Smartphone-Based Virtual Agents Can Help the General Population Concerned by Sleep Complaints: A Proof-of-Concept Study During COVID-19 Confinement

Abstract

Background: The COVID-19 crisis induces psychosocial stress and sleep complaints that require early management. KANOPEE is a smartphone-based application, providing an interaction with a virtual agent dedicated to screen and deliver behavioral interventions to fight sleep disorders. This paper describes the feasibility study of this application, during the context of COVID-19 confinement in France.

Method: 2,069 users of aged 18 years and over downloaded the app during the inclusion period (between 22 April and 5 May 2020). Users first answered a screening interview based on the insomnia severity index (ISI) that was conducted by the virtual agent. If participants were positive for insomniac complaints (ISI > 14), they could join a two-stage intervention program: a) complete an electronic sleep diary for one week, and b) follow personalized sleep recommendations for 10 days. Measures collected included socio-demographic information, ISI and sleep/wake schedules; and acceptance and trust of the agent. 

Findings: Of all participants, 80% (n=1,574) completed the screening interview with the virtual agent. The virtual agent was well accepted by users regarding its usability, satisfaction, benevolence, and credibility. Of the 773 screened subjects who reported sleep complaints (ISI>14), 214 of them followed the first step of the intervention (34%). Of these, 47 (31%) followed the second step. Users who completed step 1 found that their insomnia complaints (p > .001) and nocturnal sleep improved significantly after one week. Subjects who completed step 2 also showed an improvement compared to the initial measure (p < ·001). The most severely affected subjects (ISI >21) did not respond to either intervention.

Interpretation: These preliminary results show that KANOPEE is a promising solution to screen populations for sleep complaints, and that it provides practical and effective behavioral advice for subjects reporting moderately severe insomnia.

Funding: LABEX BRAIN, EQUIPEX PHENOVIRT, and Region Nouvelle-Aquitaine.

Declaration of Interests: The authors declare no competing interests.

Ethics Approval Statement: Following prior approval by the University and Hospital scientific committees, we obtained authorizations to be registered on the University Hospital register for GDPR approval by the French authorities (CNIL). Informed consent was obtained from all persons downloading the app according to the General Data Protection Regulation and CNIL regulations.

Keywords: Sleep disorders, virtual agents, COVID-19 confinement, technology acceptance