In February, I presented at an educational conference of the American Academy of Sleep Medicine. After my talk I met sleep physician Dr. Clifford Molin who has developed ZeeAppnea, an app that utilizes a smartphone to provide a ubiquitous way of determining sleep apnea risk. The app does not require special equipment, but rather utilizes standard earbuds with a microphone. It is important to emphasize that ZeeAppnea is not a diagnostic tool, but rather a screening tool to determine sleep apnea risk.
Shiv Gaglani, Medgadget: How did you come up with the idea for Zee Appnea?
Dr. Clifford Molin: The idea for this App actually occurred after downloading another App that demonstrated the functionality of existing sensors available in smartphones. One of the sensors available was a decibel meter that displayed the sound amplitude in a waveform tracing. Being a sleep physician interested in breathing problems I was curious to see if I could emulate sleep breathing patterns using the App on the smartphone. What appeared was a pattern of breathing that was consistent and reproducible. I was then able to reproduce on the smartphone abnormal breathing patterns that can only be demonstrated while doing an actual sleep study in the sleep lab.
The need for such an App, became clear to me after seeing one woman after the next coming in to the sleep clinic armed with a smartphone recording and with their significant other (the prospective patient) in tow. The smartphone recording demonstrated snoring and then a prolonged period of silence. What was being captured was sleep apnea. With this evidence in hand the bed partner had no choice but to agree to a sleep evaluation. The App could provide a more sophisticated and objective risk assessment tool than a crude recording of snoring.
Medgadget: Can you describe the current problem?
Dr. Molin: Currently 80% of individuals with sleep apnea are undiagnosed. A simple objective screening tool is essential to increase awareness of this disorder and encourage further evaluation. Sleep apnea symptoms like snoring and pausing to breath occur while sleeping, so are not evident to the sufferer.
ZeeAppnea helps reinforce the fact that the problem is real and quantifiable by providing actual displays of sleep breathing pauses generated by the smartphone recording.
The ultimate hope is that ZeeAppnea App, will provide a simple way, to objectively identify sleep apnea risk, so those suffering from this disorder can be identified and treated in an expeditious fashion.
Medgadget: Have you been able to validate the app?
Dr. Molin: The App has been internally validated by comparing formal sleep studies that are performed in the lab with the analysis from the smartphone. Over 85 App studies have been subsequently validated with a traditional sleep study. The results have been surprisingly consistent, demonstrating that the App recording is an excellent screening tool for determining sleep apnea risk.
Medgadget: How does this compare to other apps/devices on the market?
Dr. Molin: There are no other Apps for sleep apnea that are comparable. Apps currently on the App store record snoring and use this as a surrogate indicator of sleep apnea. ZeeAppnea actually records real breath-by-breath patterns and can effectively demonstrate breathing pauses.
Medgadget: Can you describe the process you went through to create the app?
Dr. Molin: Building a prototype and creating a functional and reliable app are two very different things. As with most things the devil is in the details. And those details come to the surface day-by-day and week-by-week as the App gets tested and deployed. It has taken many iterations of rebuilding to get an App that will work on multiple phones across multiple networks and operating systems.
The unforeseen glitches and bugs can be overwhelming and very often are only demonstrated when real users attempt to utilize the App in a variety of ways and situations.
Most of the bugs have been ironed out creating a relatively robust App that can withstand most user fallibilities, utilizing almost any phone on any network.
But the process of improving the App remains a never-ending process of development and redevelopment.
Medgadget: Do you have any advice for other people looking to develop health apps?
Dr. Molin: The current smartphone technology with the myriad of built in sensors and relatively cheap development cost, is just waiting for application development. It is important to understand the built in smartphone sensor technology and then figure out how to utilize the sensors in ways that can make tasks that where once only possible with sophisticated customized devices relatively simple and cheap to reproduce on a smartphone.3
Product page: Zee AppNea…