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Background Shift workers are at high risk of developing sleep disorders such as shift worker sleep disorder or chronic insomnia. Cognitive behavioral therapy (CBT) is the first-line treatment for insomnia, and emerging evidence shows that internet-based CBT is highly effective with additional features such as continuous tracking and personalization. However, there are limited studies on internet-based CBT for shift workers with sleep disorders. Objective This study aimed to evaluate the impact of a 4-week, physician-assisted, internet-delivered CBT program incorporating machine learning–based well-being prediction on the sleep duration of shift workers at high risk of sleep disorders. We evaluated these outcomes using an internet-delivered CBT app and fitness trackers in the intensive care unit. Methods A convenience sample of 61 shift workers (mean age 32.9, SD 8.3 years) from the intensive care unit or emergency department participated in the study. Eligible participants were on a 3-shift schedule and had a Pittsburgh Sleep Quality Index score ≥5. The study comprised a 1-week baseline period, followed by a 4-week intervention period. Before the study, the participants completed questionnaires regarding the subjective evaluation of sleep, burnout syndrome, and mental health. Participants were asked to wear a commercial fitness tracker to track their daily activities, heart rate, and sleep for 5 weeks. The internet-delivered CBT program included well-being prediction, activity and sleep chart, and sleep advice. A job-based multitask and multilabel convolutional neural network–based model was used for well-being prediction. Participant-specific sleep advice was provided by sleep physicians based on daily surveys and fitness tracker data. The primary end point of this study was sleep duration. For continuous measurements (sleep duration, steps, etc), the mean baseline and week-4 intervention data were compared. The 2-tailed paired t test or Wilcoxon signed rank test was performed depending on the distribution of the data. Results In the fourth week of intervention, the mean daily sleep duration for 7 days (6.06, SD 1.30 hours) showed a statistically significant increase compared with the baseline (5.54, SD 1.36 hours; P=.02). Subjective sleep quality, as measured by the Pittsburgh Sleep Quality Index, also showed statistically significant improvement from baseline (9.10) to after the intervention (7.84; P=.001). However, no significant improvement was found in the subjective well-being scores (all P>.05). Feature importance analysis for all 45 variables in the prediction model showed that sleep duration had the highest importance. Conclusions The physician-assisted internet-delivered CBT program targeting shift workers with a high risk of sleep disorders showed a statistically significant increase in sleep duration as measured by wearable sensors along with subjective sleep quality. This study shows that sleep improvement programs using an app and wearable sensors are feasible and may play an important role in preventing shift work–related sleep disorders. International Registered Report Identifier (IRRID) RR2-10.2196/24799.
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Effect of Sleep and Biobehavioral Patterns on Multidimensional Cognitive Performance: Longitudinal, In-the-Wild Study
Background With nearly 20% of the US adult population using fitness trackers, there is an increasing focus on how physiological data from these devices can provide actionable insights about workplace performance. However, in-the-wild studies that understand how these metrics correlate with cognitive performance measures across a diverse population are lacking, and claims made by device manufacturers are vague. While there has been extensive research leading to a variety of theories on how physiological measures affect cognitive performance, virtually all such studies have been conducted in highly controlled settings and their validity in the real world is poorly understood. Objective We seek to bridge this gap by evaluating prevailing theories on the effects of a variety of sleep, activity, and heart rate parameters on cognitive performance against data collected in real-world settings. Methods We used a Fitbit Charge 3 and a smartphone app to collect different physiological and neurobehavioral task data, respectively, as part of our 6-week-long in-the-wild study. We collected data from 24 participants across multiple population groups (shift workers, regular workers, and graduate students) on different performance measures (vigilant attention and cognitive throughput). Simultaneously, we used a fitness tracker to unobtrusively obtain physiological measures that could influence these performance measures, including over 900 nights of sleep and over 1 million minutes of heart rate and physical activity metrics. We performed a repeated measures correlation (rrm) analysis to investigate which sleep and physiological markers show association with each performance measure. We also report how our findings relate to existing theories and previous observations from controlled studies. Results Daytime alertness was found to be significantly correlated with total sleep duration on the previous night (rrm=0.17, P<.001) as well as the duration of rapid eye movement (rrm=0.12, P<.001) and light sleep (rrm=0.15, P<.001). Cognitive throughput, by contrast, was not found to be significantly correlated with sleep duration but with sleep timing—a circadian phase shift toward a later sleep time corresponded with lower cognitive throughput on the following day (rrm=–0.13, P<.001). Both measures show circadian variations, but only alertness showed a decline (rrm=–0.1, P<.001) as a result of homeostatic pressure. Both heart rate and physical activity correlate positively with alertness as well as cognitive throughput. Conclusions Our findings reveal that there are significant differences in terms of which sleep-related physiological metrics influence each of the 2 performance measures. This makes the case for more targeted in-the-wild studies investigating how physiological measures from self-tracking data influence, or can be used to predict, specific aspects of cognitive performance.
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- Award ID(s):
- 1839999
- PAR ID:
- 10217209
- Date Published:
- Journal Name:
- Journal of Medical Internet Research
- Volume:
- 23
- Issue:
- 2
- ISSN:
- 1438-8871
- Page Range / eLocation ID:
- e23936
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.2196/23936
