This is a literature review paper covering state-of-the-art sleep technologies to measure sleep and clinical sleep disorders. This paper addresses an interdisciplinary audience from a variety of subdomains in engineering and medicine. We reviewed 120 scientific papers, 15 commercial mobile apps, and 4 commercial devices. We selected the papers from scientific publishers including Institute of Electrical and Electronics Engineers (IEEE), Nature, Association for Computing Machinery (ACM), Proceedings of Machine Learning Research, Journal of Informatics in Health and Biomedicine, Plos One, PubMed, and Elsevier and Nature digital libraries. We used Google Scholar with keywords including “sleep monitoring”, “sleep monitoring technologies”, “non-contact sleep monitoring”, “mobile apps for sleep monitoring”, “AI in sleep technologies”, and “automated sleep staging.” The manuscript reviews sleep technologies, including sleep lab technologies such as polysomnography and consumer sleep technologies categorized as ambient room sensors, wearable sensors, bed sensors, mobile apps, and artificial intelligence. We primarily focused on validation and comparison studies of the reviewed technologies. The manuscript also provides an overview of several clinical datasets for sleep staging and taxonomizes the different learning methods. Finally, the manuscript offers our insights and recommendations about the application of the reviewed sleep technologies.

Biopotential electrodes play an integral role within smart wearables and clothing in capturing vital signals like electrocardiogram (ECG), electromyogram (EMG), and electroencephalogram (EEG). This study focuses on dry e-textile electrodes (E1–E6) and a laser-cut knit electrode (E7), to assess their impedance characteristics under varying contact forces and moisture conditions. Synthetic perspiration was applied using a moisture management tester and impedance was measured before and after exposure, followed by a 24 h controlled drying period. Concurrently, the signal-to-noise ratio (SNR) of the dry electrode was evaluated during ECG data collection on a healthy participant. Our findings revealed that, prior to moisture exposure, the impedance of electrodes E7, E5, and E2 was below 200 ohm, dropping to below 120 ohm post-exposure. Embroidered electrodes E6 and E4 exhibited an over 25% decrease in mean impedance after moisture exposure, indicating the impact of stitch design and moisture on impedance. Following the controlled drying, certain electrodes (E1, E2, E3, and E4) experienced an over 30% increase in mean impedance. Overall, knit electrode E7, and embroidered electrodes E2 and E6, demonstrated superior performance in terms of impedance, moisture retention, and ECG signal quality, revealing promising avenues for future biopotential electrode designs.

The advancement of smart textiles has led to significant interest in developing wearable textile sensors (WTS) and offering new modalities to sense vital signs and activity monitoring in daily life settings. For this, textile fabrication methods such as knitting, weaving, embroidery, and braiding offer promising pathways toward unobtrusive and seamless sensing for WTS applications. Specifically, the knitted sensor has a unique intermeshing loop structure which is currently used to monitor repetitive body movements such as breathing (microscale motion) and walking (macroscale motion). However, the practical sensing application of knit structure demands a comprehensive study of knit structures as a sensor. In this work, we present a detailed performance evaluation of six knitted sensors and sensing variation caused by design, sensor size, stretching percentages % (10, 15, 20, 25), cyclic stretching (1000), and external factors such as sweat (salt-fog test). We also present regulated respiration (inhale–exhale) testing data from 15 healthy human participants; the testing protocol includes three respiration rates; slow (10 breaths/min), normal (15 breaths/min), and fast (30 breaths/min). The test carried out with statistical analysis includes the breathing time and breathing rate variability. These testing results offer an empirically derived guideline for future WTS research, present aggregated information to understand the sensor behavior when it experiences a different range of motion, and highlight the constraints of the silver-based conductive yarn when exposed to the real environment.

Ambulation is a fundamental requirement of human beings for enjoying healthy community life. A neurological disorder such as stroke can significantly affect one's gait thereby restricting one's active community participation. To quantify one's gait, spatiotemporal gait parameters are widely used in clinical context with different tests such as 10 meter walk test, 6 min walk test, etc. Though these conventional observation-based methods are powerful, yet they often suffer from subjectivity, a scarcity of adequately trained therapists and frequent clinical visits for assessment. Researchers have been exploring the technology-assisted solutions for gait characterization. There are laboratory-based stereophotogrammetric methods and walk mats that are powerful tools as far as gait characterization is concerned. However, these suffer from issues with portability, accessibility due to high cost, labor-intensiveness, etc. Faced with these issues, our present research tries to investigate and quantify the gait abnormalities in individuals with neurological disorder by using a portable and cost-effective instrumented shoes (Shoes_FSR henceforth). The in-house developed Shoes_FSR comprised of a pair of shoes instrumented with Force Sensing Resistors (FSR) and a wireless data acquisition unit. The real-time FSR data was acquired wirelessly and analyzed by a central console to offer quantitative indices of one's gait. Studies were conducted with 15 healthy participants and 9 post-stroke survivors. The spatiotemporal gait parameters of healthy participants measured using Shoes_FSR were validated with standard methods such as stereophotogrammetric system and paper-based setup. Statistical analysis showed good agreement between the gait parameters measured using Shoes_FSR and the standard methods. Specifically, the mean absolute error of the spatial parameters measured by the Shoes_FSR, in the worst case, was 1.24% and that for the temporal parameters was 1.12% with that measured by standard methods for healthy gait. This research shows the potential of the Shoes_FSR to quantify gait abnormality of post-stroke hemiplegic patients. In turn, the results show a promise for the future clinical use of the Shoes_FSR.

