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The Self-Efficacy Measure for Sleep Apnea (SEMSA) is a 26-item questionnaire that investigates perceived risks, outcome expectancies and self-efficacy, i.e., the confidence to undertake treatment, in the context of continuous positive airway pressure (CPAP) interventions for sleep apnea syndrome. This questionnaire can be considered too lengthy for clinical practice; therefore, a shortened version is needed. 290 adults undergoing CPAP treatment completed the SEMSA-26. An item reduction process took into account both the results of statistical analyses and the expertise of a steering committee. Construct validity, reliability and external validity were tested for a 15-item short version. Additionally, CPAP adherence (usage more than 4 h per night) was collected, and receiver operating characteristics analyses were performed to establish the cut-off point of the SEMSA-15 that would best classify patients depending on their adherence. The structure of the SEMSA-15 was confirmed by principal components factor analysis. Cronbach’s alpha coefficients ranged from 0.66 to 0.86. The SEMSA-15 dimension scores were highly correlated with their respective SEMSA-26 dimension scores. The self-efficacy sub-score of the SEMSA-15 obtained the best classification performance, with a cut-off point of 2.78 to predict CPAP adherence. The SEMSA-15 seems to be appropriate for use in clinical practice to investigate beliefs and perception of self-efficacy in CPAP interventions. It is, therefore, a useful tool to predict long-term adherence to treatment.

Sleep apnea syndrome treatment relies primarily on continuous positive airway pressure, which requires a homecare follow-up. Excessive daytime sleepiness is a key symptom to be measured during follow-up, and there is a need for more easy-to-administer, ecological and engaging tools to assess it. Virtual agents have shown their effectiveness in performing clinical evaluation in a medical environment. A virtual agent assessing excessive daytime sleepiness via the Epworth Sleepiness Scale has been tested at home by 102 patients treated by continuous positive airway pressure (CPAP) and their homecare providers. Acceptance and trustworthiness of the agent, as well as the influence of demographics and clinical characteristics of patients, were investigated. Results showed that both patients and homecare providers reported a positive attitude towards the virtual agent, which was found to be usable, satisfactory, credible and benevolent. Homecare providers reported that it was not a burden to their working routine. Positive regression coefficients were found between patients' and homecare providers' attitudes towards the virtual agent. We found no influence of patients' demographics and clinical characteristics on their acceptance of the virtual agent. This shows that virtual agents are well accepted by patients and homecare providers, independently of their demographics and clinical characteristics. Positive regression coefficients observed between patients' and homecare providers' perceptions of the agent indicate that the opinions of both influence acceptance of the virtual agent in a homecare context. Virtual agents are new innovative digital solutions to be considered in homecare follow-up of apneic patients treated by CPAP.

International audience; Ambient Assistive Living (AAL) technologies provide promising solutions to support aging-in-place but still lack ecological validation. Frail older Individuals (FIs) are at high risk of losing their autonomy but are also acknowledged to be an optimal target population for dependency prevention based on environmental supports. In this context, a recent study revealed some promising short-term benefits of an AAL platform in supporting FIs’ everyday functioning and releasing caregiver burden. Research aim: Complementarily to this first study, we aimed to address near and far effects of an AAL platform on FIs’ everyday functioning and caregiver burden. Method: HomeAssist is an AAL platform providing environmental support thanks to services including activity verification, safety alerts, reminders, communication and leisure activities. HomeAssist efficacy has been evaluated in a field study including a nine-month deployment in the home of sixteen cognitively healthy (MMSE > 25) FIs living alone. Several efficacy measures were taken and compared to a control group (n=16), matched by age, gender, cognitive functioning and frailty condition. These measures included FIs’ autonomy (self-reported and reported by a caregiver) and caregiver burden (for supporting FIs’ autonomy and professional burnout) and were assessed at baseline, six, and nine months later. Results: Our results indicated that: (1) FIs’ autonomy reported by caregivers is improved over time for the equipped group, with a greater extent after 9 months; (2) FIs’ self-perception of everyday functioning remained constant after 9 months for the equipped group, whereas it slightly decreased for the control group; and (3) caregivers reported less burden across time in the equipped group compared to control group; while HomeAssist intervention did not significantly impact professional burden. Conclusion: Taken together, this suggests that near effects of HomeAssist are not only due to novelty, but rather benefits from HomeAssist intervention.

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 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.

