{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:44:23Z","timestamp":1785545063608,"version":"3.56.0"},"reference-count":47,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n The demand for sleep interventions is high and steadily growing. Digital therapeutics (DTx) can help individuals improve their sleep remotely, over an extended period, and with less effort from medical professionals. Obstructive sleep apnea (OSA), one of the most prevalent and consequential sleep disorders, can be treated with health-supporting behavior changes, such as physical exercise and weight loss, and, therefore, acts as a promising application for DTx.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n The study aimed to analyze a digital intervention from both medical and technological perspectives by moving beyond clinical markers and exploring more deeply how the DTx application was used. This study aimed to propose a novel way in which association rules can function as an exploratory tool to analyze the sleep, behavior, and engagement of participants with the DTx application on a day-to-day level.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n A lifestyle intervention study (N=192) targeted at adults with mild-to-moderate OSA aimed to reduce their OSA severity using a DTx application and an exercise program over a study period of 12 weeks. The participants\u2019 OSA severity was assessed through polysomnography at the beginning and at the end of the study period, and the participants tracked their sleep with a digital sleep diary and a smartwatch over the course of the entire study. The DTx application provided data on when and how the participants pursued the proposed lifestyle interventions. These heterogeneous data sources were combined into one multimodal dataset, which was explored through descriptive statistics. Ultimately, the data were turned into a transaction-based format, and association rules were derived using the Apriori algorithm.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Analyzing the participants\u2019 interaction with the application revealed the lifestyle interventions they pursued and how their behavior and sleep patterns changed over time. The Apriori algorithm generated a set of association rules with lift and confidence scores that were significantly higher than those for the co-occurrence of items through random chance. The rules show co-occurrence of missions and items from the sleep diary, as well as items derived from the watch measurements.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The study showed the richness of the various data sources provided by a digital intervention using wearables and how they can be used to get an in-depth understanding of the study. The generated association rules showed the presence of significant co-occurrences across the different data modalities and highlighted their effectiveness as an exploratory tool for multimodal health data.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/75358","type":"journal-article","created":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T17:41:31Z","timestamp":1783359691000},"page":"e75358-e75358","source":"Crossref","is-referenced-by-count":0,"title":["Mining Association Rules From a Multimodal Dataset of a Digital Therapeutics Application for Sleep Improvement Through a Healthy Lifestyle: Quantitative Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0974-202X","authenticated-orcid":false,"given":"Luka","family":"Biedebach","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6231-5053","authenticated-orcid":false,"given":"Katr\u00edn \u00ddr","family":"Fri\u00f0geirsd\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0329-2689","authenticated-orcid":false,"given":"Camilla","family":"Carpinelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7957-6285","authenticated-orcid":false,"given":"Ari P\u00e1ll","family":"Isberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3743-5852","authenticated-orcid":false,"given":"Halla","family":"Helgad\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0877-3529","authenticated-orcid":false,"given":"Erna Sif","family":"Arnard\u00f3ttir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6924-3006","authenticated-orcid":false,"given":"Jose M","family":"Saavedra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4563-0001","authenticated-orcid":false,"given":"Anna Sigridur","family":"Islind","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,7,6]]},"reference":[{"issue":"5","key":"R1","doi-asserted-by":"publisher","first-page":"2207","DOI":"10.4103\/jfmpc.jfmpc_105_20","article-title":"Role