The Ethical Implications of Sleep Technology in Health Research

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The advancement in wearable sleep technology has greatly changed the way people sleep, especially in terms of health research and clinical practice efficiency. These include the Fitbit, Apple Watches, and other wearable technology available for purchase, where people are able to track their sleep, activity, and even their pulse. Such technologies are appreciated due to factors such as convenience, cost-efficiency, and the overtime accumulation of large amounts of data. However, despite the clear benefits that may be derived from the use of such tools, their application in health research is surrounded by a number of limitations in terms of ethics. These concerns are about data security and privacy, racism and technology, efficacy, and risks tied to applying non-industry-standard wearable consumer tech for health technologies. With sleep as a burgeoning health concern, it is time to collect and reflect on the ethics of such technologies to support health equity, security, and integrity of data.

Data Privacy and Consent

The first ethical consideration reflected in wearable sleep technology is evidently data privacy. Consumer sleep devices produce a huge volume of individual data about sleep patterns, HRV, and physical activity. Some of this data is very sensitive, particularly in conducting health research or in clinical practice. With this raise, an important area of concern, including the ownership of this data and how it will be processed and disseminated, emerges to become an important ethical question concerning wearable sleep technology.

Many wearable devices are still under the regulation of policies that provide maximum protection for the user. For instance, information gathered by wearables is frequently stored with the private companies instead of the doctors and medical practitioners. This throws into question consent, particularly where the data is passed on to third-party firms, used for promotional activities, or sold without the user’s direct permission. These devices usually come with long and complicated terms of service that most users do not go through and agree to the use of their data in what can be termed unethical.

Of all values to be upheld in health research, the principle of informed consent is among the most important. Users must be aware of how the data collected from them will be used, who has access to such data, and any possible consequences of providing personal health information. However, wearable devices distort this interface because the information that the devices are collecting is real-time, and often users may not be fully aware of the extent of monitor they are under. Lack of a well-defined structure for consent and data utilization can thereby provide an unstable ethical premise for health studies that involve wearables.

Racial and Technological Bias

Another major ethical consideration in sleep technology is the question of racially perpetrated design and functionality of wearable devices. Most of the consumer wearable devices apply the PPG, which works on the basis of the blood flow and other associated cardiovascular indices like heart rate. However, this technology is not that efficient when it comes to the darker shades of skin tones. Studies reveal that smart wearable devices are less precise when worn by people with dusky complexions, and this results in biased or erroneous health records for such a population.

This inherent bias has more general ethical considerations for health equity. Reporting that the devices underperformed specifically for individuals with darker skin tones while wearables are more often incorporated into health studies and trials, this can only widen the gap in care. For instance, in the case of race, a patient of that particular race may be diagnosed wrongly or receive substandard sleep health care since the data that was fed into that device was wrong. This is not merely a technical matter; it raises a fundamental ethical question concerning the manner in which the development of healthcare technology incorporates and responds to concerns of diversity, disability, and oppressed sexuality. Researchers and developers must pay attention to equity by making sure that wearable devices have been tested in different populations before being embraced for research.

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Accuracy and Reliability of Data

The reliability of consumer sleep tracking devices is yet another ethical issue that needs to be discussed. Although these devices are common, few are standardized to the level of clinical equipment such as PSG, which is considered the gold standard for the evaluation of sleep. The current literature reveals high variability in the accuracy of wearable devices to estimate some of the fundamental sleep parameters,  including total sleep time, sleep efficiency, and wake after sleep onset. Such inaccuracies are more dramatic in the patient populations with sleep disorders, including insomnia or obstructive sleep apnea.

From an ethical perspective, utilizing unstandardized instruments in health research means that the resulting data is not accurate, and this possibly has implications for patient care and the formulation of health care policies. It is dangerous to assume that these discoveries based on wrong wearable data are used to set up treatment protocols or health advice, especially for sleep problems. Scholars and academicians have such a duty of utilizing reliable data, and the devices employed should be tested against clinical methods. Otherwise, it may be possible to make incorrect conclusions about the state of the participants’ sleep and develop the wrong interventions.

Commercial Interests and Conflicts of Interest

Wearable sleep technology is usually perfected by private companies, and their goal is to make money, not to promote health. Applying such devices in health research leads to various conflicts of interest. This is because the algorithms that are relied on to make sense of data collected during sleep are occasionally patented, which possibly denies researchers or clinicians insight into how exactly the devices come up with their conclusions, as seen with some popular sleep monitoring devices. Of course, this lack of transparency can be a significant issue in the research process, which is based on the principles of replicability and scientific accuracy.

In addition, most wearable technology devices are promoted as easy, accurate tools of measuring health status, a factor that is not supported by research studies. Another issue of concern is that through the marketing of sleep devices, consumers may rely on technology by thinking that the device is giving accurate medical information. One drawback that exists regarding the use of devices for research is that different studies’ results may be colored by financial concerns that technology companies running the studies have, or researchers could be using devices made by different companies. Transparency and being free from any conflict of interest are some of the vital ethical concerns when incorporating the sleep technology in the health research.

