
The Apple Watch can detect hypertension and sleep apnea, a new study suggests - helloworld
https://techcrunch.com/2017/11/13/the-apple-watch-can-accurately-detect-detect-hypertension-and-sleep-apnea-a-new-study-suggests/
======
smnscu
The only downside to the Apple Watch in my book is the short battery life
which should theoretically make it impractical for sleep tracking.

I was recently stupefied to discover Nokia Steel [1] and how virtually unknown
it is to the general public, my former self included. It comes with great
design, no bullshit digital screen, the usual tracking features, and most
importantly seems like it's a return to form for Nokia, considering their
country's outstanding design heritage.

edit: lol I forgot to mention the best part. THE BATTERY LASTS EIGHT MONTHS

1:
[https://health.nokia.com/es/en/steel](https://health.nokia.com/es/en/steel)

~~~
carlmcqueen
This perception of low battery life has really lasted from the first apple
watch. It was the reason, along with that it wasn't water proof enough for me,
that I didn't get the first one.

I wear my apple watch 2 all day, sleep in it, and charge it in the time I'm
getting ready in the morning. that's all it needs and it never runs out of
battery.

~~~
givinguflac
I completely agree; I wore my watch series 3 (no cell) all day yesterday,
tracked sleep last night, and this morning I still have 65% battery left. I
quick charge while I shower in the morning is all it's needed and I'm blown
away by how long it lasts. (I had a Pebble Time previously.)

~~~
passivepinetree
I also have a Series 3. What app do you use to track sleep?

I'm using AutoSleep, but it seems to really overestimate the time I'm actually
asleep, and as far as I can tell it doesn't take into account tossing/turning
during the night (either that, or I'm getting way better sleep than I think
I'm getting).

~~~
skygazer
You can tweak its sensitivity +/\- dramatically, even for the past night, in
the Tweak tab in the app. That did it for me.

~~~
passivepinetree
I'll try that. Thanks for the tip!

------
downandout
I'm skeptical about the accuracy of applications like this running on Apple
Watch. I bought the Apple Watch Series 3 precisely because of articles like
this. I now routinely get messages about how I've achieved my standing goal -
while lying in bed watching TV or working on my laptop. If it can't accurately
tell whether you're lying down or standing, it is unimaginable to me that it
could be remotely accurate in detecting far more complex conditions.

~~~
doikor
> I now routinely get messages about how I've achieved my standing goal -
> while lying in bed watching TV or working on my laptop.

I routinely get messages about having to stand up while standing up on my
standing desk at work. (Series 2 here)

~~~
013a
Apple calling it a "standing goal" is a misnomer. Its more of a walking goal.
I'm pretty confident that they're actually looking for 1 minute of consistent
steps every hour.

~~~
dkonofalski
It doesn't have to be walking. It needs to be one minute of movement in a
standing position. You can do jumping jacks or walk in place and it counts.

------
justinjlynn
Danger, danger: heavily regulated waters ahead! Remember these words well:
"This statement has not been evaluated by the Food and Drug Administration.
This product is not intended to diagnose, treat, cure, or prevent any
disease."

~~~
omginternets
I came to say "danger, danger" but for another reason.

I think a whole generation of fitbit users are going to be horrified when
their insurance premiums go up based on data that was purchased by insurers.
If Apple watch starts making a health play, I don't see why it would be any
different.

~~~
brandonb
(I'm a study author and worked on HealthCare.gov rescue team)

The good news is you're protected by the law. Under the Affordable Care Act,
insurers can only vary your rate based on your age, location, and whether you
smoke. They can't take into account prior health conditions or biomarkers,
including novel biomarkers measured on wearables.

Every major Republican "repeal & replace" bill has preserved this part of the
law, called "rating factor limitations", although sometimes they vary the
constants. For example, the Paul Ryan plan let insurers charge the elderly 5x
more than the young, compared to the current law of 3x, but otherwise
preserved the rule that insurers can only vary rate based on age, location,
and whether you smoke.

What insurers can do is offer you a 30% (maximum) premium rebate for taking
healthy actions, like going for a run, enrolling in a diabetes prevention
program, or getting your blood pressure checked. But they can't tie the rebate
to the outcome of the test (health status), only your participation.