of digital therapeutics and the changing future of healthcare","volume":"9","author":"Dang","journal-title":"J Family Med Prim Care"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1038\/s41746-023-00777-z","article-title":"Digital therapeutics from bench to bedside","volume":"6","author":"Wang","journal-title":"NPJ Digit Med"},{"issue":"6","key":"R3","doi-asserted-by":"publisher","first-page":"3061","DOI":"10.1007\/s00520-020-05810-5","article-title":"Individualized blended care for patients with colorectal cancer: the patient\u2019s view on informational support","volume":"29","author":"Islind","journal-title":"Support Care Cancer"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","first-page":"9","DOI":"10.5665\/sleep.3298","article-title":"Sleep health: can we define it? Does it matter?","volume":"37","author":"Buysse","journal-title":"Sleep"},{"issue":"9","key":"R5","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","journal-title":"Am J Epidemiol"},{"issue":"7775","key":"R6","doi-asserted-by":"publisher","first-page":"S106","DOI":"10.1038\/d41586-019-02873-1","article-title":"The emerging world of digital therapeutics","volume":"573","author":"Makin","journal-title":"Nature"},{"issue":"3","key":"R7","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s12599-023-00804-z","article-title":"Digital therapeutics (DTx)","volume":"65","author":"F\u00fcrstenau","journal-title":"Bus Inf Syst Eng"},{"issue":"2","key":"R8","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1513\/pats.200709-155MG","article-title":"The epidemiology of adult obstructive sleep apnea","volume":"5","author":"Punjabi","journal-title":"Proc Am Thorac Soc"},{"issue":"2","key":"R9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1056\/NEJM199601113340207","article-title":"Obstructive sleep apnea","volume":"334","author":"Strollo","journal-title":"N Engl J Med"},{"issue":"8","key":"R10","doi-asserted-by":"publisher","first-page":"687","DOI":"10.1016\/S2213-2600(19)30198-5","article-title":"Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis","volume":"7","author":"Benjafield","journal-title":"Lancet Respir Med"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13066","article-title":"On the rise and fall of the apnea-hypopnea index: a historical review and critical appraisal","volume":"29","author":"Pevernagie","journal-title":"J Sleep Res"},{"issue":"2","key":"R12","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1007\/s11818-016-0055-7","article-title":"Predictors of obstructive sleep apnea: anthropometric measurements and their significance","volume":"20","author":"Prochnow","journal-title":"Somnologie (Berl)"},{"issue":"6","key":"R13","doi-asserted-by":"publisher","first-page":"769","DOI":"10.5665\/sleep.1872","article-title":"A randomized, placebo-controlled trial of online cognitive behavioral therapy for chronic insomnia disorder delivered via an automated media-rich web application","volume":"35","author":"Espie","journal-title":"Sleep"},{"issue":"1","key":"R14","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1007\/s13665-025-00396-x","article-title":"Exercise interventions in obstructive sleep apnea: program features and clinical benefits","volume":"14","author":"Saavedra","journal-title":"Curr Pulmonol Rep"},{"issue":"3","key":"R15","doi-asserted-by":"publisher","DOI":"10.3390\/jfmk10030311","article-title":"A fully replicable exercise program for individuals with sleep-disordered breathing: protocol design and training load monitoring","volume":"10","author":"Saavedra","journal-title":"J Funct Morphol Kinesiol"},{"issue":"3","key":"R16","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.01134-2024","article-title":"Effects of exercise and a lifestyle app on sleep disordered breathing, physical health and quality of life","volume":"11","author":"Fridgeirsdottir","journal-title":"ERJ Open Res"},{"issue":"4","key":"R17","doi-asserted-by":"publisher","first-page":"503","DOI":"10.5664\/jcsm.8252","article-title":"Effectiveness of an intensive weight-loss program for severe OSA in patients undergoing CPAP treatment: a randomized controlled trial","volume":"16","author":"L\u00f3pez-Padr\u00f3s","journal-title":"J Clin Sleep Med"},{"issue":"5","key":"R18","doi-asserted-by":"publisher","first-page":"669","DOI":"10.5665\/sleep.4652","article-title":"Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis","volume":"38","author":"Camacho","journal-title":"Sleep"},{"key":"R19","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2017.12.003","article-title":"A