Massimiliano de Zambotti

• PhD
• Scientist at Oura Health Oy

Introduction This study examined the potential of a device agnostic approach for predicting physical activity energy expenditure (PAEE) from research grade and consumer wearable accelerometry and heartrate (HR) raw data compared to indirect calorimetry in children. Methods Two-hundred and thirty-one 5–12-year-olds (52.4% male) of diverse skin tone...

The goal was to evaluate the performance of a suite of 12 sleep measures generated by a multi‐sensor wrist‐worn wearable device, the verily numetric watch (VNW), in a diverse cohort. We used polysomnography (PSG) as reference during one‐night simultaneous recording in a sample of N = 41 (18 male, age range: 18–78 years). We performed epoch‐by‐epoch...

The National Center on Sleep Disorders Research (NCSDR) of the National Heart, Lung, and Blood Institute (NHLBI) at the National Institutes of Health (NIH) hosted a two-day virtual workshop titled Big Data Approaches for Novel Mechanistic Insights on Disorders of Sleep and Circadian Rhythms on May 2nd and 3rd, 2024. The goals of this workshop were...

Monitoring cardiac hemodynamic parameters, such as cardiac output and pre-ejection period, is critical for assessing cardiovascular function, particularly in critically ill patients. Impedance cardiography (ICG) offers a noninvasive approach to measuring these parameters; however, its utility is often compromised by motion artifacts and electrode d...

Study Objectives Evaluate the performance of actigraphy-based open-source and proprietary sleep algorithms compared to polysomnography in children with suspected sleep disorders. Methods In a sleep clinic, 110 children (5-12 years, 54% female, 50% Black, 82% with sleep disorders) wore wrist-placed ActiGraph GT9X during overnight polysomnography. A...

Most studies about the menstrual cycle are laboratory-based, in small samples, with infrequent sampling, and limited to young individuals. Here, we use wearable and diary-based data to investigate menstrual phase and age effects on finger temperature, sleep, heart rate (HR), physical activity, physical symptoms, and mood. A total of 116 healthy fem...

Introduction This study evaluated the performance of a wrist-worn wearable, Verily Study Watch (VSW), in detecting key sleep measures against polysomnography (PSG). Methods We collected data from 41 adults without obstructive sleep apnea or insomnia during a single overnight laboratory visit. We evaluated epoch-by-epoch performance for sleep versu...

The goal was to evaluate the performance of a multi-sensor wrist-worn wearable device for generating 12 sleep measures in a diverse cohort. Our study technology was the sleep suite of the Verily Numetric Watch (VNW), using polysomnography (PSG) as reference during 1-night simultaneous recording in a sample of N=41 (18 male, age range: 18-78 years)....

The menstrual cycle is a loop involving the interplay of different organs and hormones, with the capacity to impact numerous physiological processes, including body temperature and heart rate, which in turn display menstrual rhythms. The advent of wearable devices that can continuously track physiological data opens the possibility of using these p...

Early adolescent drinking onset is linked to myriad negative consequences. Using the National Consortium on Alcohol and NeuroDevelopment in Adolescence (NCANDA) baseline to year 8 data, this study (1) leveraged best subsets selection and Cox Proportional Hazards regressions to identify the most robust predictors of adolescent first and regular drin...

Nocturnal blood pressure (BP) monitoring offers valuable insights into various aspects of human wellbeing, particularly cardiovascular health. Despite recent advancements in medical technology, there remains a pressing need for a non-invasive, cuffless, and less burdensome method for overnight BP measurements. A range of machine learning models has...

Heavy alcohol drinking is a major, preventable problem that adversely impacts the physical and mental health of US young adults. Studies seeking drinking risk factors typically focus on young adults who enrolled in 4-year residential college programs (4YCP) even though most high school graduates join the workforce, military, or community colleges....

Study Objectives Evaluate wrist-placed accelerometry predicted heartrate compared to electrocardiogram (ECG) heartrate in children during sleep. Methods Children (n=82, 61% male, 43.9% Black) wore a wrist-placed Apple Watch Series 7 (AWS7) and ActiGraph GT9X during a polysomnogram. 3-Axis accelerometry data was extracted from AWS7 and the GT9X. Ac...

