart rate and heart rate variability after (but not during) the stress induction and emotion dysregulation predicted depressive and anxiety symptoms. Lower subjective sleep quality (but not the objective sleep parameters) was associated with depressive and anxiety symptoms. Emotion dysregulation mediated the relationship between sleep quality and depressive symptoms.

LIMITATIONS

A cross-sectional design, no measurement of daily activity or naps, and only self-report measures of depressive and anxiety symptoms as well as emotion dysregulation.

CONCLUSION

The findings of elevated cardiovascular activation after - but not during - the stress induction and emotion dysregulation underlines problems in regulating and recovering from stress as predictors of youth internalising psychopathology. Differences between subjective and objective measures of sleep and stress reactivity suggests a role of cognitive biases in these domains.

Wearables in Chronomedicine and Interpretation of Circadian Health

Wearable devices have gained increasing attention for use in multifunctional applications related to health monitoring, particularly in research of the circadian rhythms of cognitive functions and metabolic processes. In this comprehensive review, we encompass how wearables can be used to study circadian rhythms in health and disease. We highlight the importance of these rhythms as markers of health and well-being and as potential predictors for health outcomes. We focus on the use of wearable technologies in sleep research, circadian medicine, and chronomedicine beyond the circadian domain and emphasize actigraphy as a validated tool for monitoring sleep, activity, and light exposure. We discuss various mathematical methods currently used to analyze actigraphic data, such as parametric and non-parametric approaches, linear, non-linear, and neural network-based methods applied to quantify circadian and non-circadian variability. We also introduce novel actigraphy-derived markers, which can be used as personalized proxies of health status, assisting in discriminating between health and disease, offering insights into neurobehavioral and metabolic status. We discuss how lifestyle factors such as physical activity and light exposure can modulate brain functions and metabolic health. We emphasize the importance of establishing reference standards for actigraphic measures to further refine data interpretation and improve clinical and research outcomes. The review calls for further research to refine existing tools and methods, deepen our understanding of circadian health, and develop personalized healthcare strategies.

Exploring the Psychological and Physiological Insights Through Digital Phenotyping by Analyzing the Discrepancies Between Subjective Insomnia Severity and Activity-Based Objective Sleep Measures: Observational Cohort Study

BACKGROUND

Insomnia is a prevalent sleep disorder affecting millions worldwide, with significant impacts on daily functioning and quality of life. While traditionally assessed through subjective measures such as the Insomnia Severity Index (ISI), the advent of wearable technology has enabled continuous, objective sleep monitoring in natural environments. However, the relationship between subjective insomnia severity and objective sleep parameters remains unclear.

OBJECTIVE

This study aims to (1) explore the relationship between subjective insomnia severity, as measured by ISI scores, and activity-based objective sleep parameters obtained through wearable devices; (2) determine whether subjective perceptions of insomnia align with objective measures of sleep; and (3) identify key psychological and physiological factors contributing to the severity of subjective insomnia complaints.

METHODS

A total of 250 participants, including both individuals with and without insomnia aged 19-70 years, were recruited from March 2023 to November 2023. Participants were grouped based on ISI scores: no insomnia, mild, moderate, and severe insomnia. Data collection involved subjective assessments through self-reported questionnaires and objective measurements using wearable devices (Fitbit Inspire 3) that monitored sleep parameters, physical activity, and heart rate. The participants also used a smartphone app for ecological momentary assessment, recording daily alcohol consumption, caffeine intake, exercise, and stress. Statistical analyses were used to compare groups on subjective and objective measures.

RESULTS

Results indicated no significant differences in general sleep structure (eg, total sleep time, rapid eye movement sleep time, and light sleep time) among the insomnia groups (mild, moderate, and severe) as classified by ISI scores (all P>.05). Interestingly, the no insomnia group had longer total awake times and lower sleep quality compared with the insomnia groups. Among the insomnia groups, no significant differences were observed regarding sleep structure (all P>.05), suggesting similar sleep patterns regardless of subjective insomnia severity. There were significant differences among the insomnia groups in stress levels, dysfunctional beliefs about sleep, and symptoms of restless leg syndrome (all P≤.001), with higher severity associated with higher scores in these factors. Contrary to expectations, no significant differences were observed in caffeine intake (P=.42) and alcohol consumption (P=.07) between the groups.

