Beyond the breath count: patients want meaningful digital metrics in sleep apnoea monitoring

For non–positive airway pressure options such as mandibular advancement devices, structured monitoring and objective feedback are often lacking. By adopting a structured, patient-centric framework, we can develop digital tools that deliver meaningful, actionable insights for patients, clinicians, and healthcare systems.

The challenge: knowing whether sleep apnoea treatment is actually working

OSA is a chronic condition in which repeated breathing disruptions fragment sleep, leaving many people with non-restorative sleep, daytime sleepiness, fatigue, and cognitive difficulties, alongside increased long-term health risks. With close to one billion adults affected worldwide and prevalence rising, the need for effective monitoring and follow-up is growing.

For years, the clinical “gold standard” has been the AHI, but a single AHI value cannot fully reflect how patients feel and function, and the condition varies widely among individuals.

Positive airway pressure (PAP) therapy can generate detailed device readouts, yet they often still fall short of answering the practical question that patients and clinicians have: is treatment improving day-to-day health? For non-PAP therapies, such as mandibular advancement devices, hypoglossal nerve stimulation or positional therapy, objective monitoring is very limited or absent, so therapy adjustments and outcome assessment rely heavily on symptoms and trial-and-error based on subjective experience.

The study: measuring what matters

To bridge this gap, the Digital Biomarker Lab at TNO led a comprehensive mixed-methods study recently published in the Journal of Medical Internet Research. Using the Digital Medicine Society’s Digital Measures That Matter framework, the team started with a simple question: what does “meaningful health” look like for people living with OSA?

In an online survey of 223 people with a formal OSA diagnosis and persistent sleep problems, supported by interviews with patients, patient advocates, and healthcare professionals (n=11), participants consistently ranked lived experience above a single clinical metric. Nearly half set better sleep quality as a key health goal (46.5%). Daytime energy also stood out - both as something people want to regain (35.6%) and as an explicit health goal (25.5%). Many also prioritised physical activity, such as walking, cycling, and exercise (24.7% to restore; 16.5% as a health goal).

When asked what would make digital monitoring worthwhile, participants wanted three things: metrics beyond the Apnea–Hypopnea Index (AHI) (36.6%), better accuracy (20.4%), and outputs that are meaningful and understandable (18.3%) and actionable (9.2%). Overall, the findings point to sleep characteristics and daytime energy as priority targets for future digital measures, ideally captured through familiar wearables such as smartwatches, sleep mats, and smart rings. Crucially, the study reframes monitoring around outcomes that patients actually notice - restorative sleep, daytime energy, and daily functioning - providing clear targets for developing and validating digital measures that go beyond therapy mechanics and can be applied across treatment pathways.

From data to actionable insights

These preferences for familiar, non-invasive wearables matter for adoption: people are far more likely to use monitoring that fits into everyday life. However, the study also makes a practical point: data only help if patients can use them. Patients want monitoring that is clear and reassuring rather than overwhelming, with insights adapted to different levels of health literacy and interest - from an “at a glance” overview to deeper trends for those who want detail. Most importantly, patients want outputs that tell them whether they should seek follow-up care and what type of care would be appropriate.

What’s next?

Building on this work, TNO is running a study on digital monitoring for sleep apnea (in Dutch) as part of the care pathway at Zaans Medical Centre, continuing until June 2026. The study assesses the feasibility of at-home monitoring using two devices and an app and will explore which digital biomarkers are most meaningful after treatment initiation by linking objective signals with patient-reported experiences over time.

Are you a clinician, researcher, or industry partner working on remote monitoring? We gladly partner with you to identify what matters to patients and translate it into meaningful, actionable digital measures.