Introduction Numerous physiological processes display menstrual cycle variations, including body temperature. The advances in quality and accessibility of wearables facilitate collecting time series of physiological data, including skin temperature during sleep. The cosinor method, frequently used in circadian rhythms biology, may be a useful tool...

The purpose of this study was to evaluate the reliability and validity of the raw accelerometry output from research-grade and consumer wearable devices compared to accelerations produced by a mechanical shaker table. Raw accelerometry data from a total of 40 devices (i.e., n = 10 ActiGraph wGT3X-BT, n = 10 Apple Watch Series 7, n = 10 Garmin Vivoa...

Objective Women's increasing workforce participation necessitates understanding unique life phases like menopause for enhanced workplace inclusivity. This research investigates the challenges and needs of peri-menopausal women in work settings, using the Job Demands–Resources model as a foundation. Methods A cross-sectional survey was administered...

Wearable sleep trackers are increasingly used in applied psychology. Particularly, the recent boom in the fitness tracking industry has resulted in a number of relatively inexpensive consumer-oriented devices that further enlarge the potential applications of ambulatory sleep monitoring. While being largely positioned as wellness tools, wearable sl...

Upper Limb (UL) Rehabilitation in Multiple Sclerosis (MS) is an open research field due to the complex interplay between cognitive and physical dysfunctions. Virtual Reality (VR) can face such an issue by enriching physical training with engaging features, including biofeedback strategies to self-regulate autonomic functions according to the visual...

Wearable sleep-tracking technology is of growing use in the sleep and circadian fields, including for applications across other disciplines, inclusive of a variety of disease states. Patients increasingly present sleep data derived from their wearable devices to their providers and the ever-increasing availability of commercial devices and new-gene...

Background and Aims Recently, we demonstrated that a distinct pattern of structural covariance networks (SCN) from magnetic resonance imaging (MRI)‐derived measurements of brain cortical thickness characterized young adults with alcohol use disorder (AUD) and predicted current and future problematic drinking in adolescents relative to controls. Her...

Introduction This study examined the potential of a device agnostic approach for predicting physical activity from consumer wearable accelerometry compared to a research-grade accelerometry. Methods Seventy-five 5–12-year-olds (58% male, 63% White) participated in a 60-minute protocol. Children wore wrist-placed consumer wearables (Apple Watch Ser...

Subcortical brain morphometry matures across adolescence and young adulthood, a time when many youth engage in escalating levels of alcohol use. Initial cross-sectional studies have shown alcohol use is associated with altered subcortical morphometry. However, longitudinal evidence of sex-specific neuromaturation and associations with alcohol use r...

Goal and aims: Evaluate the performance of a sleep scoring algorithm applied to raw accelerometry data collected from research-grade and consumer wearable actigraphy devices against polysomnography. Focus method/technology: Automatic sleep/wake classification using the Sadeh algorithm applied to raw accelerometry data from ActiGraph GT9X Link, A...

The purpose of this study was to evaluate the reliability and validity of the raw accelerometry output from research-grade and consumer wearable devices compared to accelerations produced by a mechanical shaker table. Raw accelerometry data from a total of 40 devices (i.e., n=10 ActiGraph wGT3X-BT, n=10 Apple Watch Series 7, n=10 Garmin Vivoactive...

Introduction Adolescents who evince higher levels of impulsive traits are more susceptible to early use of mature-rated gaming and watching R-rated movies. This is a major public health concern because exposure to mature-rated media in youth is associated with decreased empathy and aggressive behaviors later in life. However, not all youth with hig...

Introduction Sleep is an essential part of women’s health and well-being. Hormonal fluctuations that occur across the menstrual cycle or when approaching menopause might affect sleep quality. Most studies rely on self-reported data, or laboratory measures in small samples, to examine changes in sleep across the menstrual cycle. Here, we investigate...