CONCLUSIONS

The findings demonstrate a discrepancy between subjective perceptions of insomnia severity and activity-based objective sleep parameters, suggesting that factors beyond sleep duration and quality may contribute to subjective sleep complaints. Psychological factors, such as stress, dysfunctional sleep beliefs, and symptoms of restless legs syndrome, appear to play significant roles in the perception of insomnia severity. These results highlight the importance of considering both subjective and objective assessments in the evaluation and treatment of insomnia and suggest potential avenues for personalized treatment strategies that address both psychological and physiological aspects of sleep disturbances.

TRIAL REGISTRATION

Clinical Research Information Service KCT0009175; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26133.

Biometrically measured sleep in medical students as a predictor of psychological health and academic experiences in the preclinical years

BACKGROUND

Student wellness is of increasing concern in medical education. Increased rates of burnout, sleep disturbances, and psychological concerns in medical students are well documented. These concerns lead to impacts on current educational goals and may set students on a path for long-term health consequences.

METHODS

Undergraduate medical students were recruited to participate in a novel longitudinal wellness tracking project. This project utilized validated wellness surveys to assess emotional health, sleep health, and burnout at multiple timepoints. Biometric information was collected from participant Fitbit devices that tracked longitudinal sleep patterns.

RESULTS

Eighty-one students from three cohorts were assessed during the first semester of their M1 preclinical curriculum. Biometric data showed that nearly 30% of the students had frequent short sleep episodes (<6 hours of sleep for at least 30% of recorded days), and nearly 68% of students had at least one episode of three or more consecutive days of short sleep. Students that had consecutive short sleep episodes had higher rates of stress (8.3%) and depression (5.4%) symptoms and decreased academic efficiency (1.72%).

CONCLUSIONS

Biometric data were shown to significantly predict psychological health and academic experiences in medical students. Biometrically assessed sleep is poor in medical students, and consecutive days of short sleep duration are particularly impactful as it relates to other measures of wellness. Longitudinal, biometric data tracking is feasible and can provide students the ability to self-monitor health behaviors and allow for low-intensity health interventions.

Assessing Changes in Nonspecific Symptoms After Parathyroidectomy for Primary Hyperparathyroidism Using a Smartwatch

OBJECTIVE

Parathyroidectomy (PTX) is indicated in primary hyperparathyroidism (PHPT) with osteoporosis or nephrolithiasis. There is not a uniform consensus on the benefit of PTX for nonspecific symptoms, but patient-reported questionnaires have demonstrated improved quality of life (QOL) afterward. This study aimed to evaluate physical activity and sleep after PTX using smartwatch technology.

METHODS

A prospective study of consecutive patients undergoing PTX for PHPT from August 2022 to July 2023 was conducted. Each patient received a smartwatch to continuously track physical activity and sleep, starting 1 month before to 6 months postoperatively. Euthyroid patients undergoing thyroidectomy served as controls. A disease-specific QOL questionnaire was completed at baseline and 6 months. Data were compared within and between groups using linear mixed effect models.

RESULTS

Forty-five patients were enrolled (PTX = 36, thyroidectomy = 9). The PTX group showed higher proportion of light sleep (68% vs 60%, P = .006), and a lower proportion of deep sleep (14% vs 18%, P < .001) when compared with the thyroidectomy group before surgery. After patients with PTX showed improvement in the QOL questionnaire (-16.0, P < .001) but there were no significant changes seen in the overall smartwatch physical activity or sleep patterns. However, improvements in the mood and sleep subcategory of the QOL questionnaire were associated with more deep sleep and lower number of nighttime awakenings.

CONCLUSION

Patients with PHPT seem to have worse sleeping patterns at baseline. Significant improvement after PTX can be seen using QOL questionnaires that are associated with sleep smartwatch data.