Psychiatric diagnostic relies on physician's ability to create an empathic interaction with the patient (i.e., engage the patient in the conversation with empathic sentences, while keeping an emotional distance) in order to accurately extract semiology (i.e., clinical manifestations). Virtual patients (VPs) offer new ways to train these skills but need to be validated in terms of accuracy to measure the skills of interest, and be perceived positively by its users. We recruited 34 medicine students, who interacted with a VP suffering from depressive disorders. Results suggest good abilities for the students to use empathic sentences to communicate with the VP, but results varied regarding semiology extraction, students having a specialty in psychiatry performing better than their counterparts. Additionally, results suggest that students managed to keep an emotional distance during the interaction with the VP, but they let their emotions out when answering semiology questions. Positive feedbacks and limitations raised by students during debriefing interviews provide suggestions for improvements and ideas for future works.

Background The COVID-19 crisis and consequent confinement restrictions have caused significant psychosocial stress and reports of sleep complaints, which require early management, have increased during recent months. To help individuals concerned about their sleep, we developed a smartphone-based app called KANOPEE that allows users to interact with a virtual agent dedicated to autonomous screening and delivering digital behavioral interventions. Objective Our objective was to assess the feasibility of this app, in terms of inclusion rate, follow-up rate, perceived trust and acceptance of the virtual agent, and effects of the intervention program, in the context of COVID-19 confinement in France. Methods The virtual agent is an artificial intelligence program using decision tree architecture and interacting through natural body motion and natural voice. A total of 2069 users aged 18 years and above downloaded the free app during the study period (April 22 to May 5, 2020). These users first completed a screening interview based on the Insomnia Severity Index (ISI) conducted by the virtual agent. If the users were positive for insomnia complaints (ISI score >14), they were eligible to join the 2-stage intervention program: (1) complete an electronic sleep diary for 1 week and (2) follow personalized sleep recommendations for 10 days. We collected and analyzed the following measures: sociodemographic information, ISI scores and sleep/wake schedules, and acceptance and trust of the agent. Results Approximately 76% (1574/2069) of the app users completed the screening interview with the virtual agent. The virtual agent was well accepted by 27.4% (431/1574) of the users who answered the acceptance and trust questionnaires on its usability, satisfaction, benevolence, and credibility. Of the 773 screened users who reported sleep complaints (ISI score >14), 166 (21.5%) followed Step 1 of the intervention, and only 47 of those (28.3%) followed Step 2. Users who completed Step 1 found that their insomnia complaints (baseline mean ISI score 18.56, mean ISI score after Step 1 15.99; P21) did not respond to either intervention. Conclusions These preliminary results suggest that the KANOPEE app is a promising solution to screen populations for sleep complaints and that it provides acceptable and practical behavioral advice for individuals reporting moderately severe insomnia.

This study examines the process of learning to walk from a functional perspective. To move forward, one must generate and control propulsive forces. To achieve this, it is necessary to create and tune a distance between the centre of mass (CoM) and the centre of pressure (CoP) along the antero-posterior axis. We hypothesize that learning to walk consists of learning how to calibrate these self-generated propulsive forces to control such distance. We investigated this question with six infants (three girls and three boys) who we followed up weekly for the first 8 weeks after the onset of walking and then biweekly until they reached 14-16 weeks of walking experience. The infants' walking patterns (kinematics and propelling forces) were captured via synched motion analysis and force plate. The results show that the distance between the CoM and the CoP along the antero-posterior axis increased rapidly during the first months of learning to walk and that this increase was correlated with an increase in velocity. The initial small values of (CoM-CoP) observed at walking onset, coupled with small velocity are interpreted as the solution infants adopted to satisfy a compromise between the need to generate propulsive forces to move forward while simultaneously controlling the disequilibrium resulting from creating a with distance between the CoM and CoP.

International audience; Supporting independent everyday functioning of older adults is a major challenge for aging in place. In particular, communication and social activities need support to prevent social isolation, cognitive and psychosocial well-being decline, and a risk of depression. This paper focuses on how technology can bring social support to isolated older-old adults (over 75 years old) and allow them to communicate with members of their social network. We present the design of an accessible and engaging email application dedicated to this population. We propose design principles based on the older adults' specificities and then use these principles to develop a tablet-based email application. We conducted a field study to evaluate our email application during 9 months. We equipped 13 community-dwelling old-older adults with a touchscreen tablet and our application at their home (compared to 13 control counterparts). This field study validates our design principles as shown by the effectiveness and efficiency gained by the participants in using our application. Moreover, we reveal the influence of health indicators in the usage behaviors and the long-term use of our application.