Here's why Apple didn't need FDA clearance for Apple Watch Series 6 blood oxygen sensing

Posted:
in General Discussion edited October 2020
While Apple went to great lengths to garner government approval for Apple Watch Series 4's ECG feature, the company didn't do the same for a blood oxygen monitoring function on Apple Watch Series 6. Here's why.

Credit: Andrew O'Hara, AppleInsider
Credit: Andrew O'Hara, AppleInsider


When the ECG feature was introduced on the Apple Watch Series 4, Apple made note that it navigated a lengthy approval process to gain clearance from the Food and Drug Administration.

As is typical in the consumer electronics industry, the blood oxygen feature on the Series 6 doesn't have similar certifications. According to The Verge, that's because pulse oximeters, also known as blood oxygen monitors, are in a different FDA classification. As long as a company doesn't claim that the devices can diagnose diseases, it can sell one in the U.S. with little oversight.

Generally, a company has to submit documentation to the FDA confirming the a blood oxygen sensing product works as well as other devices already on the market. But Apple, and other smartwatches and health-focused platforms, took another route. If a company claims a pulse oximeter is only used for general "wellness" or just for fun, it doesn't need to go through any type of approval process.

"Apple Watch is already a powerful health tool with apps that measure heart rate and heart rhythm. And now adding blood oxygen brings in another valuable health measurement to users," said Apple health chief Sumbul Ahmad Desai at the time of the device's release.

The Verge notes that the FDA does get involved if a health feature seeks to influence the medical care that a user gets. Apple's ECG feature falls into this category, since it serves the specific purpose of detecting and alerting users to unusual heart rhythms.

To even get the ECG cleared, Apple needed to submit documents and data proving that it could accurately detect a medical condition. It could.

And although Apple and other health partners are currently in the midst of studying how pulse oximeters can aid in the management and control of disease, there aren't yet any firm reports suggesting that it provides accurate information.
jahbladeStrangeDays
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Comments

  • Reply 1 of 32
    tmaytmay Posts: 6,340member
    For aerobic exercise, it would be useful to be able to monitor SpO2 without that 15 second pause, and better yet, continuously, to correlate with other real time data capture like the barometer and GPS, and especially ECG. I'm guessing that isn't possible to do with the current Watch, but Apple may get there in the future.
    watto_cobra
  • Reply 2 of 32
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!


    *I bet they've thought of this!
    Alex1NGeorgeBMacwatto_cobra
  • Reply 3 of 32
    MplsPMplsP Posts: 3,931member
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!


    *I bet they've thought of this!
    Overnight pulse oximetry is useful in ruling out sleep apnea (i.e. if your sats don't drop you are significantly less likely to have OSA,) but its utility in diagnosing OSA is variable and depends on the pre-test probability based on several factors. As such it would be difficult for a company to market a device to screen for OSA.

    tmay said:
    For aerobic exercise, it would be useful to be able to monitor SpO2 without that 15 second pause, and better yet, continuously, to correlate with other real time data capture like the barometer and GPS, and especially ECG. I'm guessing that isn't possible to do with the current Watch, but Apple may get there in the future.
    Pulse oximetry is often subject to motion artifact making continuous readings during exercise difficult. In addition, exercise-induced hypoxia is rare in the absence of pulmonary disease. (when you exercise, it's increased CO2 that makes you short of breath, not decreased oxygen.)
    Alex1NllamaPascalxx
  • Reply 4 of 32
    This is pretty obvious given the fact that millions of Galaxy s7/8/9 and Note 8/9 with activated SpO2 measurement sensors were already sold in US in the past without an FDA certification.
    llama
  • Reply 5 of 32
    Maybe Elizabeth Holmes should have aimed for that type of certification 🤣
  • Reply 6 of 32
    StrangeDaysStrangeDays Posts: 12,879member
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!

    *I bet they've thought of this!
    I read somewhere it does blood oxygen readings during your sleep. Mine doesn’t arrive for another week so I can’t say. 
    watto_cobra
  • Reply 7 of 32
    fastasleepfastasleep Posts: 6,418member
    This is precisely what I was arguing in the other thread where people insisted that Apple should declare you have symptoms of COVID-19 — they *can't* for these specific reasons. Told you, dummies.
    cornchipStrangeDayswatto_cobra
  • Reply 8 of 32
    fastasleepfastasleep Posts: 6,418member
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!

