Despite the prevalence of sleep-tracking devices, many individuals struggle to translate data into actionable improvements in sleep health. Current methods often provide data-driven suggestions but may not be feasible and adaptive to real-life constraints and individual contexts. We present HealthGuru, a novel large language model-powered chatbot to enhance sleep health through data-driven, theory-guided, and adaptive recommendations with conversational behavior change support. HealthGuru's multi-agent framework integrates wearable device data, contextual information, and a contextual multi-armed bandit model to suggest tailored sleep-enhancing activities. The system facilitates natural conversations while incorporating data-driven insights and theoretical behavior change techniques. Our eight-week in-the-wild deployment study with 16 participants compared HealthGuru to a baseline chatbot. Results show improved metrics like sleep duration and activity scores, higher quality responses, and increased user motivation for behavior change with HealthGuru. We also identify challenges and design considerations for personalization and user engagement in health chatbots.
Poor sleep health is an increasingly concerning public healthcare crisis, especially when coupled with a dwindling number of health professionals qualified to combat it. However, there is a growing body of scientific literature on the use of digital technologies in supporting and sustaining individuals' healthy sleep habits. Social robots are a relatively recent technology that has been used to facilitate health care interventions and may have potential in improving sleep health outcomes, as well. Social robots' unique characteristics -- such as anthropomorphic physical embodiment or effective communication methods -- help to engage users and motivate them to comply with specific interventions, thus improving the interventions' outcomes. This scoping review aims to evaluate current scientific evidence for employing social robots in sleep health interventions, identify critical research gaps, and suggest future directions for developing and using social robots to improve people's sleep health. Our analysis of the reviewed studies found them limited due to a singular focus on the older adult population, use of small sample sizes, limited intervention durations, and other compounding
We present a novel approach to personalized sleep health management using few-shot Chain-of-Thought (CoT) distillation, enabling small-scale language models (> 2B parameters) to rival the performance of large language models (LLMs) in specialized health domains. Our method simultaneously distills problem-solving strategies, long-tail expert knowledge, and personalized recommendation capabilities from larger models into more efficient, compact models. Unlike existing systems, our approach offers three key functionalities: generating personalized sleep health recommendations, supporting user-specific follow-up inquiries, and providing responses to domain-specific knowledge questions. We focus on sleep health due to its measurability via wearable devices and its impact on overall well-being. Our experimental setup, involving GPT-4o for data synthesis, Qwen-max for instruction set creation, and Qwen2.5 1.5B for model distillation, demonstrates significant improvements over baseline small-scale models in penalization, reasoning, and knowledge application. Experiments using 100 simulated sleep reports and 1,000 domain-specific questions shows our model achieves comparable performance
Sleep traits are shaped by genetic and environmental factors and may influence many health conditions. The All of Us Research Program, which includes EHR, physical measurements, genomic data, and wearable data across ancestry groups, provides an opportunity to study genetic and non-genetic contributors to sleep-related health outcomes. We examined associations between genetic predispositions to chronotype, sleep duration, and short sleep and health outcomes across ancestries, as well as the role of measured sleep duration. We used All of Us genome-wide association study results, including ancestry-specific and meta-analyses for 3,414 phenotypes, to identify phenotypes associated with 455 sleep-related SNPs. Cross-sectional and longitudinal analyses (n = 212,529) evaluated associations between polygenic risk scores (PRS) and anthropometric and metabolic measures from EHR. A subgroup analysis (n = 7,655) assessed sleep duration using Fitbit data. Across six ancestry groups, SNP analysis identified 61 phenotypes linked to 29 sleep-trait-associated SNPs. The chronotype SNP rs1421085 in FTO showed the strongest associations with obesity, diabetes, and cardiovascular conditions, mainly i
Background: Adolescence is a critical period of brain maturation and heightened vulnerability to cognitive and mental health disorders. Sleep plays a vital role in neurodevelopment, yet the mechanisms linking insufficient sleep to adverse brain and behavioral outcomes remain unclear. The glymphatic system (GS), a brain-wide clearance pathway, may provide a key mechanistic link. Methods: Participants from the Adolescent Brain Cognitive Development (ABCD) Study (n =6,800; age ~ 11 years) were categorized into sleep-sufficient (>=9 h/night) and sleep-insufficient (<9 h/night) groups. Linear models tested associations among sleep, PVS burden, brain volumes, and behavioral outcomes. Mediation analyses evaluated whether PVS burden explained sleep-related effects. Results: Adolescents with insufficient sleep exhibited significantly greater PVS burden, reduced cortical, subcortical, and white matter volumes, poorer cognitive performance across multiple domains (largest effect in crystallized intelligence), and elevated psychopathology (largest effect in general problems). Sleep duration and quality were strongly associated with PVS burden. Mediation analyses revealed that PVS burden
Cellular networks offer a unique opportunity to enable device-free and wide-area health monitoring by exploiting the sensitivity of radio-frequency (RF) propagation to human physiological activities. In this paper, we present the first experimental study of human sleep monitoring using realistic 5G signals collected from commercial cellular infrastructure. We investigate a practical scenario in which a smartphone is placed near a bed, and a 5G base station periodically configures uplink sounding reference signal (SRS) transmissions to obtain fine-grained channel state information (CSI). Leveraging uplink CSI measurements, we design a lightweight signal processing pipeline for respiration rate estimation and a CNN model for sleep body movement classification. Through extensive experiments conducted on an indoor private 5G network, our system achieves over 91.2% accuracy in respiration rate estimation and 85.5% accuracy in sleep movement classification.
