How fitness trackers could be used inpatient and outpatient to monitor medication effects

Iltifat Husain MD contributed to this piece

Mobile fitness trackers have made a huge splash in the past year with a large number of new devices released. While their initial benefit relates to the ability to track daily activities and daily caloric expenditures, the devices also offer added benefits.

One such matter is the ability to wear these devices during sleep, offering insight into a user’s sleep rhythm and a way to determine the quality of sleep had. While the mechanism is based solely on the idea that if a user is tossing, turning, and moving through the night, they must not be sleeping well, and not as in-depth of a sleep study, it does support a basic sleep assessment. With that being said, there may be an applicable way of using this beyond the outpatient setting.

Currently, my fiancee is sick with an upper respiratory infection. Her symptoms include cough, fever, malaise, and body aches. While normally active, she has seen a decrease in activity and complains of overall poor sleep. However, you don’t have to take her word for it. Since mid-December she has been using a Misfit Shine, which she wears on her wrist or around her neck and has been tracking her daily activities via the device.

Thus, I present some of her data, demonstrating some interesting measurements on her activity and her sleep pattern. I present first a sample, from last week, of a day where she was fairly active with time spent at the gym and a Zumba class. Note the activity tracker and the sleep component.

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Now, this past weekend she noted she was starting not to feel quite well, and by Wednesday was in the worst of it. As seen from the data tracker, there is a drop in activity, and no goals have been met. In addition, the output decreases, and sleep quality can be seen to have dramatically decreased as well. This is primarily due to fevers, chills, and the consistent racking cough that has been keeping us both up at night.

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So what can be made of this? On one hand, I know how bad she is doing through personal experience, but to see objective evidence puts it in another perspective. This is especially the case when she says she feels rotten and has not felt rested, and having actual data showing she is not sleeping.

This could be a beneficial tool in several regards. First off, can this data be used in some manner of clinical practice to help monitor patients for a significant change in normal activities that may signify some status change that needs to be addressed, such as acute sickness? Second, could this be a new way to conduct sleep studies upon further advancements?

Lastly, I think this may be a really beneficial way to track rest for inpatients. Staying in a hospital for a few nights is not a lovely endeavor, and often the rest is horrible. I remember my last stay of three nights and just crashing once I got home. Being awakened by assessments, medications, labs, as well as the bells and whistles of equipment (I am looking at you IV pump), and the hustle and bustle of staff do not make a constructive environment for a sick person to rest.

Patients tell us this, and often. As a team that is working off so much objective data collected to make therapeutic decisions, would it be beneficial to actually see their rest as well? If patients had a device tracking their rest, demonstrating they are not sleeping, should it not sound warning bells? This could especially be key for patients with histories of dementia or risk for delirium in certain hospital environments.

As a pharmacist, one angle I would be keen to see developed in future iterations of such devices would be centered on elderly patients. For instance, if a person is stating they are having difficulty with sleep, this may be beneficial to establish a baseline. Upon initiation of any medication for sleep management, it would then be possible to see the efficacy and if it is beneficial to continue. Lastly, for safety, the device could track any changes in gait, movement that is not in accordance with the baseline or any falls that become present that could then be related to an adverse drug event. This could be extended to even other medications that may pose some adverse effects, such as titration on antihypertensives. While far off, I see such technology as a way for healthcare professionals to track the impact of medications and issues that may become present to make significant interventions.

Nonetheless, it is an amazing time with the significant growth in mHealth technology, and I eagerly look forward to possible utilizations we have not been able to envision in the past.

Author:

Timothy Aungst, PharmD Follow Me

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