Lacticaseibacillus paracasei 207-27 alters the microbiota-gut-brain axis to improve wearable device-measured sleep duration in healthy adults: a randomized, double-blind, placebo-controlled trial

Objective: Probiotics have been reported to exert beneficial effects on sleep through the gut-brain axis. Therefore, this randomized, double-blind, placebo-controlled trial assessed the effects of Lacticaseibacillus paracasei 207-27 supplementation on sleep quality and its safety and potential mechanisms. Method and study design: Healthy adults under mild stress aged 18-35 years consumed low or high doses of L. paracasei 207-27 or a placebo for 28 days. Fecal samples, blood samples, and questionnaires were collected at the baseline and the end of the intervention. Sleep quality was measured using wearable devices and Pittsburgh sleep quality index (PSQI) questionnaire. Serum inflammatory markers, corticotropin-releasing hormone, adrenocorticotropic hormone (ACTH), cortisol (COR), γ-aminobutyric acid, and 5-hydroxytryptamine levels were detected using enzyme-linked immunosorbent assay. The gut microbiota was analyzed using 16S rRNA sequencing and bioinformatics. Short-chain fatty acids levels were detected using gas chromatography-mass spectrometry. Results: Both the low-dose and high-dose groups exhibited significant improvements in wearable device- measured sleep duration compared to the placebo group. The global scores of PSQI in three groups significantly decreased after intervention without statistical difference between groups. At the phylum level, the low-dose group exhibited a higher relative abundance of Bacteroidota and a lower Firmicutes-to-Bacteroidetes (F/B) ratio. At the genus level, two treatment groups had higher relative abundance of Bacteroides and Megamonas, alongside lower levels of Escherichia-Shigella. Furthermore, the low-dose group exhibited significant increases in acetic acid, propionic acid, butyric acid, and valeric acid levels, while two treatment groups exhibited a significant decrease in COR levels. Correlation analysis revealed that the increased levels of acetic acid and butyric acid in the low-dose group may be associated with decreased ACTH. Conclusion: L. paracasei 207-27 administration in healthy adults resulted in improvements in gut microbiota community and sleep duration. The mechanisms might involve modulation of the gut microbiota structure to regulate the function of the gut-brain axis, including increases in SCFA levels and decreases in hypothalamic-pituitary-adrenal axis activity. The Chinese clinical trial registry number is ChiCTR2300069453 (https://www.chictr.org.cn/showproj.html?proj=191193, registered 16 May 2023 - retrospectively registered).

Sleep-disordered breathing in children and adults with intellectual disability: mind the gap!

BACKGROUND

In adults and children with intellectual disability (ID), sleep -disordered breathing (SDB) is thought to be common. However, large epidemiological studies are lacking, and there are few studies on optimal methods of investigation and even fewer randomised, controlled intervention trials of treatment.

METHOD

Peer-reviewed publications from various databases were examined in line with search terms relevant to ID and SDB spanning the years 200-2024.

RESULTS

Findings suggest that, due to comorbid conditions, children and adults with ID may experience both an increased risk of SDB, as well as lower frequency of diagnosis. SDB can compromise the emotional, physical and mental health of individuals with ID. Appropriate treatment when tolerated leads to an improvement in health and well-being and several studies emphasized the importance of consistent follow-up of people with ID - something that is not universally occurring during childhood, in the transition to adulthood and during adulthood itself. As the most frequently occurring form of ID worldwide, we use Down syndrome as a specific example of how diagnosing and treating SDB can lead to improved outcomes.

CONCLUSIONS

This review highlights the importance of identifying SDB in this heterogenous population, recognising the multi-faceted, deleterious consequences of untreated SDB in people with ID, and presents some strategies that can be harnessed to improve diagnosis and management. Until further ID-specific research is available, we urge flexibility in the approach to people with ID and SDB based in guidelines and standard practice developed for the typically developing population.

