{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T20:17:38Z","timestamp":1792009058539,"version":"4.4.0"},"reference-count":50,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T00:00:00Z","timestamp":1633910400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"Belun technology company","award":["grant BL2018\/1001"],"award-info":[{"award-number":["grant BL2018\/1001"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>Many wearables allow physiological data acquisition in sleep and enable clinicians to assess sleep outside of sleep labs. Belun Sleep Platform (BSP) is a novel neural network-based home sleep apnea testing system utilizing a wearable ring device to detect obstructive sleep apnea (OSA). The objective of the study is to assess the performance of BSP for the evaluation of OSA. Subjects who take heart rate-affecting medications and those with non-arrhythmic comorbidities were included in this cohort. Polysomnography (PSG) studies were performed simultaneously with the Belun Ring in individuals who were referred to the sleep lab for an overnight sleep study. The sleep studies were manually scored using the American Academy of Sleep Medicine Scoring Manual (version 2.4) with 4% desaturation hypopnea criteria. A total of 78 subjects were recruited. Of these, 45% had AHI &lt; 5; 18% had AHI 5\u201315; 19% had AHI 15\u201330; 18% had AHI \u2265 30. The Belun apnea-hypopnea index (bAHI) correlated well with the PSG-AHI (<jats:italic>r<\/jats:italic> = 0.888, <jats:italic>P<\/jats:italic> &lt; 0.001). The Belun total sleep time (bTST) and PSG-TST had a high correlation coefficient (<jats:italic>r<\/jats:italic> = 0.967, <jats:italic>P<\/jats:italic> &lt; 0.001). The accuracy, sensitivity, specificity in categorizing AHI \u2265 15 were 0.808 [95% CI, 0.703\u20130.888], 0.931 [95% CI, 0.772\u20130.992], and 0.735 [95% CI, 0.589\u20130.850], respectively. The use of beta-blocker\/calcium-receptor antagonist and the presence of comorbidities did not negatively affect the sensitivity and specificity of BSP in predicting OSA. A diagnostic algorithm combining STOP-Bang cutoff of 5 and bAHI cutoff of 15 events\/h demonstrated an accuracy, sensitivity, specificity of 0.938 [95% CI, 0.828\u20130.987], 0.944 [95% CI, 0.727\u20130.999], and 0.933 [95% CI, 0.779\u20130.992], respectively, for the diagnosis of moderate to severe OSA. BSP is a promising testing tool for OSA assessment and can potentially be incorporated into clinical practices for the identification of OSA.<\/jats:p>\n<jats:p><jats:bold>Trial registration:<\/jats:bold> ClinicalTrial.org <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/show\/NCT03997916\" xlink:type=\"simple\">NCT03997916<\/jats:ext-link> <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03997916?term=belun+ring&amp;draw=2&amp;rank=1\" xlink:type=\"simple\">https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03997916?term=belun+ring&amp;draw=2&amp;rank=1<\/jats:ext-link><\/jats:p>","DOI":"10.1371\/journal.pone.0258040","type":"journal-article","created":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T20:29:11Z","timestamp":1633984151000},"page":"e0258040","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":30,"title":["Detection of obstructive sleep apnea using Belun Sleep Platform wearable with neural network-based algorithm and its combined use with STOP-Bang questionnaire"],"prefix":"10.1371","volume":"16","author":[{"given":"Eric","family":"Yeh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eileen","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2175-478X","authenticated-orcid":true,"given":"Chih-Wei","family":"Tsai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenbo","family":"Gu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pai-Lien","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Leung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2535-0587","authenticated-orcid":true,"given":"I-Chen","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7740-9013","authenticated-orcid":true,"given":"Kingman P.","family":"Strohl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney J.","family":"Folz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wail","family":"Yar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4061-5689","authenticated-orcid":true,"given":"Ambrose A.","family":"Chiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,10,11]]},"reference":[{"issue":"12","key":"pone.0258040.ref001","doi-asserted-by":"crossref","first-page":"1206","DOI":"10.1056\/NEJMoa041832","article-title":"Day\u2013night pattern of sudden death in obstructive sleep apnea","volume":"352","author":"AS Gami","year":"2005","journal-title":"N. Engl. J. Med"},{"issue":"8","key":"pone.0258040.ref002","doi-asserted-by":"crossref","first-page":"e1000132","DOI":"10.1371\/journal.pmed.1000132","article-title":"Sleep-disordered