Introduction Insomnia often develops during adolescence, with girls being at greater risk than boys. Alterations in response to psychosocial stress have been linked to the etiology of the disorder, but it remains unclear whether the reactivity of the major stress systems (hypothalamic-pituitary-adrenal (HPA) axis and autonomic nervous system (ANS))...

Introduction Obesity, and its co-morbidities, is a serious health risk currently facing adolescents in the US, with increased risk for adult obesity and cardiovascular health problems. Sleep is crucial for energy restorative processes and insufficient sleep influences food intake and appetite regulation. Adolescents are at risk for poor/insufficien...

Study objectives: Adolescence is characterized by significant brain development, accompanied by changes in sleep timing and architecture. It also is a period of profound psychosocial changes, including the initiation of alcohol use; however, it is unknown how alcohol use affects sleep architecture in the context of adolescent development. We track...

Objective: During the COVID-19 pandemic, adolescents and families have turned to online activities and social platforms more than ever to maintain well-being, connect remotely with friends and family, and online schooling. However, excessive screen use can have negative effects on health (e.g., sleep). This study examined changes in sleep habits an...

Study objectives: We sought to elucidate the interaction between sleep and mood considering menstrual cycle phase (menses and non-menses portions of the cycle) in 72 healthy young women (18 - 33 y) with natural, regular menstrual cycles and without menstrual-associated disorders. This work fills a gap in literature of examining mood in context of...

This cross-sectional study investigated objective-subjective sleep discrepancies and the physiological basis for morning perceptions of sleep, mood, and readiness, in adolescents. Data collected during a single in-laboratory polysomnographic assessment from 137 healthy adolescents (61 girls; age range: 12-21 years) in the United States National Con...

Importance: The use of consumer-grade wearable devices for collecting data for biomedical research may be associated with social determinants of health (SDoHs) linked to people's understanding of and willingness to join and remain engaged in remote health studies. Objective: To examine whether demographic and socioeconomic indicators are associa...

Introduction: Abnormal stress responses have been linked to the etiology of insomnia. We investigated the relationship between insomnia, stress, hypothalamic-pituitary-adrenal (HPA) axis activity, and autonomic nervous system (ANS) function in adolescence. Methods: Forty-seven post-pubertal adolescents (16-20 years old, 28 female) with (N = 16;...

Dear Editor, Over the last decade, the field of sleep research and clinical sleep medicine has dramatically expanded in its capability for measuring sleep naturalistically, longitudinally, and on a large scale. At the forefront of this sleep revolution is the exponential growth of miniaturized sleep-tracking technology like wearables and nearables...

Objectives: Characterizing daily patterns of sleep, stress, presleep worry, and mood in adolescents with and without insomnia symptomatology. Design: Two months of continuous wearable tracking and daily diary ratings. Setting: Free-living conditions. Participants: Ninety-three adolescents (59 girls; 16-19 years old) with (N = 47; 26 with cli...

Background: Self-reported physical activity is often inaccurate. Wearable devices utilizing multiple sensors are now widespread. The aim of this study was to determine acceptability of Fitbit Charge HR for children and their families, and to determine best practices for processing its objective data. Methods: Data were collected via Fitbit Charge H...

Chronic pain is a common and disabling condition in adolescents. Disturbed sleep is associated with many detrimental effects in adolescents with acute and chronic pain. While sleep and pain are known to share a reciprocal relationship, the sleep-pain relationship in adolescence warrants further contextualization within normally occurring maturation...

Sleep facilitates hippocampal-dependent memories, supporting the acquisition and maintenance of internal representation of spatial relations within an environment. In humans, however, findings have been mixed regarding sleep's contribution to spatial memory and navigation, which may be due to task designs or outcome measurements. We developed the M...

Sleep tracking devices marketed directly to consumers have resulted in the large-scale monitoring of sleep outside the research/clinical context. Consumer sleep tracking devices, worn by or placed near the user (wearables and nearables, respectively), allow for an ecologically valid, objective assessment of sleep patterns that historically were ass...