The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study: feasibility of long-term monitoring with Fitbit smartwatches in central disorders of hypersomnolence and extraction of digital biomarkers in narcolepsy

The Swiss Primary Hypersomnolence and Narcolepsy Cohort Study (SPHYNCS) is a multicenter research initiative to identify new biomarkers in central disorders of hypersomnolence (CDH). Whereas narcolepsy type 1 (NT1) is well characterized, other CDH disorders lack precise biomarkers. In SPHYNCS, we utilized Fitbit smartwatches to monitor physical activity, heart rate, and sleep parameters over 1 year. We examined the feasibility of long-term ambulatory monitoring using the wearable device. We then explored digital biomarkers differentiating patients with NT1 from healthy controls (HC). A total of 115 participants received a Fitbit smartwatch. Using a adherence metric to evaluate the usability of the wearable device, we found an overall adherence rate of 80% over 1 year. We calculated daily physical activity, heart rate, and sleep parameters from 2 weeks of greatest adherence to compare NT1 (n = 20) and HC (n = 9) participants. Compared to controls, NT1 patients demonstrated findings consistent with increased sleep fragmentation, including significantly greater wake-after-sleep onset (p = .007) and awakening index (p = .025), as well as standard deviation of time in bed (p = .044). Moreover, NT1 patients exhibited a significantly shorter REM latency (p = .019), and sleep latency (p = .001), as well as a lower peak heart rate (p = .008), heart rate standard deviation (p = .039) and high-intensity activity (p = .009) compared to HC. This ongoing study demonstrates the feasibility of long-term monitoring with wearable technology in patients with CDH and potentially identifies a digital biomarker profile for NT1. While further validation is needed in larger datasets, these data suggest that long-term wearable technology may play a future role in diagnosing and managing narcolepsy.

Clinical evidence and technical aspects of innovative technology and monitoring of chronic NIV in COPD: a narrative review

INTRODUCTION

Chronic nocturnal noninvasive ventilation (NIV) improves outcomes in COPD patients with chronic hypercapnic respiratory failure. The aim of chronic NIV in COPD is to control chronic hypercapnic respiratory insufficiency and reduce symptoms of nocturnal hypoventilation, thereby improving quality of life. Chronic NIV care is more and more offered exclusively at home, enabling promising outcomes in terms of patient and caregiver satisfaction, hospital care consumption and cost reduction. Yet, to achieve and maintain optimal ventilation, during adaptation and follow-up, effective feasible (home) monitoring poses a significant challenge.

AREAS COVERED

Comprehensive monitoring of COPD patients receiving chronic NIV requires integrating data from ventilators and assessment of the patient's status including gas exchange, sleep quality, and patient-reported outcomes. The present article describes the physiological background of monitoring during NIV and aims to provide an overview of existing methods for monitoring, assessing their reliability and clinical relevance.

EXPERT OPINION

Patients on chronic NIV are 'ideal' candidates for home monitoring; the advantages of transforming hospital to home care are huge for patients and caregivers and for healthcare systems facing increasing patient numbers. Despite the multitude of available monitoring methods, identifying and characterizing the most relevant parameters associated with optimal patient well-being remains unclear.

The Importance of Nutrition in Menopause and Perimenopause-A Review

Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.

Exploring Variations in Sleep Perception: Comparative Study of Chatbot Sleep Logs and Fitbit Sleep Data

BACKGROUND

Patient-generated health data are important in the management of several diseases. Although there are limitations, information can be obtained using a wearable device and time-related information such as exercise time or sleep time can also be obtained. Fitbits can be used to acquire sleep onset, sleep offset, total sleep time (TST), and wakefulness after sleep onset (WASO) data, although there are limitations regarding the depth of sleep and satisfaction; therefore, the patient's subjective response is still important information that cannot be replaced by wearable devices.

OBJECTIVE

To effectively use patient-generated health data related to time such as sleep, it is first necessary to understand the characteristics of the time response recorded by the user. Therefore, the aim of this study was to analyze the characteristics of individuals' time perception in comparison with wearable data.

METHODS

Sleep data were acquired for 2 weeks using a Fitbit. Participants' sleep records were collected daily through chatbot conversations while wearing the Fitbit, and the two sets of data were statistically compared.

