DIGITAL HEALTH TECHNOLOGY TO SUPPORT AUTONOMOUS SLEEP MONITORING AND MANAGEMENT IN MULTI-DOMAIN OPERATIONAL (MDO) ENVIRONMENTS

Abstract Introduction Sleep and fatigue management strategies can substantially impact the Armed Forces’ readiness and fitness. These strategies can be implemented with behavioral health personnel and Wi-Fi connectivity to support real-time assessment, monitoring, and intervention. However, these resources are not readily available in multi-domain operational (MDO) environments. An autonomous Wi-Fi-independent digital sleep and fatigue management tool (DSFMT) could offer a critical advantage in detecting, monitoring, and providing just-in-time sleep and fatigue recommendations for Soldiers and support unit performance. We describe how we adapted a validated sleep-focused clinical decision support platform into a DSFMT for use in MDO environments. Methods Semi-structured interviews were conducted with 6 Army Key Opinion Leaders (KOLs) to assess perceived utility of a DSFMT and identify key requirements. We also conducted a literature review to identify evidence-based sleep optimization and fatigue mitigation strategies in real or simulated military environments, or occupations with high sleep disruption. Directives for sleep and fatigue management from all branches of the U.S. Armed Forces were reviewed. Results KOLs were enthusiastic about the proposed DSFMT and emphasized three requirements: (1) brief and actionable content; (2) tap into Soldiers’ competitive nature; (3) provide unit level metrics to the medic. Five sleep education topics (e.g., consequences of insufficient sleep) and eight evidence-based sleep self-optimization strategies (e.g., sleep banking) were identified and included in the digital content. The resulting DSFMT consists of a smartphone-based Soldier App that captures self-reported sleep and fatigue data and offers individualized feedback and self-management strategies, and a Medic App that displays aggregate unit-level sleep and fatigue status. The apps operate when connected to Wi-Fi and have capabilities for offline data collection and transfer via Bluetooth. Conclusion We created an initial prototype of an autonomous Wi-Fi-independent DSFMT that can be used in MDO environments and meets KOL requirements. 246 Soldiers have field tested this prototype. Findings from ongoing acceptability and feasibility analyses will inform the next iteration. Support (If Any) This project is partially funded by MTEC-19-02-TeleSleep-001-2019-406. The opinions and assertions contained herein are those of the authors and do not necessarily reflect the views of the U.S. Army or the U.S. Department of Defense.