Health monitoring systems have revolutionized modern healthcare by enabling the continuous capture of physiological and behavioral data, essential for preventive measures and early health intervention. While integrating this data with Large Language Models (LLMs) has shown promise in delivering interactive health advice, traditional methods like Retrieval-Augmented Generation (RAG) and fine-tuning often fail to fully utilize the complex, multi-dimensional, and temporally relevant data from wearable devices. These conventional approaches typically provide limited actionable and personalized health insights due to their inadequate capacity to dynamically integrate and interpret diverse health data streams. In response, this paper introduces a graph-augmented LLM framework designed to significantly enhance the personalization and clarity of health insights. Utilizing a hierarchical graph structure, the framework captures inter and intra-patient relationships, enriching LLM prompts with dynamic feature importance scores derived from a Random Forest Model. The effectiveness of this approach is demonstrated through a sleep analysis case study involving 20 college students during the COVI
To examine associations between screen time and anxiety, depression, behavior or conduct problems, and ADHD among children and adolescents during the pandemic, and to assess whether physical activity, sleep duration, and bedtime regularity mediate these associations. Data from 50231 US children and adolescents aged 6 to 17 years in the 2020 to 2021 National Survey of Childrens Health were analyzed. Exact natural effect models and structural equation modeling assessed mediation by physical activity, short sleep duration, and irregular bedtime. We found that daily screen time equal or more than 4 hours was linked to higher risks of anxiety (aOR = 1.45, 95% CI 1.32, 1.58), depression (aOR = 1.65, 95% CI 1.41, 1.93), behavior or conduct problems (aOR = 1.17, 95% CI 1.05, 1.30), and ADHD (aOR = 1.21, 95% CI 1.11, 1.33). Physical activity accounted for 30.2% to 39.3% of the association, irregular bedtime for 18.2% to 25.7%, and short sleep duration for 2.77% to 7.34%. Excessive screen time was associated with poorer mental health and ADHD, partly explained by reduced physical activity, irregular bedtime, and insufficient sleep. Interventions should promote physical activity, regular slee
Accurate classification of sleep stages based on bio-signals is fundamental not only for automatic sleep stage annotation, but also for clinical health management and continuous sleep monitoring. Traditionally, this task relies on experienced clinicians to manually annotate data, a process that is both time-consuming and labor-intensive. In recent years, deep learning methods have shown promise in automating this task. However, three major challenges remain: (1) deep learning models typically require large-scale labeled datasets, making them less effective in real-world settings where annotated data is limited; (2) significant inter-individual variability in bio-signals often results in inconsistent model performance when applied to new subjects, limiting generalization; and (3) existing approaches often overlook the high-order relationships among bio-signals, failing to simultaneously capture signal heterogeneity and spatial-temporal dependencies. To address these issues, we propose MetaSTH-Sleep, a few-shot sleep stage classification framework based on spatial-temporal hypergraph enhanced meta-learning. Our approach enables rapid adaptation to new subjects using only a few labele
Mobile health has the potential to revolutionize health care delivery and patient engagement. In this work, we discuss how integrating Artificial Intelligence into digital health applications-focused on supply chain, patient management, and capacity building, among other use cases-can improve the health system and public health performance. We present an Artificial Intelligence and Reinforcement Learning platform that allows the delivery of adaptive interventions whose impact can be optimized through experimentation and real-time monitoring. The system can integrate multiple data sources and digital health applications. The flexibility of this platform to connect to various mobile health applications and digital devices and send personalized recommendations based on past data and predictions can significantly improve the impact of digital tools on health system outcomes. The potential for resource-poor settings, where the impact of this approach on health outcomes could be more decisive, is discussed specifically. This framework is, however, similarly applicable to improving efficiency in health systems where scarcity is not an issue.
