Andrew Barakat

The autonomic nervous system (ANS) is activated during stress, which can have negative effects on cardiovascular health, sleep, the immune system, and mental health. While there are ways to quantify ANS activity in laboratories, there is a paucity of methods that have been validated in real-world contexts. We present the Fitbit Body Response Algorithm, an approach to continuous remote measurement of ANS activation through widely available remote wrist-based sensors. The design was validated via two experiments, a Trier Social Stress Test (n = 45) and ecological momentary assessments (EMA) of perceived stress (n=87), providing both controlled and ecologically valid test data. Model performance predicting perceived stress when using all available sensor modalities was consistent with expectations (accuracy=0.85) and outperformed models with access to only a subset of the signals. We discuss and address challenges to sensing that arise in real world settings that do not present in conventional lab environments.

Researchers are interested in measuring both objective and subjective assessments of sleep, and associated phenomena such as sleepiness, quality and restoration. Predicting perceived sleep quality accurately from objective measurements remains an unsolved and interesting problem. Previous studies using polysomnograms and actigraphy have shown poor concordance between objective metrics and subjective sleep quality, but were often limited by study duration (e.g., one or two nights of PSG, study population in low 100 s). In this chapter, we consider whether consumer sleep trackers could significantly improve the assessment of subjective sleep quality through longer periods of assessment and larger data scale. We describe a recent study that modeled two subjective sleep quality metrics (PROMIS Sleep-Related Impairment (SI) and Sleep Disturbance (SD) Index) from objective sleep metrics acquired from a consumer wearable device (Fitbit). However, the goodness-of-fit parameter remains relatively low, even with the increased data availability and scale of data provided by consumer wearables. Specifically, for a well-characterized normative population of 2106 adults, we see that a linear multivariate model produces an R² of 0.107 for predicting SI and R² of 0.147 for SR, consistent with prior results using PSG and actigraphy. We conclude that subjective sleep quality remains broadly a psychological construct that cannot be fully modeled solely by objective sleep metrics.