This is a good point, though, and shows a case where regulation helps
technology have a positive impact. If people fear their insurance premiums
will go up, they'll avoid all forms of diagnosis, not just Apple Watch.

~~~
moe
_They can 't take into account prior health conditions or biomarkers,
including novel biomarkers measured on wearables._

Yet.

------
brandonb
I'm one of the co-founders of Cardiogram and involved in this study -- happy
to answer questions if folks have them!

(EDIT: heading to bed, but will answer questions in the morning!)

~~~
ISL
I didn't see a reference in the TechCrunch article -- is there a technical
paper out?

Edit: A presentation is linked, as "study":

Link to presentation:
[http://www.abstractsonline.com/pp8/#!/4412/presentation/4522...](http://www.abstractsonline.com/pp8/#!/4412/presentation/45220)

A followup: Does the neural network provide some extra insight into what part
of the waveform/time-series of pulses is able to provide predictive
information?

~~~
brandonb
Correct -- the abstract will be included in a special issue of Circulation:
[http://circ.ahajournals.org/content/136/Suppl_1/A21042](http://circ.ahajournals.org/content/136/Suppl_1/A21042)

The study was presented at the American Heart Association's Scientific
Sessions earlier today. We included some details beyond what appears in the
TechCrunch article in a blog post here: [https://blog.cardiogr.am/screening-
for-hypertension-and-slee...](https://blog.cardiogr.am/screening-for-
hypertension-and-sleep-apnea-with-deepheart-416c9bc03efc)

I'd expect a more mature version of this work to appear in a medical journal,
but that often takes 6-12 extra months.

~~~
ktta
Couldn't find the measurement process.

What is the common root cause of error? Inaccuracies in measurement or the
model classifying data incorrectly?

------
demomode
As someone with diagnosed apnea I have so many doubts about this.

Machines to diagnose apnea have lots of sensors including electrodes, "chest-
band" pulsometers, and "saturationmeters". I have asked doctors about
capabilities of smart devices for apnea control or detection, all I got was
laughs.

Sorry but I think this is not true. Go and see your doctor.

~~~
PierceJoy
> Machines to diagnose apnea have lots of sensors including electrodes,
> "chest-band" pulsometers, and "saturationmeters".

It seems like a fallacy to claim that since diagnosis required complicated
equipment in the past, that it will be necessary going forward. Machine
learning is going to make tons of current diagnostic equipment look archaic in
comparison.

> I have asked doctors about capabilities of smart devices for apnea control
> or detection, all I got was laughs.

Medical doctors are rarely up to date on the latest technology. I wouldn't be
surprised if my doctor has never heard the term machine learning before in his
life.

Also, their livelihood kind of depends on this technology not being available.
Just food for thought.

~~~
demomode
> It seems like a fallacy to claim that since diagnosis required complicated
> equipment in the past, that it will be necessary going forward. Machine
> learning is going to make tons of current diagnostic equipment look archaic
> in comparison.

As someone sais below "ML is not going to replace raw input from sensors."

> Medical doctors are rarely up to date on the latest technology. I wouldn't
> be surprised if my doctor has never heard the term machine learning before
> in his life.

Current dignose equipament is big, invasive and unconfortable; often they
require you to stay one night at the hospital.

There are tests programs about using those devices to replace current tech
(obvious reasons: less costs, less invasive tests, subject owns the hardware…)

This kind of procedures are not used because "doctors are old and non-tech
people", it's because it's not working.

Sure, apps and smart devices could replace some day those devices but they
need more and accurate sensors. Extrapolation of data from a good-enough pulse
rate sensor it's not a replacement.

~~~
dkonofalski
While I understand and mostly agree with your general sentiment, I think
you're downplaying the extent of how valuable the machine learning is in this
process. The reason why we need all these sensors and machines currently is
because we need a reasonable picture of how all that data works together so
that a _human being_ can look at that picture as a whole and make some
deductions.

This isn't the first time or the last time that computers have been able to
find patterns in much simpler measurements simply because they're not human. A
similar example, although not quite as advanced, is the ability for a computer
to extract sound information from a black and white video. Computers have been
able to recreate sounds from behind double-paned glass by analyzing vibrations
captured through videos. Humans have had to rely on various arrays of lasers,
sonar, and other directional instruments to get 1/10th of the accuracy that a
computer algorithm has been able to achieve from a simple, low-quality video
camera. The point is that more machines and sensors doesn't always equal a
better diagnosis. Better analysis of existing sensors and tech, even if it
seems to be lower fidelity, _can_ actually yield more accurate results.

------
kevinherron
I went to sleep wearing my Apple Watch one night and awoke to a few hundred
irregular heartbeat notifications.

They weren’t legit. The watch just can’t get a good heart rate reading if it’s
not situated perfectly on your wrist, and while sleeping it was pushed one way
or another often enough to be useless.