Objective: Cerebrovascular accidents are the second leading cause of death and the third leading cause of disability worldwide. We hypothesized that cerebellar transcranial direct current stimulation (ctDCS) of the dentate nuclei and the lower-limb representations in the cerebellum can improve functional reach during standing balance in chronic (>6 months’ post-stroke) stroke survivors. Materials and Methods: Magnetic resonance imaging (MRI) based subject-specific electric field was computed across a convenience sample of 10 male chronic (>6 months) stroke survivors and one healthy MRI template to find an optimal bipolar bilateral ctDCS montage to target dentate nuclei and lower-limb representations (lobules VII–IX). Then, in a repeated-measure crossover study on a subset of 5 stroke survivors, we compared 15 min of 2 mA ctDCS based on the effects on successful functional reach (%) during standing balance task. Three-way ANOVA investigated the factors of interest– brain regions, montages, stroke participants, and their interactions. Results: “One-size-fits-all” bipolar ctDCS montage for the clinical study was found to be PO9h–PO10h for dentate nuclei and Exx7–Exx8 for lobules VII–IX with the contralesional anode. PO9h–PO10h ctDCS performed significantly (alpha = 0.05) better in facilitating successful functional reach (%) when compared to Exx7–Exx8 ctDCS. Furthermore, a linear relationship between successful functional reach (%) and electric field strength was found where PO9h–PO10h montage resulted in a significantly (alpha = 0.05) higher electric field strength when compared to Exx7–Exx8 montage for the same 2 mA current. Conclusion: We presented a rational neuroimaging based approach to optimize deep ctDCS of the dentate nuclei and lower limb representations in the cerebellum for post-stroke balance rehabilitation. However, this promising pilot study was limited by “one-size-fits-all” bipolar ctDCS montage as well as a small sample size.

Background: Investigation of lobule-specific electric field effects of cerebellar transcranial direct current stimulation (ctDCS) on overground gait performance has not been performed, so this study aimed to investigate the feasibility of two lobule-specific bilateral ctDCS montages to facilitate overground walking in chronic stroke. Methods: Ten chronic post-stroke male subjects participated in this repeated-measure single-blind crossover study, where we evaluated the single-session effects of two bilateral ctDCS montages that applied 2 mA via 3.14 cm² disc electrodes for 15 min targeting (a) dentate nuclei (also, anterior and posterior lobes), and (b) lower-limb representations (lobules VIIb-IX). A two-sided Wilcoxon rank-sum test was performed at a 5% significance level on the percent normalized change measures in the overground gait performance. Partial least squares regression (PLSR) analysis was performed on the quantitative gait parameters as response variables to the mean lobular electric field strength as the predictors. Clinical assessments were performed with the Ten-Meter walk test (TMWT), Timed Up & Go (TUG), and the Berg Balance Scale based on minimal clinically important differences (MCID). Results: The ctDCS montage specific effect was found significant using a two-sided Wilcoxon rank-sum test at a 5% significance level for 'Step Time Affected Leg' (p = 0.0257) and '%Stance Time Unaffected Leg' (p = 0.0376). The changes in the quantitative gait parameters were found to be correlated to the mean electric field strength in the lobules based on PLSR analysis (R² statistic = 0.6574). Here, the mean electric field strength at the cerebellar lobules, Vermis VIIIb, Ipsi-lesional IX, Vermis IX, Ipsi-lesional X, had the most loading and were positively related to the 'Step Time Affected Leg' and '%Stance Time Unaffected Leg,' and negatively related to the '%Swing Time Unaffected Leg,' '%Single Support Time Affected Leg.' Clinical assessments found similar improvement in the TMWT (MCID: 0.10 m/s), TUG (MCID: 8 s), and BBS score (MCID: 12.5 points) for both the ctDCS montages. Conclusion: Our feasibility study found an association between the lobular mean electric field strength and the changes in the quantitative gait parameters following a single ctDCS session in chronic stroke. Both the ctDCS montages improved the clinical outcome measures that should be investigated with a larger sample size for clinical validation. Trial registration: Being retrospectively registered.