systematic review and meta-analysis of cognitive and behavioral interventions to improve sleep health in adults without sleep disorders","volume":"40","author":"Murawski","journal-title":"Sleep Med Rev"},{"issue":"5","key":"R20","doi-asserted-by":"publisher","first-page":"387","DOI":"10.1539\/joh.l7154","article-title":"Evaluation of an internet-based self-help program for better quality of sleep among Japanese workers: a randomized controlled trial","volume":"50","author":"Suzuki","journal-title":"J Occup Health"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1007\/s40675-017-0065-4","article-title":"Digital cognitive behavioral therapy (dCBT) for insomnia: a state-of-the-science review","volume":"3","author":"Luik","journal-title":"Curr Sleep Med Rep"},{"issue":"1","key":"R22","doi-asserted-by":"publisher","DOI":"10.2196\/47356","article-title":"Patient engagement and provider effectiveness of a novel sleep telehealth platform and remote monitoring assessment in the US military: pilot study providing evidence-based sleep treatment recommendations","volume":"7","author":"Wickwire","journal-title":"JMIR Form Res"},{"issue":"2","key":"R23","doi-asserted-by":"publisher","DOI":"10.2196\/24607","article-title":"Framework for the design engineering and clinical implementation and evaluation of mHealth apps for sleep disturbance: systematic review","volume":"23","author":"Aji","journal-title":"J Med Internet Res"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2022.886783","article-title":"Engagement in digital health app-based prevention programs is associated with weight loss among adults age 65","volume":"4","author":"Auster-Gussman","journal-title":"Front Digit Health"},{"issue":"2","key":"R25","doi-asserted-by":"publisher","DOI":"10.2196\/23180","article-title":"Associations between digital health intervention engagement, physical activity, and sedentary behavior: systematic review and meta-analysis","volume":"23","author":"Mclaughlin","journal-title":"J Med Internet Res"},{"issue":"1","key":"R26","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1093\/jamia\/ocab254","article-title":"Estimating the impact of engagement with digital health interventions on patient outcomes in randomized trials","volume":"29","author":"Nelson","journal-title":"J Am Med Inform Assoc"},{"key":"R27","doi-asserted-by":"publisher","DOI":"10.3389\/fdgth.2021.764079","article-title":"Effect of engagement with digital interventions on mental health outcomes: a systematic review and meta-analysis","volume":"3","author":"Gan","journal-title":"Front Digit Health"},{"key":"R28","doi-asserted-by":"crossref","unstructured":"Concaro S Sacchi L Cerra C et al. Mining healthcare data with temporal association rules: improvements and assessment for a practical use. In: Artificial Intelligence in Medicine. Springer; 2009:16-25. [doi: 10.1007\/978-3-642-02976-9_3]","DOI":"10.1007\/978-3-642-02976-9_3"},{"issue":"Suppl 2","key":"R29","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-018-0633-7","article-title":"Query-constraint-based mining of association rules for exploratory analysis of clinical datasets in the National Sleep Research Resource","volume":"18","author":"Abeysinghe","journal-title":"BMC Med Inform Decis Mak"},{"issue":"2","key":"R30","doi-asserted-by":"publisher","first-page":"475","DOI":"10.1007\/s11277-018-5983-z","article-title":"Mining based time-series sleeping pattern analysis for life big-data","volume":"105","author":"Kim","journal-title":"Wireless Pers Commun"},{"key":"R31","doi-asserted-by":"crossref","unstructured":"Laxminarayan P Ruiz C Alvarez SA Moonis M . Mining associations over human sleep time series. Presented at: 18th IEEE Symposium on Computer-Based Medical Systems (CBMS\u201905); Jun 23-24, 2005; Dublin, Ireland. [doi: 10.1109\/CBMS.2005.75]","DOI":"10.1109\/CBMS.2005.75"},{"issue":"3","key":"R32","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s10462-016-9483-9","article-title":"Applications of association rule mining in health informatics: a survey","volume":"47","author":"Altaf","journal-title":"Artif Intell Rev"},{"key":"R33","doi-asserted-by":"crossref","unstructured":"Liang Z Martell MAC Nishimura T . Mining hidden correlations between sleep and lifestyle factors from quantified-self data. Presented at: UbiComp \u201916 Adjunct: Proceedings of the 2016 ACM International Joint Conference on Pervasive and Ubiquitous Computing: Adjunct; Sep 12-16, 