RESULTS

In total, 736 people aged 30-59 years were recruited for this study, and the sleep data of 543 people who wore a Fitbit and responded to the chatbot for more than 7 days on the same day were analyzed. Research participants tended to respond to sleep-related times on the hour or in 30-minute increments, and each participant responded within the range of 60-90 minutes from the value measured by the Fitbit. On average for all participants, the chat responses and the Fitbit data were similar within a difference of approximately 15 minutes. Regarding sleep onset, the participant response was 8 minutes and 39 seconds (SD 58 minutes) later than that of the Fitbit data, whereas with respect to sleep offset, the response was 5 minutes and 38 seconds (SD 57 minutes) earlier. The participants' actual sleep time (AST) indicated in the chat was similar to that obtained by subtracting the WASO from the TST measured by the Fitbit. The AST was 13 minutes and 39 seconds (SD 87 minutes) longer than the time WASO was subtracted from the Fitbit TST. On days when the participants reported good sleep, they responded 19 (SD 90) minutes longer on the AST than the Fitbit data. However, for each sleep event, the probability that the participant's AST was within ±30 and ±60 minutes of the Fitbit TST-WASO was 50.7% and 74.3%, respectively.

CONCLUSIONS

The chatbot sleep response and Fitbit measured time were similar on average and the study participants had a slight tendency to perceive a relatively long sleep time if the quality of sleep was self-reported as good. However, on a participant-by-participant basis, it was difficult to predict participants' sleep duration responses with Fitbit data. Individual variations in sleep time perception significantly affect patient responses related to sleep, revealing the limitations of objective measures obtained through wearable devices.

Challenges of Applying Automated Polysomnography Scoring at Scale

Automatic polysomnography analysis can be leveraged to shorten scoring times, reduce associated costs, and ultimately improve the overall diagnosis of sleep disorders. Multiple and diverse strategies have been attempted for implementation of this technology at scale in the routine workflow of sleep centers. The field, however, is complex and presents unsolved challenges in a number of areas. Recent developments in computer science and artificial intelligence are nevertheless closing the gap. Technological advances are also opening new pathways for expanding our current understanding of the domain and its analysis.

Consumer Wearable Sleep Trackers: Are They Ready for Clinical Use?

As the importance of good sleep continues to gain public recognition, the market for sleep-monitoring devices continues to grow. Modern technology has shifted from simple sleep tracking to a more granular sleep health assessment. We examine the available functionalities of consumer wearable sleep trackers (CWSTs) and how they perform in healthy individuals and disease states. Additionally, the continuum of sleep technology from consumer-grade to medical-grade is detailed. As this trend invariably grows, we urge professional societies to develop guidelines encompassing the practical clinical use of CWSTs and how best to incorporate them into patient care plans.

New non-invasive electrical stimulation devices for treatment of snoring and obstructive sleep apnoea: a systematic review

INTRODUCTION

Recently, new non-invasive electrical stimulation devices have been developed with the aim to increase the tongue muscle tone for patients with obstructive sleep apnoea (OSA) and snorers. The aim of this study was to provide a review of the first results found in the literature regarding the efficacy of non-invasive electric stimulation devices for the treatment of primary snoring and OSA.

MATERIAL AND METHODS

An electronic search was performed on PubMed/MEDLINE, Google Scholar, and Ovid databases. The PRISMA statement was followed. Databases were searched from inception through September, 2021.

RESULTS

Four studies met the criteria for inclusion in this review, for a total of 265 patients. Two devices were included in this review, Apone-Stim 400 Muscle Stimulator and eXciteOSA. All studies suggested that these new devices are effective in improving snoring by approximately 50% after device training, without major complications. However data regarding OSA improvement are conflicting.

CONCLUSIONS

Intraoral non-invasive electrical stimulation devices can be considered a valid option to current therapies for snoring. Further studies are needed to support these interesting new devices for treatment of OSA.

