Evaluation of Physiological Signals in Wearable Assistive Technology to Detect Obstructive Sleep Apnea in Youth with Down Syndrome

Abstract

Obstructive sleep apnea is a condition experienced during sleep caused by complete or partial obstruction of the airways resulting in stopped breathing. Although uncommon in the paediatric general population, youth with Down syndrome are at a significantly higher risk of experiencing obstructive sleep apnea due to anatomic differences and underlying health complications. Sleep apnea can cause deleterious health effects including failure to thrive, cardiovascular complications, behaviour problems, and low daytime functioning levels in youth with Down syndrome. The primary goal of this research was to co-design a non-invasive, accessible, and wearable device that uses physiological signals to detect and monitor signs of obstructive sleep apnea in youth with Down syndrome.

To address the needs of an at-home, user-friendly wearable device, an iterative design process was employed. Building off a pilot study conducted to evaluate the accessibility of different physiological signal acquisition methods, a wearable prototype was developed. After initial testing and re-direction of the prototype, the use of photoplethysmography was selected for processing to identify and notify stopped breathing occurrences. A cross-sectional study was completed to validate the use of wavelet decomposition to characterize respiration and the results demonstrated reliability. To determine the wearability of the current prototype, a co-design session with individuals with Down syndrome and their caregivers took place. Youth with Down syndrome and their caregivers identified design requirements prior to device evaluation, as well as recommendations for future design iterations and identification of positive and negative design aspects.

This thesis provides an overview of the limitations in current gold-standard and commercially available wearable technology to detect obstructive sleep apnea in youth with Down syndrome. This understanding as well as results highlighted in this thesis demonstrate alternative methods to monitor breathing and well-being of youth with Down syndrome during sleep. With the prevalence of underlying health and heart comorbidities, detection of obstructive sleep apnea leading to early intervention can help preserve the cardiovascular health, cognitive abilities, and overall quality of life of individuals with Down syndrome and their families.