Wesper used to objectively monitor oral device titration in a patient with moderate OSA
Wesper consists of two soft, flexible biosensor patches, which adhere to the abdomen and thorax. Wesper connects wirelessly to a mobile device, is rechargeable and reusable, and is extremely user-friendly. The patches collect a wide range of sleep and respiratory metrics, which allow for real time monitoring of patients going through the oral titration processes. Wesper organizes patient data into individual reports and collates each test into a longitudinal view, allowing the provider to easily visualize whether their patient’s respiration is improving after each titration.
Here, we provide a case study demonstrating how Wesper was utilized to quickly and objectively titrate an oral appliance for a moderate sleep apnea patient. Wesper also demonstrated real-time improvement in other sleep quality metrics.
Case Presentation
We present a 63 year old male with a BMI of 26.3 and a history of moderate obstructive sleep apnea and snoring. The patient was referred for oral appliance therapy after failing to adjust to CPAP. During the first consultation, the patient was provided with Wesper and instructed to test for three nights without therapy to set a baseline for their typical night time respiration.
Wesper reports moments of increased respiratory effort or reduced airflow as “breathing events”. On completion of the baseline tests, the patient’s results were consistent with their previous diagnosis of moderate sleep apnea (Table 1). Their average total number of breathing events was 147 (min/max: 121, 176 max) and an average of 27 events per hour (min/max: 21, 31). The patient also had an average of 130 minutes of total snoring time (min/max: 91, 155).
In addition to respiratory metrics, Wesper also collected additional sleep metrics to demonstrate how moderate sleep apnea was affecting the patient’s overall sleep quality (Table 1). These metrics include sleep efficiency, sleep time, and resting heart rate (beats per minute).
Wesper demonstrated that prior to oral appliance therapy, the patient’s average sleep efficiency was 83.6% (min/max: 78%, 87%), average sleep time was 323.6 minutes (min/max: 303, 342), average resting heart rate was 72 beats per minutes (min/max: 69, 74).
Table 1: Summary of respiratory and sleep metric data collected by Wesper prior to use of oral appliance therapy
Once baseline testing was complete, the patient was instructed to use their oral appliance and conduct three additional tests with Wesper to determine whether initial application of the appliance improved respiration and sleep quality.
On application of the oral appliance, Wesper demonstrated an immediate improvement in both respiration and overall sleep quality (Table 2). The patient’s results with oral appliances showed a reduction in total respiratory events from 147 to 94 (min/max: 65, 148; Figure 1), a reduction in average respiratory events per hour from 27 to 11 (min/max: 8, 16; Figure 2).
Figure 1: Wesper demonstrated improvement in Sleep Apnea after application of oral appliance.
Total snoring time increased from an average of 130 minutes to 176 minutes (min/max: 79, 240; Figure 3), however, it is important to note that total snoring time is related to an overall increase of total sleep time (Figure 4). This demonstrated that snoring was not increased by the use of the oral appliance. Further titration may be required to improve snoring.
Figure 2: Wesper shows that the overall percentage of time spent snoring did not improve with application of the oral appliance.
Sleep quality metrics also improved on application of the oral appliance. Sleep efficiency increased from 83.6% to 86.6% (min/max: 86%, 87%). Total sleep time improved from 323.6 minutes to 548.6 minutes (min/max: 344, 558; Figure 3) on average Finally, average resting heart rate decreased from 72 beats per minute to 67 (min/max 66, 70). 
Figure 3: Wesper showed improved sleep time with oral appliance use.
Figure 4: Wesper demonstrates improved resting heart rate while using oral appliance.
Table 2: Summary of respiratory and sleep metric data collected by Wesper after application of oral appliance therapy
Summary and Conclusion
The six Wesper tests conducted over a period of 11 days clearly demonstrate immediate improvement of sleep apnea pathology, including positive effects on sleep quality and resting heart rate. The health provider was provided with an objective guide for further titration.
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