    *I bet they've thought of this!
    I read somewhere it does blood oxygen readings during your sleep. Mine doesn’t arrive for another week so I can’t say. 
    It does, and doesn't require any coordination with the sleep app which I don't use (still using Sleep++ for now). Just looked up my data and you can highlight all data from during periods of sleep, etc.
    watto_cobra
  • Reply 9 of 32
    silvergold84silvergold84 Posts: 107unconfirmed, member
    This is my short video test about the precision of Apple Watch oxygen’s sensor. Its incredible for a smartwatch. I did test between it and the Masimo MightySat , for many the best product about oximeters. Clearly you have to live on correctly the Apple Watch and pay attention to don’t move during the measurements.  https://youtu.be/xg86EFsiJvQ
    StrangeDayswatto_cobra
  • Reply 10 of 32
    FoodLover said:
    This is pretty obvious given the fact that millions of Galaxy s7/8/9 and Note 8/9 with activated SpO2 measurement sensors were already sold in US in the past without an FDA certification.
    It's "pretty obvious" how FDA regulations apply to medical and health claims?  Huh.  I guess you have a different sense of intuition than us normal humans.
    StrangeDayswatto_cobra
  • Reply 11 of 32
    tmaytmay Posts: 6,340member
    MplsP said:
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!


    *I bet they've thought of this!
    Overnight pulse oximetry is useful in ruling out sleep apnea (i.e. if your sats don't drop you are significantly less likely to have OSA,) but its utility in diagnosing OSA is variable and depends on the pre-test probability based on several factors. As such it would be difficult for a company to market a device to screen for OSA.

    tmay said:
    For aerobic exercise, it would be useful to be able to monitor SpO2 without that 15 second pause, and better yet, continuously, to correlate with other real time data capture like the barometer and GPS, and especially ECG. I'm guessing that isn't possible to do with the current Watch, but Apple may get there in the future.
    Pulse oximetry is often subject to motion artifact making continuous readings during exercise difficult. In addition, exercise-induced hypoxia is rare in the absence of pulmonary disease. (when you exercise, it's increased CO2 that makes you short of breath, not decreased oxygen.)
    I live at almost 5K feet in Northern Nevada, and I do have some mild pulmonary issues, primarily asthma. I have taken a pulse oximeter with me to see how far into oxygen debt I go on short, steep, trail sections. That's the data I'm looking for.
    edited October 2020 GeorgeBMaccornchipwatto_cobra
  • Reply 12 of 32
    So far the implementation of the oxymeter has been a slight disappointment, in my case. Especially compared to how wonderfully something like the ECG application is implemented. Too glitchy too often, and fails to read the oxygen level 75% of the time.

    Weirdly, it needs the Watch to be somewhat loose on the hand (a "no-no" according to Apple itself, when it comes to BPM measurement, for example), and it needs to be loosened from the wrist and moved further up in the lower arm to get a clean reading. The hand also has to be PERFECTLY still, and fingers outstretched. Perhaps it's still getting used to my hand. Not the end of the world to do all this, but it's a suboptimal experience, overall.

    Hope there's a software fix of some kind, soon.
    edited October 2020 tmaymuthuk_vanalingamGeorgeBMac
  • Reply 13 of 32
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!

    *I bet they've thought of this!
    I read somewhere it does blood oxygen readings during your sleep. Mine doesn’t arrive for another week so I can’t say. 
    That it does. But the interval for automatic readings seems to be every six hours, which hasn't helped me at all. I already use a CPAP machine to assist with my OSA and was wondering how helpful the watch would be in monitoring overnight.

    So far, and admittedly I haven't taken a deep dive into what can be achieved, it hasn't been particularly useful in this regard. But it's early days, and once I get a useful amount of data I'll be performing some analysis with my GP for everything that's getting logged. The BP graphs are reasonably nice to look at, though. :D
    razorpitGeorgeBMaccornchipwatto_cobra
  • Reply 14 of 32
    ‘Team FDA?’
  • Reply 15 of 32
    razorpitrazorpit Posts: 1,796member
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!