Objectives COVID-19 has infected millions of people worldwide, with growing evidence that individuals with a history of infection may continue to show persistent post-COVID symptoms (long COVID). The aim of this study was to investigate sleep health in an international sample of individuals who reported previously testing positive for COVID-19. De...

To determine the persistent effects of the pandemic on mental health in young adults, we categorized depressive symptom trajectories and sought factors that promoted a reduction in depressive symptoms in high-risk individuals. Specifically, longitudinal analysis investigated changes in the risk for depression before and during the pandemic until De...

Insomnia is the most common sleep disorder in adolescence, and frequently emerges during this vulnerable period of profound biobehavioral maturation. Insomnia tends to be chronic, and if left untreated, could be detrimental for the teenagers’ mental and physical health, social, and emotional development. However, there is a paucity of data about in...

Objective: In this study, we describe the rationale, supported by preliminary data, for a novel, digital, immersive virtual reality (VR)-based mind-body approach, designed to reduce bedtime arousal in adolescents with insomnia. Methods: Fifty-two high-school students (16-20 years; 32 female) with (N = 18) and without (N = 34) DSM-5 insomnia symp...

Introduction Adolescence is characterized by developmental changes in sleep timing and architecture as well as alcohol use initiation. While the effects of acute and chronic alcohol use on sleep in adults are well-documented, much less is known in adolescents. We used longitudinal data from the National Consortium on Alcohol and Neurodevelopment in...

Introduction Emotional, more than neutral, experiences are preferentially consolidated during sleep. Fluctuating reproductive hormonal levels across the menstrual cycle are associated with changes in sleep features that are implicated in emotional memory consolidation. Yet, the interaction between menstrual cycle phases, sleep, and emotional memory...

Introduction Insomnia in adolescence is a common and debilitating condition, and vulnerability to stress is known to play a major role its development. In this study, we investigated the effects of sleeping under stress in a sample of adolescents with and without clinically significant insomnia symptoms. The first night in the laboratory was used a...

Introduction The menses phase of a woman’s menstrual cycle, compared to other phases, is more likely to be associated with poorer sleep quality and alterations in cognitive performance, specifically impaired working memory. However, the relationship among these factors has been poorly investigated, and how age impacts these relationships is current...

Introduction The COVID-19 pandemic has been associated with profound biopsychosocial changes for children, potentially affecting their health and wellbeing. Among these changes are altered sleep patterns and screen time use, however, no work has examined interactions between these two behaviors in the context of the pandemic. Here, we used longitud...

New sleep technologies have become pervasive in the consumer space, and are becoming highly common in research and clinical sleep settings. The rapid, widespread use of largely unregulated and unstandardized technology has enabled the quantification of many different facets of sleep health, driving scientific discovery. As sleep scientists, it is o...

Background and Objective The ovulatory menstrual cycle is characterized by hormonal fluctuations that influence physiological systems and functioning. Multi-sensor wearable devices can be sensitive tools capturing cycle-related physiological features pertinent to women’s health research. This study used the Oura ring to track changes in sleep and r...

Objective: This case-control study examines if measures of subjective and objective (actigraphic) sleep difficulties mediate alterations in amygdalar connectivity in adolescents with migraine compared to healthy adolescents. Background: Adolescents with migraine have different functional connectivity of the amygdala compared to individuals witho...

Objectives /Background. Insomnia in adolescence is common and debilitating yet it remains poorly understood. Here, we examine the complexity of clinical, behavioral, and psychosocial factors characterizing insomnia in adolescents. Methods Ninety-five adolescents (16-19 years) with (N=47, 31 female) and without (N=48, 28 female) insomnia symptoms p...

Purpose Adolescence is characterized by dramatic physical, social, and emotional changes, making teens particularly vulnerable to the mental health effects of the COVID-19 pandemic. This longitudinal study identifies young adolescents who are most vulnerable to the psychological toll of the pandemic and provides insights to inform strategies to hel...

