Physical Activity, Sleep, and Quality of Life in Pulmonary Arterial Hypertension: Novel Insights from Wearable Devices

Background: Reduced functional capacity and poor sleep quality are common in pulmonary arterial hypertension (PAH). We aimed to determine whether Fitbit-derived activity and sleep trends provide clinically meaningful information in patients with PAH. Methods: Our prospective observational study recruited patients with PAH from across the United States. Participants with PAH wore a Fitbit device for 12-weeks at baseline and a subgroup with one-year follow-up. A matched control cohort was generated from the All of Us Research Program and we evaluated changes in patients with PAH compared to matched controls. Results: Among 109 patients with baseline monitoring, average daily steps correlated with 6MWD (r=0.66, p < 0.001) and percent rapid eye movement (REM) sleep (r=0.26, p=0.016). In 44 PAH participants who completed baseline and one-year monitoring, there was a group-time interaction for percent light sleep (p=0.024) and percent REM sleep (p=0.034), which demonstrated that sleep quality worsened in patients with PAH over one year compared to matched controls. Average daily steps in patients with PAH decreased from 5200 IQR 3212 - 7458 at baseline to 4651 IQR 2912 - 6827 at one year (p=0.008). Compared to matched controls, activity levels were significantly lower in patients with PAH at both time points. Conclusions: Our study demonstrated the potential clinical value of wearable devices by showing that activity and sleep quality are reduced in PAH compared to matched controls and these measures decline over time. Future studies should investigate if monitoring these health behaviors detects early functional decline and whether targeted interventions may improve outcomes.