The Impact on Health Behaviors and Self-Monitoring

The wearables, especially those tracking the amount of sleep, have resulted in self-monitoring, where individuals treat themselves based on the results provided by the gadgets. This trend, although it holds the possibility to increase the level of health literacy and patient-centered control, might be ethically questionable.

For some, tracking can bring anxiety and a culmination of an unhealthy interest and preoccupation with sleep data as a result of tracking it every night—orthosomnia. For instance, orthosomnia is a term used to refer to a situation in which people get overly concerned with getting the ‘perfect’ sleep according to the included metrics of wearable devices. Their fatal attraction to numbers and metrics can be counterproductive as it contributes to stress and a worse night’s sleep. Health researchers and clinicians thus have to be cautious regarding these effects in their recommendations for wearable devices so as to avert negative impacts of the technology.

Also, the information that can be collected with consumer sleep trackers may not necessarily be of medical interest while the user associates it with valuable medical data. They are at times able to misunderstand what the data is stating concerning their health, hence leading to poor decision-making if not guided by healthcare professionals. This could lead to more elaborate testing and diagnosis and even more treatment, which is not always required, or safety on the other side about the health status. In order to minimize the adverse effects on people’s health, it is very important to make the people realize the limitations of their gadgets.

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The Ethical Use of Big Data

Fitness trackers gather large quantities of information over long hours, which is valuable in the continually growing subject of big data. This generates some ethical concern about how such data is utilized, especially in health-related research. The value of analytics in big data is in the capacity to examine population health trends and develop personalized treatments. However, big data also has its disadvantages, and they are felt especially where issues of data security and privacy are concerned.

However, there are several worries as it pertains to the anonymization of data gathered from the use of wearables. However, it is worth noting that even if data is anonymized at times, re-identification of the data is possible by combining it with other datasets. They posit that big data applications in health research should be subjected to high ethical standards in order to prevent violations of individuals’s privacy and unauthorized use of their data.

Also, the accumulation of aggregate information from the wearable technologies has to be done carefully so that it does not reinforce current bias. For instance, data collected may be coming from specific demographics or a restricted area only, which may indicate results that do not depict the whole population. One way of making sure that the data sets the researcher uses are not unethical is to make sure that the data sets used are diverse and representative.

Conclusion

While wearables for sleep are still spaces for innovation in health and clinical practice, these technologies have considerable ethical points that require attention. Concerns of data privacy, race, bias, accuracy, and performance, as well as the impact of these technologies from commercial aspects, should be looked at very keenly to ensure that they are not misused whenever they are implemented. Finally, there are the psychological issues related to self-monitoring and the handling of big data that also have several ethical considerations that ought to be considered keenly.

Lastly, the use of wearable sleep technology in the field of health research should encourage health improvement and also enhance scientific knowledge without violating ethical benchmarks. But when researchers and clinicians approach such applications with careful consideration of how they could harm or help the populations trying to attain equality and respect, new technologies can unlock humankind’s potential in medicine, education, and social justice.

References

  1. Colvonen, P.J., DeYoung, P.N., Bosompra, N.O.A. and Owens, R.L., 2020. Limiting racial disparities and bias for wearable devices in health science research. Sleep, 43(10), p.zsaa159.
  2. Menghini, L., Cellini, N., Goldstone, A., Baker, F.C. and de Zambotti, M., 2021. A standardized framework for testing the performance of sleep-tracking technology: step-by-step guidelines and open-source code. Sleep, 44(2), p.zsaa170.
  3. Kahawage, P., Jumabhoy, R., Hamill, K., de Zambotti, M. and Drummond, S.P., 2020. Validity, potential clinical utility, and comparison of consumer and research‐grade activity trackers in Insomnia Disorder I: In‐lab validation against polysomnography. Journal of sleep research, 29(1), p.e12931.
  4. Moreno-Pino, F., Porras-Segovia, A., López-Esteban, P., Artés, A. and Baca-García, E., 2019. Validation of Fitbit Charge 2 and Fitbit Alta HR against polysomnography for assessing sleep in adults with obstructive sleep apnea. Journal of Clinical Sleep Medicine, 15(11), pp.1645-1653.
  5. Depner, C.M., Cheng, P.C., Devine, J.K., Khosla, S., De Zambotti, M., Robillard, R., Vakulin, A. and Drummond, S.P., 2020. Wearable technologies for developing sleep and circadian biomarkers: a summary of workshop discussions. sleep, 43(2), p.zsz254.
  6. Haghayegh, S., Khoshnevis, S., Smolensky, M.H., Diller, K.R. and Castriotta, R.J., 2019. Accuracy of wristband Fitbit models in assessing sleep: systematic review and meta-analysis. Journal of medical Internet research, 21(11), p.e16273.
  7. Schade, M.M., Bauer, C.E., Murray, B.R., Gahan, L., Doheny, E.P., Kilroy, H., Zaffaroni, A. and Montgomery-Downs, H.E., 2019. Sleep validity of a non-contact bedside movement and respiration-sensing device. Journal of Clinical Sleep Medicine, 15(7), pp.1051-1061.

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