~~~
jads
That's probably the case with all HR monitors, no? If it's not securely in
place, any HR monitor will have the same problem. I bought a knock-off velcro
wrist strap for my watch and it keeps it in place. I have mixed success with
traditional watch straps as my wrist size always seems to be in-between
notches.

~~~
kevinherron
All the optical wrist-based ones, probably.

I imagine if I wore my chest strap monitor I'd have better results as long as
I put some kind of jelly on the electrodes to make up for the lack of sweat
through the night.

------
janaagaard
Interesting, but are people really sleeping with their Apple Watch on? I don't
you need to charge it every night?

~~~
pdn
You are overestimating how long it takes to charge an Apple Watch and
underestimating the battery. 30-45 minutes while you're showering and having
breakfast is enough.

------
arikr
Does anyone know how we can use this today?

~~~
brandonb
Good question—this clinical validation study is a first, necessary step to
prove that this technology is accurate enough to be used in a real-world
setting, but the research study alone is a milestone rather than the end goal.

We're now working on implementing care pathways within the Cardiogram app. If
all goes well, you should hear something from us in the next few months.

(In general, a digital health startup requires more patience than most other
types of startups: you need to run rigorous, IRB-approved clinical studies to
prove the technology really works; work with health systems and insurers
rigorously show health economics; and comply with applicable regulations like
HIPAA and FDA. There are just a lot of details to think through.)

~~~
arikr
Okay. Any way for me to get updates on when it's available for use?

~~~
brandonb
It'll appear directly in the Cardiogram app. (Would you personally find it
helpful to have another mechanism, like a mailing list?)

~~~
arikr
Yeah. Don't have an Apple watch but if it can detect sleep apnea or other
issues, I'd consider buying one for my partner. Mailing list would be ideal.

------
benevol
It's quite interesting - the way we have evolved as a society has completely
broken the link between "us and our body". We have stopped listening to it a
long time ago. If we really listened to our bodies, we wouldn't
eat/drink/consume stuff we don't need, we wouldn't be overweight, and we'd
rapidly be aware of any health-related imbalance which needs restoring.

But no, we forget our original (and free-of-charge) way of functioning and
desperately turn to commercial and unnatural solutions.

As a start, I recommend looking into the mindful meditation technique,
championed by pioneers like John Kabat-Zinn.

~~~
ryan-allen
Hypertension presents no symptoms and left undiagnosed can lead to kidney
failure. It's often referred to by doctors as 'the silent killer', and you
don't need to eat like shit and be fat to have it.

Going to your GP 2-3 times a year and getting your blood pressure checked (and
your blood tested for the 'regular stuff') solves the problem. 'Listening to
your body' pseudoscience doesn't really solve the problem.

~~~
jen729w
When I had a medical test for my Australian permanent residency - full thorax
x-ray, HIV test, the works - I asked the doctor doing the final once-over if
"a routine checkup" is something I should be doing.

He asked me how old I was. 30-ish, at the time. He asked me if I felt healthy.
Yep.

He said no, don't bother.

~~~
ryan-allen
It goes against typical advice, then.

Or don't do it, maybe you'll develop cancer and not find out until it's too
late!

EDIT: It's also free to go to the doctors in Australia so at least go once a
year and do your routine bloods. Abnormalities can catch things before they
progress too far that you have worse outcomes. You're paying for Medicare, use
it! :)

~~~
astura
The "annual physical" is not evidence based. It might seem to "make sense,"
however, that's not how science works.

Not only that but there's no such thing as "routine bloods." The reason I say
that is because 1) to my knowledge there's no evidence based group that
recommends any sort of blood test annually and 2)I have been to many GPs over
my lifetime (~10?) and I was well into my 30s until I saw one that ordered
routine bloodwork as a matter or course. All the ones before that just
listened to my heart, took vitals, felt organs, etc. Then that doctor retired
and I her replacement also ordered routine bloodwork. The two doctors differed
greatly on which test they considered routine.

