Keywords
public health - mobile applications - e-Health - sleep - sleeping habits
Introduction
Decreased sleep time is harmful to physical and mental health and may be associated
with changes in the normal functioning of the hypothalamic-pituitary-adrenal axis,
thereby exerting an influence on stress response.[1] Moreover, inadequate sleep can trigger obesity by favoring an increase in the ratio
between the hormones leptin and ghrelin and, consequently, appetite and hunger.[2] As a result, altered sleep can reduce quality of life and cause complications, such
as increased daytime sleepiness and poor work performance.[3]
Sleep assessment has been a target of health application developers and a variety
of programs with different functionalities are offered. Although the algorithms provide
data regarding the structure of sleep, there is not a great deal of focus on scientific
evidence.[4]
Consumer sleep technologies (CSTs) are broad computer-based systems available to the
public for the purpose of improving the self-monitoring of sleep. Mobile applications
running on smartphones and tablets are the most popular CSTs, as they do not require
sensors and may include sleep tracking, alarm functions, and sleep-related recordings.[5] With the widespread adoption of smartphones by the general public, there is a growing
interest in such applications. Thus, knowledge on the most common programs and their
characteristics is necessary to guide users.[4]
Mobile health (mHealth) applications are defined as a means of medical and public
health practice, available on mobile devices such as cellphones, personal digital
assistants, and other wireless devices.[6]
[7] Thus, they can be used as a tool with functionality to perform tasks in different
areas of interest, such as wellness management, health data collection, patient reminders
etc.[8]
The systematic evaluation of the quality of applications can be performed using the
mobile application rating scale (MARS), which establishes parameters such as engagement,
functionality, aesthetics, information quality, and subjective application quality
scores.[9] Based on MARS, Choi et al.[10] found that few mHealth apps available at online stores in the United States meet
the pre-established criteria of quality, content, and functionality.
To the best of our knowledge, there are no scientific studies that systematically
evaluate the quality of applications with the function of counting sleep hours for
Brazilian consumers. Furthermore, some studies evaluated applications developed in
a foreign language, which may be a barrier for the Brazilian population.[4]
[5]
[10]
Thus, the aim of the present study was to perform a systematic search of online stores
available in Brazil (Google Play Store and App Store) for mHealth applications designed
for monitoring sleep time, and to evaluate their engagement, functionality, aesthetics,
and quality of information. The findings can inform healthcare providers, clinical
researchers, patients, and other users regarding the best mobile technology applications
available in Brazil for monitoring sleep time. The results may also serve as a guide
for the development of new sleep applications.
Materials and Methods
The Preferred Reporting Items for Systematic Reviews and Metanalyses (PRISMA)[11] were followed but adapted to suit the systematic search of app stores, as in similar
studies.[12]
[13] Ethical approval was not necessary, as this study did not involve human subjects.
The review was not registered.
Search Devices and Strategies
The search for mobile applications for monitoring sleep time was performed in the
Google Play Store (Google LLC., CA, USA) and App Store (Apple Inc., CA, USA) using
a Galaxy Note20 Ultra 5G (Samsung, South Korea) Android device, system version Android
12, and an iPhone XR (Apple Inc., CA, USA), system version iOS 15.3.1. The App Store
offers almost two million applications available worldwide.[14] Both stores together account for 99.2% of the system market share of global operations,
with the participation of the Google Play Store in the Brazilian market corresponding
to 57.1%.[15]
The terms used in both stores were the same and directly related to sleep monitoring.
The keywords used were “sleep,” “sleep monitor,” “sleep technology,” “sleep application,”
“hours of sleep,” and “sleep quality.” These keywords were searched in Brazilian Portuguese.
Inclusion and Exclusion Criteria
Only applications that worked independently of external devices and did not require
add-ons beyond their operating vehicle were included.[16] Those that had the option of using the Portuguese language aimed at monitoring sleep
and providing data regarding user sleep time were included.