Background The coronavirus disease 2019 (COVID-19) pandemic has significantly increased depression rates, particularly in emerging adults. The aim of this study was to examine longitudinal changes in depression risk before and during COVID-19 in a cohort of emerging adults in the U.S. and to determine whether prior drinking or sleep habits could pr...

We aim to evaluate the feasibility and performance of a novel hot flash (HF) classification algorithm based on multisensor features integration using commercial wearable sensors. First, we processed feature sets from wrist-based multi-sensor data (photoplethysmography, motion, temperature, skin conductance and). Then, we classified (Decision Tree)...

Enhancing the embodiment of artificial limbs—the individuals' feeling that a virtual or robotic limb is integrated in their own body scheme—is an impactful strategy for improving prosthetic technology acceptance and human-machine interaction. Most studies so far focused on visuo-tactile strategies to empower the embodiment processes. However, novel...

Presentation attacks are falsified biometric traits presented on biometric systems to deceive them. While biometric systems can be tuned and modified to reliably detect known presentation attacks, their performance significantly degrades when encountering unknown presentation attacks. Here, we propose a new approach toward detecting unknown present...

Study objectives: Restless legs syndrome (RLS) is a common neurological disorder characterized by an uncontrollable nocturnal urge to move the legs and often associated with chronic sleep disturbances. The most common treatments for RLS are medications that can have debilitating side-effects. Here, we evaluated a novel alternative modality of RLS...

Introduction Sleep modulates mood, with adequate, good-quality sleep associated with a more positive mood. Additionally, sleep is affected by the menstrual cycle in women, with better self-reported sleep quality during non-menses, compared with pre- and during menses. The present study examines the interaction between self-reported sleep quality an...

Introduction Adolescence is a transitional life-stage accompanied by large biopsychosocial changes and greater psychophysiological vulnerability. Global events like the COVID-19 pandemic may increase vulnerability to depression and anxiety in this population. Poor sleep is often associated with depression, and both sleep and mood have been shown to...

Introduction Insomnia is common in adolescence, particularly in older girls, with an overall prevalence comparable to major depression. Despite being associated with adverse outcomes such as an increased risk for substance dependence and suicidality, insomnia in adolescence is still under-recognized, under-diagnosed, and under-treated, and poorly d...

Introduction Estrogen and progesterone cycle through two main phases across a typical 28-day menstrual cycle: a perimense phase, when both hormones are low; and a non-perimenses phase, when both hormones are high. These fluctuations affect a range of daily activities, including sleep, mood, and physical feelings such as bloating. Here we aimed to p...

Introduction A woman’s menstrual cycle is characterized by hormonal changes that might affect sleep and therefore daily functionality. While some studies using self-reports have shown a lower sleep quality in the peri-menstruation phase, objective – in lab – studies have not found significant differences in sleep continuity during the menstrual cyc...

Adolescents with migraine have different functional connectivity of the amygdala compared to individuals without migraine. Considering that sleep is often disturbed in those adolescents with migrane, this study examined if measures of subjective and objective (actigraphic) sleep difficulties mediate alterations in amygdalar connectivity in adolesce...

We evaluated the performance of Fitbit Charge 3™ (FC3), a multi-sensor commercial sleep-tracker, for measuring sleep in adolescents against gold-standard laboratory polysomnography (PSG). Single-night PSG and FC3 sleep outcomes were compared in thirty-nine adolescents (22 girls; 16–19 years), 12 of whom presented with clinical/subclinical DSM-5 ins...

Sleep and the autonomic nervous system (ANS) are intimately connected. The ANS is under the influence of circadian and sleep-dependent modulation. Forced desynchrony and constant routine protocols indicate strong circadian influences on heart rate (HR) and cardiac vagal activity, which fluctuate across 24 hours, with HR being lower, and vagal activ...

Introduction Insomnia disorder is a common sleep disorder and frequently emerges in the context of menopause, being associated with menopause-specific factors such as hot flashes and other psychosocial variables. Increased vulnerability to stress may also contribute to the development of insomnia in midlife women. Here, we aimed to investigate whet...