breathing and mortality: a prospective cohort study","volume":"6","author":"NM Punjabi","year":"2009","journal-title":"PLOS Med"},{"issue":"8","key":"pone.0258040.ref003","first-page":"1071","article-title":"Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort","volume":"31","author":"T Young","year":"2008","journal-title":"Sleep"},{"issue":"20","key":"pone.0258040.ref004","doi-asserted-by":"crossref","first-page":"2169","DOI":"10.1001\/jama.2012.3418","article-title":"Association between treated and untreated obstructive sleep apnea and risk of hypertension","volume":"307","author":"JM Marin","year":"2012","journal-title":"JAMA"},{"issue":"4","key":"pone.0258040.ref005","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1161\/CIRCULATIONAHA.109.901801","article-title":"Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure","volume":"122","author":"DJ Gottlieb","year":"2010","journal-title":"Circulation"},{"issue":"11","key":"pone.0258040.ref006","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1164\/rccm.200505-702OC","article-title":"Association of sleep-disordered breathing and the occurrence of stroke","volume":"172","author":"M Arzt","year":"2005","journal-title":"Am. J. Respir. Crit. Care Med"},{"issue":"9464","key":"pone.0258040.ref007","doi-asserted-by":"crossref","first-page":"1046","DOI":"10.1016\/S0140-6736(05)71141-7","article-title":"Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study","volume":"365","author":"JM Marin","year":"2005","journal-title":"Lancet"},{"issue":"9","key":"pone.0258040.ref008","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"PE Peppard","year":"2013","journal-title":"Am. J. Epidemiol"},{"issue":"4","key":"pone.0258040.ref009","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study","volume":"3","author":"R Heinzer","year":"2015","journal-title":"Lancet Respir. Med"},{"key":"pone.0258040.ref010","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.smrv.2016.07.002","article-title":"Prevalence of obstructive sleep apnea in the general population: a systematic review","volume":"34","author":"C V Senaratna","year":"2017","journal-title":"Sleep Med. Rev"},{"issue":"05","key":"pone.0258040.ref011","doi-asserted-by":"crossref","first-page":"531","DOI":"10.5664\/JCSM.1328","article-title":"Obstructive sleep apnea devices for out-of-center (OOC) testing: technology evaluation","volume":"07","author":"AN Collop","year":"2011","journal-title":"J. Clin. Sleep Med"},{"key":"pone.0258040.ref012","doi-asserted-by":"crossref","first-page":"479","DOI":"10.5664\/jcsm.6506","article-title":"Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea: an American Academy of Sleep Medicine clinical practice guideline","volume":"13","author":"VK Kapur","year":"2017","journal-title":"J. Clin. Sleep Med"},{"key":"pone.0258040.ref013","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.5664\/jcsm.6774","article-title":"Clinical use of a home sleep apnea test: an American Academy of Sleep Medicine position statement","volume":"13","author":"I Rosen","year":"2017","journal-title":"J. Clin. Sleep Med"},{"issue":"5","key":"pone.0258040.ref014","doi-asserted-by":"crossref","first-page":"325","DOI":"10.7326\/M19-3575","article-title":"The Management of chronic insomnia disorder and obstructive sleep apnea: synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense clinical practice guidelines","volume":"172","author":"V Mysliwiec","year":"2020","journal-title":"Ann. Intern. Med"},{"issue":"7","key":"pone.0258040.ref015","first-page":"939","article-title":"Periodic, Profound peripheral vasoconstriction\u2014a new marker of obstructive sleep apnea","volume":"22","author":"RP Schnall","year":"1999","journal-title":"Sleep"},{"issue":"5","key":"pone.0258040.ref016","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S1389-9457(03)00111-4","article-title":"Assessment of a wrist-worn device in the detection of obstructive sleep apnea","volume":"4","author":"NT Ayas","year":"2003","journal-title":"Sleep Med"},{"issue":"10","key":"pone.0258040.ref017","doi-asserted-by":"crossref","DOI":"10.5664\/jcsm.8620","article-title":"Performance of peripheral arterial tonometry\u2014based testing for the diagnosis of obstructive sleep apnea in a large sleep clinic cohort","volume":"16","author":"OC Ioachimescu","year":"2020","journal-title":"J. Clin. Sleep Med"},{"key":"pone.0258040.ref018","doi-asserted-by":"crossref","first-page":"743","DOI":"10.3389\/fphys.2018.00743","article-title":"A critical review of consumer wearables, mobile applications, and equipment for providing biofeedback, monitoring stress, and sleep in physically active populations","volume":"9","author":"JM Peake","year":"2018","journal-title":"Front. Physiol"},{"issue":"5","key":"pone.0258040.ref019","doi-asserted-by":"crossref","first-page":"429","DOI":"10.2217\/pme-2018-0044","article-title":"Wearables