2016; Heidelberg Germany. [doi: 10.1145\/2968219.2968319]","DOI":"10.1145\/2968219.2968319"},{"key":"R34","doi-asserted-by":"crossref","unstructured":"Alslaity A Chan G Wilson R Orji R . Toward understanding users\u2019 interactions with a mental health app: an association rule mining approach. Presented at: 16th EAI International Conference on Pervasive Computing Technologies for Healthcare; Dec 12-14, 2022:477-495; Thessaloniki, Greece. [doi: 10.1007\/978-3-031-34586-9_32]","DOI":"10.1007\/978-3-031-34586-9_32"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13630","article-title":"The Sleep Revolution project: the concept and objectives","volume":"31","author":"Arnardottir","journal-title":"J Sleep Res"},{"issue":"5","key":"R36","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1177\/19322968211000815","article-title":"Randomized trial for weight loss using a digital therapeutic application","volume":"16","author":"Thorgeirsson","journal-title":"J Diabetes Sci Technol"},{"issue":"5","key":"R37","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1177\/1932296820942286","article-title":"A digital lifestyle program in outpatient treatment of type 2 diabetes: a randomized controlled study","volume":"15","author":"Hilmarsd\u00f3ttir","journal-title":"J Diabetes Sci Technol"},{"key":"R38","unstructured":"Willermark S Islind AS . Choice architecture, friend, or foe? Future designers perspective on the ethics of digital nudges. Presented at: Thirteenth Scandinavian Conference on Information Systems (SCIS2022); Aug 14-17, 2022; Helsinge, Denmark. URL: https:\/\/aisel.aisnet.org\/scis2022\/4\/ [Accessed 19-05-2026]"},{"key":"R39","unstructured":"The AASM manual for the scoring of sleep and associated events: summary of updates in version 2.5. American Academy of Sleep Medicine; 2018. URL: https:\/\/aasm.org\/wp-content\/uploads\/2018\/04\/Summary-of-Updates-in-v2.5-1.pdf [Accessed 19-05-2026]"},{"issue":"2","key":"R40","doi-asserted-by":"publisher","DOI":"10.1111\/jsr.13977","article-title":"Self-applied somnography: technical feasibility of electroencephalography and electro-oculography signal characteristics in sleep staging of suspected sleep-disordered adults","volume":"33","author":"Rusanen","journal-title":"J Sleep Res"},{"key":"R41","doi-asserted-by":"publisher","DOI":"10.1016\/j.sleep.2022.05.824","article-title":"Towards a digital sleep diary standard","volume":"100","author":"Schmitz","journal-title":"Sleep Med"},{"issue":"2","key":"R42","doi-asserted-by":"publisher","DOI":"10.1093\/sleepadvances\/zpaf021","article-title":"A performance validation of six commercial wrist-worn wearable sleep-tracking devices for sleep stage scoring compared to polysomnography","volume":"6","author":"Schyvens","journal-title":"Sleep Adv"},{"issue":"1","key":"R43","first-page":"71","volume":"32","author":"Kotsiantis","journal-title":"GESTS Int Trans Comput Sci Eng"},{"key":"R44","unstructured":"Agrawal R Mannila H Srikant R Toivonen H Verkamo AI . Fast discovery of association rules. In: Fayyad UM Piatetsky-Shapiro G Smyth P Smyth R , editors. Advances in Knowledge Discovery and Data Mining. American Association for Artificial Intelligence Press (AAAI Press); 1996:307-328. URL: https:\/\/www.cs.bme.hu\/~marti\/adatbanya\/apriori_hashtree.pdf [Accessed 05-06-2026]"},{"issue":"2","key":"R45","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1145\/253262.253327","article-title":"Beyond market baskets: generalizing association rules to correlations","volume":"26","author":"Brin","journal-title":"ACM SIGMOD Rec"},{"issue":"18","key":"R46","doi-asserted-by":"publisher","DOI":"10.3390\/diagnostics13182883","article-title":"Evaluating user compliance in mobile health apps: insights from a 90-day study using a digital sleep diary","volume":"13","author":"Kristbergsdottir","journal-title":"Diagnostics (Basel)"},{"key":"R47","doi-asserted-by":"crossref","unstructured":"Deci EL Ryan RM . Self-determination theory. In: Handbook of Theories of Social Psychology. Vol 1. SAGE Publications; 2012:416-437. [doi: 10.4135\/9781446249215.n21]","DOI":"10.4135\/9781446249215.n21"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e75358","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T22:27:04Z","timestamp":1785536824000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e75358"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,6]]},"references-count":47,"URL":"https:\/\/doi.org\/10.2196\/75358","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,6]]},"article-number":"v10i5e75358"}}