Furthermore, applications with no Portuguese description at the online stores and
those aimed only at advertising products or companies were excluded. Those not developed
or updated between 2020 and 2022 were also excluded, as updates ensure software functionality
and user support.[16]
Screening
Two independent researchers reviewed the mHealth apps. A third reviewer was available
to settle any disagreements. In the presence of two identical applications on both
platforms (iOS and Android), the iOS version was selected. Two applications had two
versions (one paid and one free); only the free version was reviewed, but paid features
relevant to the research topic were obtained while using the application (free full
version ranging from 3–7 days).[16] All extensions offered for in-app purchase were acquired to evaluate the full content
provided.
The applications selected for inclusion were organized on an Excel spreadsheet with
their characteristics, including information on the developer, installation number,
content rating, and a brief summary of the content, in addition to the price and version
of the application.
Application Quality Assessment
To ensure the highest possible performance in evaluating the applications, the operating
system version of both cellphones was updated with the latest option available. The
MARS results were used to assess the products' quality. This scale has 23 items and
is a simple, reliable tool for assessing the quality of applications. There are 5
sections: engagement (5 items), functionality (4 items), aesthetics (3 items), information
quality (7 items), and subjective quality (4 items). A 5-point scale was used for
each item: 1 - inadequate, 2 - bad, 3 - acceptable, 4 - good, and 5 - excellent.[9]
[Table 1] displays a detailed description of the scale.
Table 1
Detailed sections of Mobile Application Rating Scale (MARS)
|
Section
|
Feature
|
|
Engagement
|
Entertainment, interest, personalization, interactivity, and target group suitability
|
|
Functionality
|
Performance, ease of use, navigation, and gestural design
|
|
Aesthetics
|
Layout, graphics, and visual appeal
|
|
Information
|
App description accuracy, objectives, quality of information, quantity of information,
visual information, credibility, and evidence base
|
|
Subjective quality
|
Recommendation to others, app star ratings, usage, and whether users are willing to
pay for the product
|
Source: adapted from Stoyanov et al. (2015, p.5).[9]
The subscales of engagement, functionality, aesthetics, and quality of information
were used to calculate the mean and standard deviation (SD) of the app scores. To
ensure objectivity in the quality assessment, subjective app quality items were not
included, as this section is reported as optional.
The application must be based on evidence found in the scientific literature to answer
the item “evidence base” in the information section. To assess this item, a search
was performed in Medline/PubMed and Google Scholar databases with the name of the
application as a keyword followed by the terms “app” or “mobile app” to identify related scientific publications.
The two primary reviewers were trained to employ MARS using the training material
developed by the scale's authors.[9] Any items with unclear meaning were discussed between the reviewers. A pilot test
was conducted for additional training and for checking consensus between the reviewers.
A limit score of two points of difference between results was established and, in
case of disagreement (difference greater than two points on any item of the MARS subscales),
the item was discussed with a third reviewer to reach a consensus. For the pilot test,
10 free apps available at the App Store and Google Play Store were randomly selected
and evaluated by both reviewers.
Data Analysis
A Microsoft Excel (Microsoft Corp., Redmond, WA) version 2019, spreadsheet was used
to compile the data. Mean scores were first calculated from the results of each item
of the MARS sections, engagement, functionality, aesthetics, and information quality.
They were then added together to provide an overall mean and SD for the app's quality
score. The next step was to determine the sum of the means and SDs for each MARS section
and all incorporated apps.
Results
Among the 2,264 relevant mHealth apps identified, 11 were eligible for inclusion ([Fig. 1]). Excluded apps were duplicates, not up-to-date, or not relevant to this research's
purpose (apps with internal content in English). Among the 11 apps included in this
study, 3 (27.3%) were found exclusively on the App Store, 4 (36.4%) were found exclusively
on the Google Play Store, and 4 (36.4%) were found on both. All apps were free to
download and only 2 did not offer in-app purchases. The selection process of the mHealth
apps is shown in [Fig. 1]. The characteristics of those included are described in [Table 2].
Fig. 1 Flow diagram for mobile health applications (mHealth apps) search results. *To ensure
software functionality and ongoing technical support to users, only apps developed
or updated between 2020 and 2022 were included. † One app was not found in the Google
Play Store; one app was excluded due to a functionality error; seven apps were excluded
because they did not fit the research's objective; seven apps were excluded because
they were not in the search language.
