Feasibility of remote home monitoring with a T-shirt wearable device in post-recovery COVID-19 patients

Mapelli, Massimo; Vignati, Carlo; Gugliandolo, Paola; Fumagalli, Daniela; Agostoni, Piergiuseppe

BACKGROUND AND AIM OF THE STUDY During the last months, a pandemic by a novel coronavirus (Sars-Cov-2) has spread worldwide, putting hospitals under enormous pressure. Although follow-up data in this setting are scarce, early reports suggested that more than 80% of patients who had recovered from COronaVIrus Disease 19 (COVID-19) reported persistence of at least one symptom during follow-up. Therefore, a prolonged post-discharge monitoring for long-lasting effects is advisable. We assessed the feasibility of cardiorespiratory home monitoring through a wearable device in post-COVID-19 patients. METHODS In this pilot study, we enrolled patients with a confirmed diagnosis of COVID-19 after hospital discharge at home. A wearable device, consisting of a technologically advanced T-Shirt composed of ink-based dry electrodes linked to standard 12-lead ECG monitoring, 5 respiratory strain sensors, 1 accelerometer, a digital pulse oximeter (L.I.F.E.) was used. Monitoring was carried out for at least 7 days and comprehended a two-hour monitoring period a day during rest and a short exercise (6 minutes of brisk walking) and an overnight sleep monitoring on the last day. RESULTS Seventeen COVID-19 patients (male 8; age 54.4±15.3 year old; BMI 25.1±3.1) were enrolled at hospital discharge. They underwent 12.5±2.5 (7-17) days of monitoring. At hospital discharge, cardiorespiratory parameters were good, and no significant changes were observed between the first and the last day of monitoring (baseline vs last day: rest SpO2 96.91.8 vs 96.81.8, exercise SpO2 95.72.7 vs 95.71.8, rest respiratory rate 17.53.3 vs 17.63.5, exercise respiratory rate 25.56.5 vs 23.54.8, all p > 0.05). Twelve patients (70.6%) performed the nighttime monitoring. Among them, one showed an apnea-hypopnea index (AHI) of 20, suggestive of moderate sleep apnea syndrome. Small technical problems (e.g. connection of the device to the Wi-Fi line) were solved with remote assistance. CONCLUSIONS Our study demonstrated that a post-discharge home monitoring program for COVID-19 patients is feasible and safe. The L.I.F.E. T-Shirt device was able to collect a full set of cardiorespiratory parameters (i.e. heart rate, a full ECG, respiratory rate, SpO2), both at rest and during a brief exercise. We identified one patient without any previous disease who presented a sleep apnea syndrome. Further studies are certainly needed to assess the prevalence and the clinical impact of this complication in post-COVID-19 patients.