[https://sciencebasedmedicine.org/re-thinking-the-annual-
phys...](https://sciencebasedmedicine.org/re-thinking-the-annual-physical/)

>Not too long ago, the “if it ain’t broke don’t fix it” mindset changed. It
became customary for everyone to have a yearly checkup with a doctor even if
they were feeling perfectly well. The doctor would look in your eyes, ears and
mouth, listen to your heart and lungs with a stethoscope and poke and prod
other parts of your anatomy. He would do several routine tests, perhaps a
blood count, urinalysis, EKG, chest-x-ray and TB tine test. There was even an
“executive physical” based on the concept that more is better if you can
afford it. Perhaps the need for maintenance of cars had an influence: the
annual physical was analogous to the 30,000 mile checkup on your vehicle. The
assumption was that this process would find and fix any problems and insure
that any disease process would be detected at an early stage where earlier
treatment would improve final outcomes. It would keep your body running like a
well-tuned engine and possibly save your life.

>We have gradually come to realize that the routine physical did little or
nothing to improve health outcomes and was largely a waste of time and money.
Today the emphasis is on identifying factors that can be altered to improve
outcomes. We are even seeing articles in the popular press telling the public
that no medical group advises annual checkups for healthy adults. If patients
see their doctor only when they have symptoms, the doctor can take advantage
of those visits to update vaccinations and any indicated screening tests.

>The physical exam of a healthy, asymptomatic adult is unlikely to reveal any
significant abnormality (1) that would not have been detected eventually when
symptoms developed and (2) whose earlier detection and treatment would reduce
morbidity and mortality in the long run.

>A directed physical exam is sometimes indicated in patients with risk factors
for specific conditions. A Pap smear is indicated in most women, but not every
year, and the accompanying pelvic exam is likely a waste of time.

>For healthy adults between the ages of 18 and 65, The American Academy of
Family Physicians (AAFP) recommends only these components of the traditional
physical exam:

>For men, a blood pressure measurement. >For women, a blood pressure
measurement and a periodic Pap smear.

>They have other recommendations including vaccinations, counseling, and
screening tests; but none of those require a physical exam.

>There is a general perception, among the public and among doctors, that
there’s no such thing as a bad screening test, that early detection is
important, that knowing is always better than not knowing. If something is
wrong with you, you need to know because, if you find a problem in time, it
can be treated effectively to prevent morbidity and mortality. If you get a
checkup and everything looks OK, you can breathe a sigh of relief and relax.
Unfortunately this is all wrong.

>A recent book explains why: Overdiagnosed: Making People Sick in the Pursuit
of Health, by Drs. H. Gilbert Welch, Lisa M. Schwartz, and Steven Woloshin.
It’s a comprehensive explanation of how test results make people sick and why
visiting a doctor can be hazardous to your health.

>For a healthy, asymptomatic patient, the physical exam with the laying on of
hands and stethoscope and other rituals is pretty much meaningless. If nothing
is found, it can produce false reassurance. If something is found, it is not
likely to prolong the patient’s life and it has a significant likelihood of
leading to harm from unnecessary treatment or from a diagnostic cascade of
tests, unnecessary surgeries, unnecessary expense, and unnecessary worry.

[https://sciencebasedmedicine.org/a-skeptical-look-at-
screeni...](https://sciencebasedmedicine.org/a-skeptical-look-at-screening-
tests/)

[https://sciencebasedmedicine.org/overdiagnosis/](https://sciencebasedmedicine.org/overdiagnosis/)

------
edejong
97% accuracy seems high, but with an approximate sales number of 10 million
Apple watches, it will give 300 thousand users an incorrect diagnosis.

~~~
outworlder
Which is not so bad. They can follow up and figure it out.

Some people will go for decades before getting a proper diagnostic - or even
die before they get one.