Table 2
Description of mobile health applications for sleep time monitoring included in present
review
|
Android
|
|
App name
|
Purpose
|
Price (R$)
|
Downloads*
|
Developer
|
Affiliations
|
|
Sleep as Android: Ciclo do sono
|
Sleep monitoring
|
Freemium
R$9.99/month (Initial month R$2.99; First 7 days free) or R$25.99 (lifetime)
|
10.000.000+
|
Urbandroid (Petr Nálevka)
|
Commercial
|
|
PrimeNap: Free Sleep Tracker
|
Sleep monitoring
|
Free
Remove ads: R$19.99
|
100.000+
|
Excelling Apps
|
Commercial
|
|
SnoreClock - Você ronca?
|
Sleep monitoring
|
Free
Remove ads: R$13.99
|
1.000.000
|
Ralph Schiffhauer
|
Commercial
|
|
iOS
|
|
App name
|
Purpose
|
Price (R$)
|
Developer
|
Affiliations
|
|
Despertador Ciência do Sono
|
Sleep time monitoring
|
Free
|
Phase4 Mobile
|
Commercial
|
|
Google Fit: monitor fitness
|
Sleep records
|
Free
|
Google LLC.
|
Commercial
|
|
Sleep Tracker Helper
|
Sleep time monitoring
|
Freemium
R$30.90/week (First 3 days free); R$40.90/month; R$224.90/semester or R$249/year
|
Sergey Kolibaba
|
Commercial
|
|
Sleepzy - Relógio Despertador
|
Sleep monitoring
|
Freemium
R$26.90/month; R$45.90/quarter or R$152.90/year (First 7 days free)
|
ThrivePort, LLC.
|
Commercial
|
|
Rastreador de sono & Alarme (Monitor de Sono)
|
Sleep monitoring
|
Freemium
R$ 112.90/year (First 7 days free)
|
ABISHKKING Ltd.
|
Commercial
|
|
Vigilantes do Sono
|
Insomnia program, sleep logs and education
|
Freemium
R$199.90/ year (First 7 days free)
|
Vigilantes do Sono
|
Commercial
|
|
SnoreLab: Grave seu ronco
|
Sound recording, sleep time monitoring and education
|
Freemium
R$10.90/week;
R$19.90/month (First 7 days free); R$32.90/quarter or R$58.90/year
|
SnoreLab Ltd.
|
Commercial
|
|
SleepUp: Durma bem
|
Sleep monitoring and education
|
Freemium
Standard Plan R$24.99/month (First 7 days free) or R$149.99 (First 7 days free);
Premium Plan
R$69.99/month (First 7 days free) or R$399.99/year (First 7 days free)
|
SleepUp
|
Commercial
|
Commercial companies developed all 11 apps included in the present systematic review.
SnoreLab: Grave seu ronco and SnoreClock – Você ronca? were tested and had partially positive results in scientific studies that were not
randomized controlled clinical trials.[17]
[18]
[19]
[Table 3] offers a more detailed description of the main objectives of the applications.
Table 3
Detailed description of main objectives of apps included in present review
|
App name
|
Store where it is available
|
Objectives
|
|
Despertador Ciência do Sono
|
App Store
|
Records sleep time using the smartphone's microphone and accelerometer. Uses the time
setting in the alarm function and presents the results in graphs of data obtained
during the week, month, and year.
|
|
Google Fit: monitor fitness
|
App Store
Google Play Store
|
In addition to manual recording of sleep data (time user went to bed and woke up),
it offers contents on general health, such as heart rate monitoring, menstrual period,
weight, daily physical activity, food intake, and personal goals.
|
|
Sleep Tracker Helper
|
App Store
|
Presents daily and weekly sleep analysis by enabling the device's microphone and setting
alarm times, offering the results in graphs and sound recording, pointing out the
quality of sleep in percentages, in addition to proposing recommendations and challenges
to help users sleep better.