Pediatric sleep is an important but often overlooked area in health informatics. We present PedSleepMAE, a generative model that fully leverages multimodal pediatric sleep signals including multichannel EEGs, respiratory signals, EOGs and EMG. This masked autoencoder-based model performs comparably to supervised learning models in sleep scoring and in the detection of apnea, hypopnea, EEG arousal and oxygen desaturation. Its embeddings are also shown to capture subtle differences in sleep signals coming from a rare genetic disorder. Furthermore, PedSleepMAE generates realistic signals that can be used for sleep segment retrieval, outlier detection, and missing channel imputation. This is the first general-purpose generative model trained on multiple types of pediatric sleep signals.
This study introduces a novel, rich dataset obtained from home sleep apnea tests using the FDA-approved WatchPAT-300 device, collected from 7,077 participants over 21,412 nights. The dataset comprises three levels of sleep data: raw multi-channel time-series from sensors, annotated sleep events, and computed summary statistics, which include 447 features related to sleep architecture, sleep apnea, and heart rate variability (HRV). We present reference values for Apnea/Hypopnea Index (AHI), sleep efficiency, Wake After Sleep Onset (WASO), and HRV sample entropy, stratified by age and sex. Moreover, we demonstrate that the dataset improves the predictive capability for various health related traits, including body composition, bone density, blood sugar levels and cardiovascular health. These results illustrate the dataset's potential to advance sleep research, personalized healthcare, and machine learning applications in biomedicine.
The gut microbiota has emerged as a fundamental regulator of sleep physiology, influencing neural, endocrine, and immune pathways through the gut-microbiota-brain axis (GMBA). This bidirectional communication system modulates neurotransmitter production, circadian rhythms, and metabolic homeostasis, while disruptions in microbial composition have been linked to sleep disorders, neuroinflammation, and systemic immune dysfunction. Recent findings suggest that gut dysbiosis contributes to sleep disturbances by altering serotonin, GABA, and short-chain fatty acid (SCFA) metabolism, with implications for neurodegenerative diseases, metabolic syndromes, and mood disorders. Additionally, the gut microbiota interacts with the endocrine and immune systems, shaping inflammatory responses and stress adaptation mechanisms. This review explores the intricate connections between sleep and the gut microbiota, integrating emerging research on microbiota-targeted therapies, such as probiotics, fecal microbiota transplantation (FMT), and chrononutrition, as potential interventions to restore sleep homeostasis and improve health outcomes
Despite being crucial to health and quality of life, sleep -- especially pediatric sleep -- is not yet well understood. This is exacerbated by lack of access to sufficient pediatric sleep data with clinical annotation. In order to accelerate research on pediatric sleep and its connection to health, we create the Nationwide Children's Hospital (NCH) Sleep DataBank and publish it at Physionet and the National Sleep Research Resource (NSRR), which is a large sleep data common with physiological data, clinical data, and tools for analyses. The NCH Sleep DataBank consists of 3,984 polysomnography studies and over 5.6 million clinical observations on 3,673 unique patients between 2017 and 2019 at NCH. The novelties of this dataset include: 1) large-scale sleep dataset suitable for discovering new insights via data mining, 2) explicit focus on pediatric patients, 3) gathered in a real-world clinical setting, and 4) the accompanying rich set of clinical data. The NCH Sleep DataBank is a valuable resource for advancing automatic sleep scoring and real-time sleep disorder prediction, among many other potential scientific discoveries.
Selecting the right monitoring level in Remote Patient Monitoring (RPM) systems for e-healthcare is crucial for balancing patient outcomes, various resources, and patient's quality of life. A prior work has used one-dimensional health representations, but patient health is inherently multidimensional and typically consists of many measurable physiological factors. In this paper, we introduce a multidimensional health state model within the RPM framework and use dynamic programming to study optimal monitoring strategies. Our analysis reveals that the optimal control is characterized by switching curves (for two-dimensional health states) or switching hyper-surfaces (in general): patients switch to intensive monitoring when health measurements cross a specific multidimensional surface. We further study how the optimal switching curve varies for different medical conditions and model parameters. This finding of the optimal control structure provides actionable insights for clinicians and aids in resource planning. The tunable modeling framework enhances the applicability and effectiveness of RPM services across various medical conditions.