~~~
edejong
Unfortunately, most arrhythmias are benign and do not lead to further
treatment from a physician. So you are taking 300,000 worried people wrongly
to a general practitioner, who in fact can do nothing but write down the event
and perhaps correlate it with other data.

~~~
vidarh
It's worth always keeping this in mind, and not just taking extra worried
people to the gp, but also giving unwarranted peace of mind to those who have
a problem.

Even just having them get in a car and go to their GP, or increase their
stress levels, have the potential to cause harm. It may be an exceedingly low
risk, but applied to a large enough number of people and it starts adding up.
When applied to conditions that not everyone has, this can easily tilt the
balance.

Consider a hypothetical condition and a population of 1000000. If 1% has the
condition at any one time, and the accuracy of the test is 97%, then 10,000
should have the condition. Of those we'd expect 9,700 to get the correct
diagnosis; 300 would remain undiagnosed; But 3% of those who don't have the
condition - an additional 29,700 - will be wrongly diagnosed.

Let's say this is a condition where 10% would die untreated without this new
intervention, it'd be tempting to suggest we've saved 970 people. But early
detection might not make that much of a difference - for many things the most
severe cases will be noticed anyway and/or late detection is still sufficient
to save the patient.

Let's assume for this hypothetical condition, earlier detection will save 10%
more of those. In the above that'd save 97 people. Awesome. But lets say it
causes 10% more of the undiagnosed ones to die because they wait longer.
That's 3 more dead. So net 94?

But if only 0.33% of those wrongfully diagnosed end up dying as the result of
the misdiagnosis, be it car crashes on the way to the GP, or the visit leading
to a follow up error leading to an intervention that is generally but not
always safe, then the wrongful diagnosis would kill 98 people.

I'm not saying that would be the case here. But it's an illustration of why it
is important to consider not how many problems are detected, but what benefits
early detection gives vs. the cost of wrongly diagnosing people, even when it
seems benign enough (just another test, and they'll confirm it was a mistake?)

E.g. there's been pushback against large scale breast cancer screening for
this very reason: They're very successful at finding cancer early, but most
gets found eventually anyway, and the improvement in long term survival rates
from the earlier detection is reasonably small.

Couple this with low overall rates of occurrence across the total population
at any given point in time (cancer rates look high when considering "will X
get cancer _at some point_ in their life?", but most people will be free of
cancer at any given single point in their life; even most people who have had
cancer), and the impact of false positives and potential health implications
of a (very small but still existent) risk involved in even something "simple"
like a biopsy, and it's unclear if large scale screening is ethical (over
general populations; screening of groups with sufficiently high risk factors
is another matter entirely).

------
victor106
I love my Apple Watch series 1.

The one thing that’s frustrating is installing any apps on it takes a really
long time.

------
melling
In the Future Everyone will Wear a Smartwatch

[https://h4labs.wordpress.com/2015/07/28/in-the-future-
everyo...](https://h4labs.wordpress.com/2015/07/28/in-the-future-everyone-
will-wear-a-smartwatch/)

------
KirinDave
Unless you have a heart murmur like I do.

Then: it just lies.

~~~
bertil
I suspect that the technology (and data) from cases like yours will make
building either dedicated software or hardware for your case cheaper.

~~~
KirinDave
My snarky reply: "It's too bad I have to pay for the priviledge of being
included in a data set used for product refinement."

Also: no. When I was working as an intern at St. Jude Medical we were training
neural networks to recognize heart conditions and adjust other measurements.
It was 2002. That work was later published and widely adopted. Modern medical
hardware can account for it (inexpensive or older hardware often asks the
technician to diagnose and calibrate the machine).

It's very frustrating that Apple continues to pretend economy of scale is
breaking into new territory.

~~~
bertil
Adapting your model from 2002 is not a trivial operation. Apple and others are
building Machine learning platforms that make that work easier but saying that
you worked on it, therefore it should be done by others comes off as a little
naive about software integration. Going through other people’s code is not
instant or trivial.

~~~
KirinDave
I'm saying Apple's system fails to catch edge cases that prior ML systems,
system using a tiny fraction of the computing power and ultimately based off
animal data, achieved.

I think the job they're doing is unimpressive. I think it's doubly impressive
to imply I have to buy a watch to help them. I don't see why they wouldn't pay
me for my unique data. I don't need or want to help them build a shoddy
diagnosis product.

------
throw401
I think this is a great feature provided Apple won't collect the data.

[edit] Btw, I really don't mind getting down voted, but would appreciate to
see your opinion on why you think Apple collecting that data is a good idea.