|
|
Sleepzy – Relógio Despertador
|
App Store
Google Play Store
|
Uses the device's internal microphone to analyze the sleep cycle and recognize sounds
during sleep, also offering alarm, sleep records with a graph demonstrating sleep
phases, sound resources, breathing exercises, and sleep trends based on nights of
sleep recorded. It also provides a demographic comparison of the data, recordings,
notes, and sleep goals.
|
|
Rastreador de Sono & Alarme
|
App Store
Google Play Store
|
Uses the device's microphone to monitor and analyze sleep quality, offering the setting
of bedtime and alarm time, in addition to helping users fall asleep with calming sounds,
stretching exercises, which are demonstrated through interactive videos, and breathing
methods. It also has daily statistics with the record of sleep time, phases, notes,
and night noises.
|
|
Vigilantes do Sono
|
App Store
Google Play Store
|
Provides a program for insomnia based on a step-by-step guide, an interactive chat
with a virtual assistant, guiding and suggesting instructions and information on how
to improve quality of sleep, in addition to manual recording of sleep time, monitoring
using the smartphone's accelerometer, and synchronization of sleep-time data from
the resources of the device itself.
|
|
SleepUp: Durma bem
|
App Store
Google Play Store
|
Offers complete manual recording of sleep time and quality, as well as education and
information on the subject through videos, written content, charts, guidelines, and
resources for sleep monitoring.
|
|
SnoreLab: Grave seu ronco
|
App Store
Google Play Store
|
Offer sleep recording, with a focus on monitoring snoring, in addition to graphs,
patterns of noises, and accounting for hours of sleep.
|
|
SnoreClock – Você ronca?
|
Google Play Store
|
|
Sleep as Android: Ciclo do sono
|
Google Play Store
|
Only offer the alarm function, sleep monitoring based on the start and wake time of
the alarm, graphs, individual customizations of sleep data, and counts the hours of
sleep using the device's accelerometer and microphone.
|
|
PrimeNap: Free Sleep Tracker
|
Google Play Store
|
Quality Assessment (MARS)
The mean ± SD of the MARS results of the 11 apps was 3.5 ± 0.8 on a scale of 1 to
5. Most apps scored lower in terms of credibility. The mean score on the engagement
subscale was 3.5 ± 0.7. The mean score on the functionality subscale was 4.2 ± 0.5,
with most applications considered functional. Mean aesthetics subscale score was 3.7 ± 0.4,
with some applications featuring attractive layouts and graphics with good resolution.
Most apps did not provide scientific evidence found in the literature. However, some
apps cited sources of verifiable legitimacy. The mean score assigned to the information
subscale was 2.7 ± 1.5. There was agreement between both reviewers using this tool
and differences between scores did not exceed the pre-established 2-points threshold.
[Table 4] displays the quality assessment of the applications according to MARS.
Table 4
Mobile app rating scale (MARS) scores of apps included in present review (n = 11)
|
App name
|
Version
|
Engagement
|
Functionality
|
Aesthetics
|
Information
|
Overall quality score
|
|
SleepUp: Durma bem
|
1.27.0
|
4.5
|
4.3
|
4.7
|
3.9
|
4.3 (0.9)
|
|
Vigilantes do Sono
|
5.12
|
4.5
|
4.8
|
4.0
|
3.6
|
4.2 (0.8)
|
|
Sleepzy – Relógio Despertador
|
3.44.2
|
4.1
|
4.6
|
4.3
|
3.4
|
4.1 (0.7)
|
|
Rastreador de Sono & Alarme
|
2.3.1
|
3.9
|
4.9
|
4.2
|
3.1
|
4.0 (0.7)
|
|
SnoreLab: Grave seu ronco
|
5.3.16
|
3.5
|
4.3
|
4.0
|
3.9
|
3.9 (0.7)
|
|
Google Fit: monitor fitness
|
1.70
|
3.4
|
4.4
|
3.7
|
3.0
|
3.6 (0.8)
|
|
Sleep Tracker Helper
|
1.1.8
|
3.4
|
4.8
|
4.2
|
2.1
|
3.6 (0.8)
|
|
Sleep as Android: Ciclo do sono
|
20221101
|
3.1
|
3.6
|
3.5
|
2.2
|
3.1 (0.8)
|
|
Despertador Ciência do Sono
|
3.2
|
2.9
|
3.9
|
3.2
|
1.9
|
3.0 (0.9)
|
|
SnoreClock – Você ronca?
