{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T07:59:27Z","timestamp":1771919967056,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,15]],"date-time":"2026-02-15T00:00:00Z","timestamp":1771113600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["1R41DA056276-01"],"award-info":[{"award-number":["1R41DA056276-01"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>The shoulder may be an effective central site for continuous oxygen saturation (SpO2) monitoring but studies of shoulder-mounted pulse oximetry technology are limited. We hypothesized that an alternative location would be similar in function and user acceptance to a standard FDA-cleared finger-based pulse oximeter. We conducted a quantitative and descriptive pilot study of two prototype biosensor designs in patients with clinical suspicion of hypoxic episodes at an outpatient sleep center. Participants wore two prototype biosensors\u2014the primary a shoulder-mounted adhesive and the secondary a combination ring\u2013bracelet\u2014in addition to a control FDA-approved finger-based pulse oximeter. We assessed the comfort of the devices based on a survey. We monitored 27 patients during an overnight polysomnography study. Participants rated the shoulder-mounted device more highly than the control device on a Likert scale survey of comfort (4.6 out of 5 versus 3.1 out of 5). Open-ended questionnaires showed that the two major criticisms of the control and ring devices were devices falling off and disruption to sleep, while only one participant commented on the shoulder device specifically. We also investigated SpO2 agreement between the primary shoulder-mounted prototype and the control finger-based pulse oximeter. This study confirms that alternative configurations for SpO2 monitoring offer potential as well-tolerated devices with preliminary findings of acceptable agreement. Problems with traditional pulse oximetry, such as false readings of hypoxia due to device removal or noisy data, were encountered less frequently in shoulder-mounted pulse oximetry than in the commercial finger-based device. Future directions include studies of additional populations that are at risk of respiratory collapse and surveys to elicit specific feedback on the configurations, whether positive or negative.<\/jats:p>","DOI":"10.3390\/s26041276","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:38:39Z","timestamp":1771231119000},"page":"1276","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Feasibility and Form Factor Validation of Reflective Shoulder-Mounted Pulse Oximeter in Patients with Suspected Sleep Apnea"],"prefix":"10.3390","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5778-9984","authenticated-orcid":false,"given":"Katie N.","family":"Kanter","sequence":"first","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-1926-8561","authenticated-orcid":false,"given":"Aaron","family":"Wang","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9557-7405","authenticated-orcid":false,"given":"David","family":"Gordon","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, 1025 Walnut St #100, Philadelphia, PA 19107, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adina","family":"Singer","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8437-0161","authenticated-orcid":false,"given":"Jacob S.","family":"Brenner","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6889-399X","authenticated-orcid":false,"given":"Indira","family":"Gurubhagavatula","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8438-6104","authenticated-orcid":false,"given":"Anush","family":"Lingamoorthy","sequence":"additional","affiliation":[{"name":"College of Electrical Engineering, Drexel University, 3141 Chestnut St, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olumuyiwa","family":"Oni","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0124-1415","authenticated-orcid":false,"given":"Cameron M.","family":"Baston","sequence":"additional","affiliation":[{"name":"Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA 19104, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Alberto, R., Draicchio, F., Varrecchia, T., Silvetti, A., and Iavicoli, S. (2018). Wearable Monitoring Devices for Biomechanical Risk Assessment at Work: Current Status and Future Challenges-A Systematic Review. Int. J. Environ. Res. Public Health, 15.","DOI":"10.3390\/ijerph15092001"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"125817","DOI":"10.1016\/j.talanta.2024.125817","article-title":"Recent advances in smart wearable sensors for continuous human health monitoring","volume":"272","author":"Kulkarni","year":"2024","journal-title":"Talanta"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"111374","DOI":"10.1016\/j.jclinane.2024.111374","article-title":"Role of continuous pulse oximetry and capnography monitoring in the prevention of postoperative respiratory failure, postoperative opioid-induced respiratory depression and adverse outcomes on hospital wards: A systematic review and meta-analysis","volume":"94","author":"Khanna","year":"2024","journal-title":"J. Clin. Anesth."