Insufficient Sleep Syndrome: A Blind Spot in Our Vision of Healthy Sleep

Chronic sleep deficiency (CSD) poses a threat to physical health, mental well-being, and social functioning. The concept of behaviorally induced CSD has not changed much since it was first introduced four decades ago. Behaviorally induced CSD is currently referred to as insufficient sleep syndrome (ISS). In the latest edition of the International Classification of Sleep Disorders (ICSD-3, 2014), ISS is considered a disorder of central hypersomnolence with diagnostic codes ICD-9-CM 307.44 and ICD-10-CM F51.12. In this review, we will describe the biological importance of sleep, the ramifications of CSD on the individual and society, the nosological status and diagnostic features of ISS, and the apparent lack of attention to ISS in contemporary medical practice and public health programs. The last three decades have seen a global rise in voluntary sleep curtailment such that ISS may already be the leading cause of CSD, not only in adults but also in school-aged children and adolescents. Acknowledging ISS as a public health priority is a necessary first step in our response to the global threat of CSD and CSD-related health consequences. It is only by confronting ISS directly that we can hope to develop and implement effective educational and advocacy programs, along with more responsible public health policies and regulations.

Wearable Devices for Physical Monitoring of Heart: A Review

Cardiovascular diseases (CVDs) are the leading cause of death globally. An effective strategy to mitigate the burden of CVDs has been to monitor patients' biomedical variables during daily activities with wearable technology. Nowadays, technological advance has contributed to wearables technology by reducing the size of the devices, improving the accuracy of sensing biomedical variables to be devices with relatively low energy consumption that can manage security and privacy of the patient's medical information, have adaptability to any data storage system, and have reasonable costs with regard to the traditional scheme where the patient must go to a hospital for an electrocardiogram, thus contributing a serious option in diagnosis and treatment of CVDs. In this work, we review commercial and noncommercial wearable devices used to monitor CVD biomedical variables. Our main findings revealed that commercial wearables usually include smart wristbands, patches, and smartwatches, and they generally monitor variables such as heart rate, blood oxygen saturation, and electrocardiogram data. Noncommercial wearables focus on monitoring electrocardiogram and photoplethysmography data, and they mostly include accelerometers and smartwatches for detecting atrial fibrillation and heart failure. However, using wearable devices without healthy personal habits will cause disappointing results in the patient's health.

Perceptions of traditional Chinese medicine doctors about using wearable devices and traditional Chinese medicine diagnostic instruments: A mixed-methodology study

Objective

This study aimed to investigate the perceptions of traditional Chinese medicine doctors about wearable devices and diagnostic instruments and explore the factors that influence them.

Methods

Data on the perceptions of the traditional Chinese medicine doctors in Hangzhou, China, about wearable devices and diagnostic instruments were collected through face-to-face semi-structured interviews. The author coded the interview responses using grounded theory. A cross-sectional survey was conducted in four traditional Chinese medicine hospitals in Hangzhou, China. The responses of 385 traditional Chinese medicine doctors were considered valid. Descriptive statistics and binary logistic regression models were used for analysis.

Results

This study categorized the perceptions of traditional Chinese medicine about wearable devices and traditional Chinese medicine diagnostic instruments under convenience, reliability, suitable population, machine usage scenario, and the integration of traditional Chinese medicine and information communication technology. Convenience encompassed portability and the convenience of carrying instruments or wearing the devices and operating them and the human-device interface. Reliability encompassed the underlying principles, accuracy, durability, and reference to diagnosis. Suitability for people encompassed age distinction and disease differentiation. Machine usage scenarios included use in daily life, educational institutions, and primary medical institutions. The combination of traditional Chinese medicine and information communication technology encompassed the integration of traditional Chinese medicine and wearable functions and diagnostic interpretation. The perceptions of traditional Chinese medicine doctors were affected by age, title, type of hospital, and specialty.

Conclusions

The use of wearable devices and traditional Chinese medicine diagnostic instruments has gradually been accepted by traditional Chinese medicine doctors. Traditional Chinese medicine doctors need to improve their knowledge and skills for information communication technology integration, and their standardized training should incorporate information communication technology and digital health.