|
5.2.7
|
2.1
|
3.9
|
3.2
|
2.1
|
2.8 (0.8)
|
|
PrimeNap: Free Sleep Tracker
|
1.1.4
|
2.6
|
2.8
|
2.3
|
1.1
|
2.2 (0.8)
|
|
Scores for all apps
|
–
|
3.5 (0.7)
|
4.2 (0.5)
|
3.7 (0.4)
|
2.7 (1.5)
|
3.5 (0.8)
|
Notes: Data are presented as mean and mean and standard deviation (SD). Score ranges from
1 (inadequate quality) to 5 (excellent quality). Total score based on mean of each
subscale.
Privacy Policy
Regarding the data privacy policy, only two apps (SleepUp: Sleep well and Vigilantes do Sono) have a data privacy policy in Portuguese and are in accordance with the General
Data Protection Law (LGPD). One app (PrimeNap: Free Sleep Tracker) does not present any information on this matter. One (Google Fit: fitness tracker) follows the privacy and security policy of the Google platform. Two apps (Sleep Science Alarm Clock and SnoreClock Do you snore?) explain data protection in their privacy policy. The other apps guarantee privacy
and data protection in accordance with the General Data Protection Regulation (GDPR)
and/or California Consumers Protection Act (CCPA) for the users residing in the countries
where they were developed, which means they do not extend to Brazil.
Application Rating
The three highest scoring apps had mean overall app quality scores ranging from 4.1
to 4.3. Two apps (SleepUp: Durma bem and Vigilantes do Sono) provided social media components or interactive support groups for users. The three
applications presented a good level of content and visual appeal. All were developed
for commercial purposes. However, in addition to the team of sleep experts, Sleep Up: Durma bem is the first platform to improve sleep with clinically validated digital therapies
approved by the Brazilian Health Surveillance Agency (Anvisa). The Vigilantes do Sono app is a startup accelerated by the Eretz.bio incubator at Albert Einstein Israelita
Hospital and the Google Fit: monitor fitness app worked in collaboration with the world health organization (WHO) as well as the
American heart association (AHA).
SleepUp: Durma Bem
This is a freemium application with the possibility of subscribing to two types of
plans (standard or premium) available at the Google Play Store. The overall mean MARS
score was 4.3. The standard plan offers the following: sleep diary and goals; lifestyle
tips; music and guided meditations; daily, weekly and monthly reports; personalized
guidance; four clinical trials; sleep hygiene module; relaxation and meditation module;
learning about sleep module; mindfulness therapy; and telemedicine with sleep specialists
with separate payment. The premium plan has the features of the standard plan and
offers a complete therapeutic program of cognitive behavioral therapy for insomnia,
nine clinical tests and access to sleep specialists via chat.
This application has a team of sleep specialists and is the first digital therapy
platform clinically validated and approved by Anvisa to improve sleep. Sleep Up: Durma bem monitors sleep by manual recording or wearable technologies. The weak point of the
app is that, if the user does not use wearable technologies, manual recording is necessary
of the time that they went to bed, managed to sleep, woke up and got out of bed. The
strong point is the variety of features provided to improve the user's sleep, increasing
the likelihood of achieving the desired goal.
Vigilantes do Sono
This application's overall mean MARS score was 4.2. Vigilantes do Sono is a freemium application with the possibility of subscription available at the Google
Play Store and App Store and seeks to improve sleep, insomnia, anxiety and depression
through behavioral changes. The program is based on cognitive behavioral therapy for
insomnia guided by an artificial intelligence (Sônia) and lasting approximately seven
weeks. Sleep monitoring occurs with the smartphone facing down on the mattress and
close to the pillow. There is no need to connect the charger to the device, but it
is necessary to have a fully charged battery. The user needs to start and end the
monitoring and it is possible to keep a sleep diary.