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e40389","DOI":"10.2196\/40389","article-title":"Overdose Alert and Response Technologies: State-of-the-art Review","volume":"25","author":"Oteo","year":"2023","journal-title":"J. Med. Internet Res."},{"key":"ref_5","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":"Kapur","year":"2017","journal-title":"J. Clin. Sleep Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e2302752","DOI":"10.1002\/advs.202302752","article-title":"Recent Progress in Flexible and Wearable All Organic Photoplethysmography Sensors for SpO2 Monitoring","volume":"10","author":"Dcosta","year":"2023","journal-title":"Adv. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"May, J.M., Phillips, J.P., Fitchat, T., Ramaswamy, S., Snidvongs, S., and Kyriacou, P.A. (2019). A Novel Photoplethysmography Sensor for Vital Signs Monitoring from the Human Trachea. Biosensors, 9.","DOI":"10.3390\/bios9040119"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1007\/s00246-007-9105-z","article-title":"Reliability of a single pulse oximetry reading as a screening test for congenital heart disease in otherwise asymptomatic newborn infants: The importance of human factors","volume":"29","author":"Reich","year":"2008","journal-title":"Pediatr. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"504","DOI":"10.55730\/1300-0144.5610","article-title":"A prospective study for an alternative probe site for pulse oximetry measurement in male patients with severe burn trauma: Penile shaf","volume":"53","author":"Keskin","year":"2023","journal-title":"Turk. J. Med. Sci."},{"key":"ref_10","unstructured":"(2026, February 02). Opioid HaloTM Opioid Overdose Prevention & Alert System. Available online: https:\/\/www.mymasimo.com\/products\/opioid-halo\/."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1186\/s13054-015-0984-8","article-title":"Pulse oximetry","volume":"19","author":"Jubran","year":"2015","journal-title":"Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"22663","DOI":"10.1038\/s41598-021-01990-0","article-title":"Closed-loop wearable naloxone injector system","volume":"11","author":"Chan","year":"2021","journal-title":"Scientific Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1177\/0194599813504074","article-title":"Obstructive sleep apnea: Strategies for minimizing liability and enhancing patient safety","volume":"149","author":"Svider","year":"2013","journal-title":"Otolaryngol.\u2014Head Neck Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"24513","DOI":"10.1038\/s41598-021-04094-x","article-title":"Hypoxia driven opioid targeted automated device for overdose rescue","volume":"11","author":"Imtiaz","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1186\/s12954-021-00522-3","article-title":"Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia","volume":"18","author":"Kanter","year":"2021","journal-title":"Harm Reduct. J."},{"key":"ref_16","unstructured":"Lingamoorthy, A., Watson, A., Donlon, E., Weimer, J., and Brenner, J.S. (2022). DOVE: Noninvasive Shoulder-based Opioid Overdose Detection Device. Proceedings of the 2022 IEEE\/ACM Conference on Connected Health: Applications, Systems and Engineering Technologies (CHASE), Arlington, VA, USA, 17\u201319 November 2022, IEEE."},{"key":"ref_17","unstructured":"(2024, December 30). FDA Executive Summary: Performance Evaluation of Pulse Oximeters Taking into Consideration Skin Pigmentation, Race, and Ethnicity, Available online: https:\/\/www.fda.gov\/media\/175828\/download."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1213\/ANE.0000000000000841","article-title":"Perioperative Complications in Obstructive Sleep Apnea Patients Undergoing Surgery: A Review of the Legal Literature","volume":"122","author":"Fouladpour","year":"2016","journal-title":"Anesth. Analg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Elgendi, M. (2016). Optimal signal quality index for photoplethysmogram signals. Bioengineering, 3.","DOI":"10.3390\/bioengineering3040021"}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/4\/1276\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T05:12:28Z","timestamp":1771909948000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/26\/4\/1276"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,15]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["s26041276"],"URL":"https:\/\/doi.org\/10.3390\/s26041276","relation":{},"ISSN":["1424-8220"],"issn-type":[{"value":"1424-8220","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,15]]}}}