Nocturnal cough and sleep quality to assess asthma control and predict attacks

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Nocturnal cough and sleep quality to assess asthma control and predict attacks
Peter.Tinschert@unisg.ch ERS International Congress 2020
Peter Tinschert2, Frank Rassouli1, Filipe Barata3, Claudia Steurer-Stey4,5, Elgar Fleisch2,3, Milo A Puhan4, Florent Baty1, Tobias Kowatsch2,3, Martin H Brutsche1
1Lung center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland; 2Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland; 3Center for Digital Health
Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland; 4Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland; 5mediX group practice
Zurich, Switzerland
Introduction
Methods
Results (1)
Conclusion
Acknowledgments
Results (2)
•Objective markers for asthma, that can be measured
without extra patient effort, could mitigate current
shortcomings in asthma monitoring
•We investigated whether smartphone-recorded
nocturnal cough and sleep quality can be utilized for
the detection of periods with uncontrolled asthma or
meaningful changes in asthma control, and for the
prediction of asthma attacks
•We analyzed questionnaire and sensor data of 79
adults with asthma
•Data were collected in situ for 29 days by means of a
smartphone
•Sleep quality and nocturnal cough frequencies were
measured every night with the Pittsburgh Sleep Quality
Index and by manually annotating coughs from
smartphone audio recordings
•Primary endpoint was asthma control assessed with a
weekly version of the Asthma Control Test
•Secondary endpoint were self-reported asthma attacks
•Nocturnal cough and sleep quality have useful
properties as markers for asthma control and seem to
have prognostic value for the early detection of asthma
attacks
•This study was funded by CSS Health Insurance, Lucerne, Switzerland
•79 analyzed patients: median ACT score of 21 points
(IQR = 18 – 23) in 308 available weeks
•Asthma was controlled in 192 weeks and uncontrolled
in 116 weeks
•Clinically significant deteriorations occurred in 29
weeks in 25 patients
•Eight asthma attacks occured in a total of 2,004 study
days
•Mixed effects regression analyses showed that
nocturnal cough and sleep quality were statistically
significantly associated with asthma control on a
between- and within-patient level (p < .05)
•Decision trees indicated that sleep quality was more
useful for detecting weeks with uncontrolled asthma
(balanced accuracy (BAC) 68% vs. 61%; Δ sensitivity -
12%; Δ specificity -2%), while nocturnal cough better
detected weeks with asthma control deteriorations
(BAC 71% vs. 56%; Δ sensitivity 3%; Δ specificity -34%)
•Cut-offs using both markers predicted asthma attacks
up to five days ahead with BACs between 70% and 75%
(sensitivities 75%-88% and specificities 57%-72%,
figure)