The strength of the application is the daily, quick interaction with the digital coach
Sônia as well as a sleep diary to monitor and direct the program. The user's responses
are used to personalize the service with tools and tips according to the individual.
The user learns concepts about insomnia, sleep tips, relaxation training and cognitive
techniques with a scientific basis and a team of sleep specialists. The limitation
of the application is that the content of the application is presented mostly in text
format, which may discourage use.
Sleepzy – Relógio Despertador
This is a freemium subscription-based app available at the Google Play Store and App
Store, having achieved an overall MARS score of 4.1. Sleepzy – Relógio Despertador is a sleep monitor in addition to being a smart alarm clock that seeks to wake the
user better. The app also provides a bedtime ritual with breathing exercises before
sleeping, classical music, and relaxing melodies.
Sleep recording occurs through the microphone or accelerometer with the smartphone
close to the user. There is no need to put the smartphone on the bed, but the charger
needs to be connected to the device, and the user needs to start and pause the sleep
recording. The application performs a comparison of the quality and duration of the
user's sleep with Brazilian and worldwide average values. The strengths of the application
are that, in addition to analysis and a sleep diary, it also works as a snoring recorder.
The weak point of this application is that one must subscribe to the premium version
to listen to the recording.
Discussion
To the best of our knowledge, this is the first systematic search to evaluate mHealth
technologies aimed at monitoring sleep time available at Brazilian online application
stores. In this study, we highlight the need to develop new evidence-based products
that can help monitor sleep time for Brazilian users. According to the findings, two
of the applications (SleepUp: Durma bem and Vigilantes do Sono) satisfactorily met the objective of the study, obtaining higher MARS scores and
offering resources, information, and language compatible with Brazilian users. A third
one (Sleepzy – Relógio Despertador) scored well on the MARS, but was not completely adapted for Brazilian users, as
its privacy policy and terms of use are described in English, and the contents and
resources are too broad.
Most apps had low MARS scores due to poor evidence-based information (i.e., whether
the app has been scientifically tested or not), aesthetics (screen settings and visual
elements), and/or engagement (i.e., users' experience when interacting with elements
of the application may not be attractive enough to keep their interest).
This study can be compared with another study performed in Jordan, in which the lowest
scores among the 6 applications included were also attributed to engagement and information
issues.[20] However, the average MARS quality score (3.3) was lower than that found in the present
study, as the evaluation was focused on applications in English (nonofficial language)
and without subscription fees, which are the two main barriers for populations in
developing countries.
The characteristics users value the most can improve the usability and results of
health data. According to Mendiola et al.,[21] to promote sustained use and positively influence the user, it is necessary for
applications to have features such as general education (offering basic educational
material on the topic, motivating user autonomy and knowledge), data export (enabling
the patient-consumer to dialogue with a healthcare provider) and improved engagement
(this can be guided by gamification, for example, which is based on points and levels
to be achieved according to a pre-established health objective).
Most current sleep applications are not supported by scientific evidence, and few
have been submitted to validation studies using polysomnography (gold standard), having
been developed for commercial purposes and, therefore, resulting in an exemption from
medical liability.[22] Moreover, according to an American survey, consumers of mobile applications express
concerns about their personal data; however, 91% of the population accepts the terms
and conditions of the installation without even reading them.[23] Despite the existence of strict laws in the respective countries as well as proposals
to protect users in relation to using and sharing their personal information, most
apps may not comply with protection rules, as reported in a mHealth study conducted
in Brazil,[13] and corroborated in the present study. Thus, for a better experience and greater
security, it is important for these points to receive attention in the development
of mHealth applications.
The MARS score[9] does not address aspects of privacy and security. These aspects of mHealth apps
are critical to increasing acceptance and usage among patients and healthcare professionals.
In Brazil, user privacy and security rely on the “General Data Protection Law.” A
total of 72% of the apps included in the present review did not provide terms of use
or privacy policies to users. Thus, they did not comply with Brazilian data protection
rules, posing a potential risk to the security of user data.