and the medical revolution","volume":"15","author":"J Dunn","year":"2018","journal-title":"Per. Med"},{"issue":"12","key":"pone.0258040.ref020","first-page":"1455","article-title":"Consumer sleep technologies: a review of the landscape","volume":"11","author":"P-RT Ko","year":"2021","journal-title":"J. Clin. Sleep Med"},{"issue":"7","key":"pone.0258040.ref021","doi-asserted-by":"crossref","first-page":"1538","DOI":"10.1249\/MSS.0000000000001947","article-title":"Wearable sleep technology in clinical and research settings","volume":"51","author":"M de Zambotti","year":"2019","journal-title":"Med. Sci. Sports Exerc"},{"issue":"1","key":"pone.0258040.ref022","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jsmc.2019.11.003","article-title":"Sensors capabilities, performance, and use of consumer sleep technology","volume":"15","author":"M de Zambotti","year":"2020","journal-title":"Sleep Med. Clin"},{"issue":"9","key":"pone.0258040.ref023","doi-asserted-by":"crossref","DOI":"10.21037\/jtd-sleep-2020-003","article-title":"Technologic advances in the assessment and management of obstructive sleep apnoea beyond the apnoea-hypopnoea index: a narrative review","volume":"12","author":"AM O\u2019Mahony","year":"2020","journal-title":"J. Thorac. Dis"},{"issue":"1","key":"pone.0258040.ref024","doi-asserted-by":"crossref","first-page":"13512","DOI":"10.1038\/s41598-020-69935-7","article-title":"Wearable monitoring of sleep-disordered breathing: estimation of the apnea\u2013hypopnea index using wrist-worn reflective photoplethysmography","volume":"10","author":"GB Papini","year":"2020","journal-title":"Sci. Rep"},{"issue":"3","key":"pone.0258040.ref025","doi-asserted-by":"crossref","first-page":"1702616","DOI":"10.1183\/13993003.02616-2017","article-title":"Challenges and perspectives in obstructive sleep apnoea","volume":"52","author":"W Randerath","year":"2018","journal-title":"Eur. Respir. J"},{"key":"pone.0258040.ref026","doi-asserted-by":"crossref","first-page":"101227","DOI":"10.1016\/j.smrv.2019.101227","article-title":"A systematic review of the accuracy of sleep wearable devices for estimating sleep onset","volume":"49","author":"H Scott","year":"2020","journal-title":"Sleep Med. Rev"},{"issue":"1","key":"pone.0258040.ref027","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1038\/s41746-020-0244-4","article-title":"The future of sleep health: a data-driven revolution in sleep science and medicine","volume":"3","author":"I Perez-Pozuelo","year":"2020","journal-title":"npj Digit. Med"},{"issue":"1","key":"pone.0258040.ref028","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41746-019-0121-1","article-title":"Best practices for analyzing large-scale health data from wearables and smartphone apps","volume":"2","author":"JL Hicks","year":"2019","journal-title":"npj Digit. Med"},{"issue":"1","key":"pone.0258040.ref029","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41591-018-0307-0","article-title":"The practical implementation of artificial intelligence technologies in medicine","volume":"25","author":"J He","year":"2019","journal-title":"Nat. Med"},{"issue":"1","key":"pone.0258040.ref030","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1038\/s41591-018-0300-7","article-title":"High-performance medicine: the convergence of human and artificial intelligence","volume":"25","author":"EJ Topol","year":"2019","journal-title":"Nat. Med"},{"key":"pone.0258040.ref031","article-title":"A novel home screening platform for obstructive sleep apnea through wearable ring-type pulse oximeter","volume":"41","author":"W Gu","year":"2018","journal-title":"Sleep"},{"issue":"9","key":"pone.0258040.ref032","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.5664\/jcsm.8592","article-title":"Belun Ring Platform: a novel home sleep apnea testing system for assessment of obstructive sleep apnea","volume":"16","author":"W Gu","year":"2020","journal-title":"J. Clin. Sleep Med"},{"key":"pone.0258040.ref033","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.smrv.2016.10.004","article-title":"Diagnostic accuracy of the Berlin questionnaire, STOP-BANG, STOP, and Epworth sleepiness scale in detecting obstructive sleep apnea: A bivariate meta-analysis","volume":"36","author":"H-Y Chiu","year":"2017","journal-title":"Sleep Med. Rev"},{"issue":"3","key":"pone.0258040.ref034","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1378\/chest.15-0903","article-title":"STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea","volume":"149","author":"F Chung","year":"2016","journal-title":"Chest"},{"issue":"12","key":"pone.0258040.ref035","doi-asserted-by":"crossref","first-page":"e0143697","DOI":"10.1371\/journal.pone.0143697","article-title":"Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis","volume":"10","author":"M Nagappa","year":"2015","journal-title":"PLOS One"},{"key":"pone.0258040.ref036","author":"R Berry","year":"2017","journal-title":"The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. Version 2.4."