A wearable-based pathway for characterizing COMISA, Insomnia, and OSA: a feasibility study in a community hospital

Comorbid insomnia and obstructive sleep apnea (COMISA) – the co-occurrence of both disorders – is associated with greater morbidity and is underdiagnosed in fragmented care outside sleep centers. This study examined the feasibility of using an AI-powered wearable device, the Belun Ring (BR), to characterize COMISA, insomnia, and obstructive sleep apnea (OSA) in a community hospital setting. Consecutive new patients undergoing baseline diagnostic evaluation were classified as having OSA if AHI ≥ 15, as insomnia when met ICSD-3 clinical criteria or ISI ≥ 15 pragmatically when interview data were inconclusive.

Diagnosed COMISA if both conditions were present. Participants completed at least 3 nights of BR assessment with sleep architecture, respiratory metrics, and pulse rate variability compared using nonparametric tests, regression analyses, and principal component analysis. Among 96 participants (13 COMISA, 47 insomnia, 36 OSA), COMISA and insomnia showed longer sleep onset latency, greater wake after sleep onset (WASO), and more awakenings than OSA, while AHI was higher in OSA and COMISA.

In the prespecified primary non-AHI multinomial model, sleep efficiency, REM, total sleep time, and WASO retained discriminatory information. A supportive robustness model replacing AHI metrics with BR-derived hypoxic burden improved model fit. Multi-night wearable monitoring may complement group-level phenotype characterization and early triage in real-world sleep services.

No funding was received for this research. Department of Medicine and Rehabilitation, Tung Wah Eastern Hospital, Hong Kong, China Department of Clinical Psychology, Tung Wah Eastern Hospital, Hong Kong, China Belun Technology Company Limited, Hong Kong, China Chih-Wei Tsai, Lydia Leung & Cynthia Cheung Department of Clinical Psychology, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China All procedures performed in studies involving human participants were in accordance with the ethical standards of the institution (Hospital Authority Central Institutional Review Board) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Betty Hai Ka Young purchased Belun Ring devices from Belun Technology Company Limited for clinical use at Tung Wah Eastern Hospital. Lydia Leung, Cynthia Cheung, and Chih-Wei Tsai are employees of Belun Technology Company Limited. Authors affiliated with Belun Technology contributed to study conceptualization, methodology, and formal statistical analysis.

Clinical investigators at Tung Wah Eastern Hospital were responsible for patient evaluation, clinical classification, and data collection. The results were reviewed and interpreted by the author group as a whole. No external funding was received for this work.