Study Objectives: Fetal sleep is a vital yet underexplored aspect of prenatal neurodevelopment. Its cyclic organization reflects the maturation of central neural circuits, and disturbances in these patterns may offer some of the earliest detectable signs of neurological compromise. This is the first review to integrate more than seven decades of research into a unified, cross-species synthesis of fetal sleep. We examine: (i) Physiology and Ontogeny-comparing human fetuses with animal models; and (ii) Methodological Evolution-transitioning from invasive neurophysiology to non-invasive monitoring and deep learning frameworks. Methods: A structured narrative synthesis was guided by a systematic literature search across four databases (PubMed, Scopus, IEEE Xplore, and Google Scholar). From 2,925 identified records, 171 studies involving fetal sleep-related physiology, sleep-state classification, or signal-based monitoring were included in this review. Results: Across the 171 studies, fetal sleep states become clearly observable as the brain matures. In fetal sheep and baboons, organized cycling between active and quiet sleep emerges at approximately 80%-90% gestation. In humans, this d
Sleep is particularly important to the health of infants, children, and adolescents, and sleep scoring is the first step to accurate diagnosis and treatment of potentially life-threatening conditions. But pediatric sleep is severely under-researched compared to adult sleep in the context of machine learning for health, and sleep scoring algorithms developed for adults usually perform poorly on infants. Here, we present the first automated sleep scoring results on a recent large-scale pediatric sleep study dataset that was collected during standard clinical care. We develop a transformer-based model that learns to classify five sleep stages from millions of multi-channel electroencephalogram (EEG) sleep epochs with 78% overall accuracy. Further, we conduct an in-depth analysis of the model performance based on patient demographics and EEG channels. The results point to the growing need for machine learning research on pediatric sleep.
Electronic Health Record (EHR) has become an essential tool in the healthcare ecosystem, providing authorized clinicians with patients' health-related information for better treatment. While most developed countries are taking advantage of EHRs to improve their healthcare system, it remains challenging in developing countries to support clinical decision-making and public health using a computerized patient healthcare information system. This paper proposes a novel EHR architecture suitable for developing countries--an architecture that fosters inclusion and provides solutions tailored to all social classes and socioeconomic statuses. Our architecture foresees an internet-free (offline) solution to allow medical transactions between healthcare organizations, and the storage of EHRs in geographically underserved and rural areas. Moreover, we discuss how artificial intelligence can leverage anonymous health-related information to enable better public health policy and surveillance.
YouTube has rapidly emerged as a predominant platform for content consumption, effectively displacing conventional media such as television and news outlets. A part of the enormous video stream uploaded to this platform includes health-related content, both from official public health organizations, and from any individual or group that can make an account. The quality of information available on YouTube is a critical point of public health safety, especially when concerning major interventions, such as vaccination. This study differentiates itself from previous efforts of auditing YouTube videos on this topic by conducting a systematic daily collection of posted videos mentioning vaccination for the duration of 3 months. We show that the competition for the public's attention is between public health messaging by institutions and individual educators on one side, and commentators on society and politics on the other, the latest contributing the most to the videos expressing stances against vaccination. Videos opposing vaccination are more likely to mention politicians and publication media such as podcasts, reports, and news analysis, on the other hand, videos in favor are more li
The Oregon Health Insurance Experiment (OHIE) offers a unique opportunity to examine the causal relationship between Medicaid coverage and happiness among low-income adults, using an experimental design. This study leverages data from comprehensive surveys conducted at 0 and 12 months post-treatment. Previous studies based on OHIE have shown that individuals receiving Medicaid exhibited a significant improvement in mental health compared to those who did not receive coverage. The primary objective is to explore how Medicaid coverage impacts happiness, specifically analyzing in which direction variations in healthcare spending significantly improve mental health: higher spending or lower spending after Medicaid. Utilizing instrumental variable (IV) regression, I conducted six separate regressions across subgroups categorized by expenditure levels and happiness ratings, and the results reveal distinct patterns. Enrolling in OHP has significantly decreased the probability of experiencing unhappiness, regardless of whether individuals had high or low medical spending. Additionally, it decreased the probability of being pretty happy and having high medical expenses, while increasing the