},{"issue":"05","key":"pone.0258040.ref037","doi-asserted-by":"crossref","first-page":"597","DOI":"10.5664\/jcsm.2172","article-title":"Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events","volume":"08","author":"R Berry","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"pone.0258040.ref038","volume-title":"R: a language and environment for statistical computing","author":"R Core Team","year":"2021"},{"issue":"4","key":"pone.0258040.ref039","first-page":"719","article-title":"Statistical aspects of the analysis of data from retrospective studies of disease","volume":"22","author":"N Mantel","year":"1959","journal-title":"JNCI J. Natl. Cancer Inst"},{"issue":"8476","key":"pone.0258040.ref040","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1016\/S0140-6736(86)90837-8","article-title":"Statistical methods for assessing agreement between two methods of clinical measurement","volume":"327","author":"JM Bland","year":"1986","journal-title":"Lancet"},{"issue":"2","key":"pone.0258040.ref041","doi-asserted-by":"crossref","first-page":"139","DOI":"10.2307\/3314608","article-title":"Nonparametric standard errors and confidence Intervals","volume":"9","author":"B Efron","year":"1981","journal-title":"Can. J. Stat"},{"key":"pone.0258040.ref042","doi-asserted-by":"crossref","first-page":"3099","DOI":"10.1007\/s00405-013-2555-4","article-title":"Assessment of a portable monitoring device Watch PAT 200 in the diagnosis of obstructive sleep apnea","volume":"270","author":"W Li","year":"2013","journal-title":"Eur. Arch. Oto-Rhino-Laryngology"},{"issue":"3","key":"pone.0258040.ref043","doi-asserted-by":"crossref","first-page":"1741","DOI":"10.1007\/s00405-016-4351-4","article-title":"Validation study of WatchPat 200 for diagnosis of OSA in an Asian cohort","volume":"274","author":"YJ Gan","year":"2017","journal-title":"Eur. Arch. Oto-Rhino-Laryngology"},{"key":"pone.0258040.ref044","doi-asserted-by":"crossref","first-page":"1791","DOI":"10.5664\/jcsm.7398","article-title":"An evaluation of the NightOwl home sleep apnea testing system","volume":"14","author":"F Massie","year":"2018","journal-title":"J. Clin. Sleep Med"},{"issue":"7","key":"pone.0258040.ref045","doi-asserted-by":"crossref","first-page":"838","DOI":"10.3109\/00016480903431139","article-title":"Validation study of portable device for the diagnosis of obstructive sleep apnea according to the new AASM scoring criteria: Watch-PAT 100","volume":"130","author":"JH Choi","year":"2010","journal-title":"Acta Otolaryngol"},{"key":"pone.0258040.ref046","article-title":"A comparison of automated and manual sleep staging and respiratory event recognition in a portable sleep diagnostic device with in-lab sleep study","author":"Z Zhang","year":"2020","journal-title":"J. Clin. Sleep Med"},{"key":"pone.0258040.ref047","article-title":"Improving the performance of peripheral arterial tonometry-based testing for the diagnosis of obstructive sleep apnea","author":"OC Ioachimescu","year":"2020","journal-title":"J. Investig. Med"},{"issue":"11","key":"pone.0258040.ref048","first-page":"1491","article-title":"In-home, self-assembled sleep studies are useful in diagnosing sleep apnea in the elderly","volume":"35","author":"CR Morales","year":"2012","journal-title":"Sleep"},{"issue":"4","key":"pone.0258040.ref049","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1111\/jch.12073","article-title":"Screening for severe obstructive sleep apnea syndrome in hypertensive outpatients","volume":"15","author":"I Gurubhagavatula","year":"2013","journal-title":"J. Clin. Hypertens"},{"key":"pone.0258040.ref050","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1016\/j.sleep.2020.03.027","article-title":"Combined nocturnal pulse oximetry and questionnaire-based obstructive sleep apnea screening\u2013A cohort study","volume":"72","author":"S Mashaqi","year":"2020","journal-title":"Sleep Med"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0303713","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2024,5,9]],"date-time":"2024-05-09T00:00:00Z","timestamp":1715212800000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0258040","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,11]],"date-time":"2021-10-11T20:30:07Z","timestamp":1633984207000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0258040"}},"subtitle":[],"editor":[{"given":"Heming","family":"Wang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2021,10,11]]},"references-count":50,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,10,11]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0258040","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pone.0303713","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,11]]}}}