Consumer sleep technology (CST) is at the core of the ongoing Internet of Things digital health revolution, with about one-third of the US population reporting regular use of CST wearables to track sleep, physical activity, and other health-related indicators. Wearables provides a low-cost and technologically advanced approach to measure sleep over...

Objective/Background This pilot study explored the efficacy of a novel forehead cooling device for perceived sleep difficulties and hot flashes in menopausal-age women. Participants 20 women (55.1 ± 4.2 years; 19 post-menopausal) with insomnia symptoms and self-reported two or more hot flashes per day. Methods Participants completed daily assessm...

A restorative health and wellness system that provides an immersive environment is provided herein. In some embodiments, the system includes one or more sensors configured to measure physiological properties of an individual and/or the properties of the individual's surroundings, one or more actuators configured to create the immersive environment...

Purpose This study sought to assess the performance of the Fitbit Charge HR, a consumer-level multi-sensor activity tracker, to measure physical activity and sleep in children. Methods 59 healthy boys and girls aged 9–11 years old wore a Fitbit Charge HR, and accuracy of physical activity measures were evaluated relative to research-grade measures...

Sleep-tracking devices, particularly within the consumer sleep technology (CST) space, are increasingly used in both research and clinical settings, providing new opportunities for large-scale data collection in highly ecological conditions. Due to the fast pace of the CST industry combined with the lack of a standardized framework to evaluate the...

Study objectives To investigate the dose-dependent impact of moderate alcohol intake on sleep-related cardiovascular (CV) function, in adult men and women. Methods Twenty-six healthy adults (30-60y; 11 women) underwent three nights of laboratory polysomnographic (PSG) recordings in which different doses of alcohol (low: 1 standard drink for women...

Objectives Starting in adolescence, female sex is a strong risk factor for the development of insomnia. Reasons for this are unclear but could involve altered stress reactivity and/or autonomic nervous system (ANS) dysregulation, which are strongly associated with the pathophysiology of insomnia. We investigated sex differences in the effect of str...

Introduction Many women experience sleep difficulties in the approach to menopause and post-menopause, with about 25% experiencing severe symptoms that impact daytime functioning and quality of life. Hot flashes contribute to these sleep difficulties, being associated with nocturnal awakenings, poorer sleep quality, and chronic insomnia. New non-ph...

Introduction Sleep disturbances frequently emerge during adolescence amongst profound, normative, sleep maturation and biopsychosocial changes. Factors like stress, worry or rumination may make falling asleep and maintaining sleep more difficult. Here, we evaluate the efficacy of a novel intervention based on virtual reality (VR) and slow breathing...

Introduction Commercial wearable devices have shown the capability of collecting and processing multisensor information (motion, cardiac activity), claiming to be able to measure sleep-wake patterns and differentiate sleep stages. While using these devices, users should be aware of their accuracy, sources of measurement error and contextual factors...

Introduction Restless Legs Syndrome (RLS) is a sensorimotor neurological condition characterized by an uncontrollable urge to move the legs that interferes with falling and staying asleep. For the over 5 million Americans with clinically significant RLS, these symptoms occur multiple nights per week, significantly impair quality of life, increase t...

There are sex differences in human sleep behavior, whether assessed by self-report or with polysomnographic (PSG) and electroencephalographic (EEG) measures. Women report more sleep problems and a poorer sleep quality, and are at greater risk for developing insomnia disorder, than men across a wide age range. Men and women also interpret sleep qual...

Sleep is crucial for the proper functioning of bodily systems and for cognitive and emotional processing. Evidence indicates that sleep is vital for health, well-being, mood, and performance. Consumer sleep technologies (CSTs), such as multisensory wearable devices, have brought attention to sleep and there is growing interest in using CSTs in rese...

Purpose: The aim of the study was to investigate associations between sleep disturbances and mental health in adolescents. Methods: Data are from a national sample of 11,670 U.S. participants (5,594 females, aged 9 -10 years, 63.5% white) in the Adolescent Brain Cognitive Development study. Initial longitudinal analyses were conducted for a subset...