Despite the availability of mHealth apps for monitoring sleep time in Brazil, evidence
regarding their effectiveness is limited. Only 2 of the 11 apps evaluated in the present
review have been tested and demonstrated partially positive results in studies that
were not randomized controlled clinical trials, being Snorelab: Grave seu ronco
[17]
[18] and SnoreClock - Você ronca?
[19] and the studies evaluated the accuracy of applications in detecting snoring.
Only the SnoreLab: Grave seu ronco application has been compared with polysomnography, with acceptable accuracy regarding
the measurement of especially loud snoring.[17] These mHealth applications for monitoring sleep time are indicated for self-management
of the user's sleep and do not replace medical examination,[24] as none of the 11 applications included in our analysis had their results compared
with polysomnography in terms the number of sleep hours.
Although the 11 apps evaluated do not have such validation, evidence suggests that
the accelerometers in smartphones can reliably assess sleep time when compared with
actigraph accelerometers.[25]
[26] Thus, it is possible that smartphone technology offers opportunities to support
sleep self-management through mHealth applications, while still being able to promote
healthy sleep habits, awareness, and home monitoring accessible to users.[27]
All of the 11 apps were developed for commercial purposes. However, 3 (SleepUp: Durma bem, Vigilantes do Sono, and Google Fit: monitor fitness) had greater credibility in the assessment using MARS compared with the other apps.
In addition to the team of sleep experts, SleepUp: Durma bem is the first platform to improve sleep with digital therapies clinically validated
and approved by Anvisa. The Vigilantes do Sono app is a startup accelerated by the Eretz.bio incubator at the Albert Einstein Israelita
Hospital and the Google Fit app worked in collaboration with WHO and AHA.
Strengths and Limitations
The strengths of our study include its systematic approach following established reporting
guidelines,[11]
[28] and the applicability of methods that can be used by other researchers aiming to
evaluate new applications or new versions of existing applications. Furthermore, MARS
is a simple, objective, reliable tool developed to classify and evaluate mobile health
applications,[9] with good to excellent reliability and high objectivity. This scale proved to be
adequate for assessing the quality of the sleep applications.[29] Additionally, the researchers who evaluated the apps using MARS underwent structured
training that resulted in high agreement between them, ranging from 80 to 100% on
the different subitems.
A limitation of our study is related to the rapid changes in the application market,
with the updating of existing applications and the launching of new ones. Our systematic
search covered applications launched or updated until May 2022 and, therefore, did
not include more recent updates or new apps released after the period. However, this
aspect can be a strong point, since this is the first and most recent review in the
period of its publication and, as such, the closest to the current situation of products
related to monitoring sleep time available at online stores in Brazil.
Conclusion
There were 11 relevant mHealth apps eligible for inclusion in this review. The sleep
monitoring apps currently available in Brazil are of moderate to good quality but
have limited credibility. The use of mHealth technologies to monitor sleep time is
a topic with considerable potential for future investigation but is a relatively new
and underexplored topic. Additionally, we highlight the importance of collaborations
between researchers, clinical professionals, patients, and developers for the creation
of new mHealth applications focused on Brazilian users and their sleep monitoring
demands.
The most advantageous applications identified in this study were Sleep Up: Durma bem, Vigilantes do Sono, and Sleepzy – Relógio Despertador. The first one offers a comprehensive educational content and diversity of resources,
such as the possibility of consulting experts. The second provides good informational
content and a variety of options to monitor sleep time, namely the synchronization
of data from the device itself, manual completion, and the monitoring of hours through
the accelerometer of the device, in addition to daily, rapid interaction with the
virtual coach. Lastly, Sleepzy – Relógio Despertador shows comparative and global statistics in relation to the users' average.
Future studies should evaluate the quality of the 3 most advantageous apps with potential
end-users. For such, the user version of the mobile application rating scale (uMARS)
is recommended as an objective tool that provides a reliable measure of the quality
of apps from the users' standpoint.[30]