    *I bet they've thought of this!
    I read somewhere it does blood oxygen readings during your sleep. Mine doesn’t arrive for another week so I can’t say. 
    That it does. But the interval for automatic readings seems to be every six hours, which hasn't helped me at all. I already use a CPAP machine to assist with my OSA and was wondering how helpful the watch would be in monitoring overnight.

    So far, and admittedly I haven't taken a deep dive into what can be achieved, it hasn't been particularly useful in this regard. But it's early days, and once I get a useful amount of data I'll be performing some analysis with my GP for everything that's getting logged. The BP graphs are reasonably nice to look at, though. :D
    I have sleep apnea and use a CPAP. If any one has experience using AW6 to monitor O2 saturation during sleep please post!
    watto_cobra
  • Reply 16 of 32
    FoodLover said:
    This is pretty obvious given the fact that millions of Galaxy s7/8/9 and Note 8/9 with activated SpO2 measurement sensors were already sold in US in the past without an FDA certification.
    It's "pretty obvious" how FDA regulations apply to medical and health claims?  Huh.  I guess you have a different sense of intuition than us normal humans.
    What do you mean by "us"? You can speak for yourself only and not for the rest of people here.
    Maybe you just didn't like the part that others have been offering SpO2 measurement sensors for a while? Sure you didn't :D 
    GeorgeBMaccornchip
  • Reply 17 of 32
    GeorgeBMacGeorgeBMac Posts: 11,421member
    tmay said:
    For aerobic exercise, it would be useful to be able to monitor SpO2 without that 15 second pause, and better yet, continuously, to correlate with other real time data capture like the barometer and GPS, and especially ECG. I'm guessing that isn't possible to do with the current Watch, but Apple may get there in the future.

    Even though its over 15 years old, my hospital grade SpO2 sensor takes less than 5 seconds to measure SpO2.
    I don't understand why Apple's has such a long lag time and I hope that they improve it.   But, right now, for tracking the effect of aerobic exercise on one's SoO2 level, it seems pretty worthless.   And, for me, completely worthless since it would be much quicker and easier for me to just use my own pulse ox at home.

    I can though see a benefit for somebody with impaired lung function (say from Covid or COPD) who is out and about without oxygen and this could be a way to monitor SpO2 levels while on the go.

    edited October 2020
  • Reply 18 of 32
    GeorgeBMacGeorgeBMac Posts: 11,421member
    MplsP said:
    ....
    tmay said:
    For aerobic exercise, it would be useful to be able to monitor SpO2 without that 15 second pause, and better yet, continuously, to correlate with other real time data capture like the barometer and GPS, and especially ECG. I'm guessing that isn't possible to do with the current Watch, but Apple may get there in the future.
    Pulse oximetry is often subject to motion artifact making continuous readings during exercise difficult. In addition, exercise-induced hypoxia is rare in the absence of pulmonary disease. (when you exercise, it's increased CO2 that makes you short of breath, not decreased oxygen.)

    i suspect that may depend on what type of exercise one is doing:   "moderate" vs "vigourous" vs "vigorous vigorous".  Typically those levels are measured by heart rate and its percent of its max because, well, that's the best we have while outside of a lab.

    For endurance athletes VO2Max (the ability of the body to take in oxygen, transport it to the muscles and burn it) is the primary measure of their ability.   To some degree it is heritable but mostly, for most, it is built with lots and lots of hard work.    And, while yes, it is true that the body signals to increase breathing by monitoring CO2 blood levels rather than O2 blood levels, the two go hand in hand:   as one goes up the other goes down and is mostly due to the lung's ability to clear the CO2 and oxygenate the blood.

    The process is:  the lungs oxygenate the blood while the mitochondria deoxygenate it (and replace it with carbon dioxide).   So, blood levels of O2 are important.

    Further, as demand increases beyond the ability of the blood to supply the muscles with oxygen the mitochondria shift from aerobic metabolism to anaerobic metabolism and that is an important shift for the athlete.   Aerobic metabolism can power the athlete for hours but once he shifts over into anaerobic his endurance is measured more in minutes.

    So yes, for endurance athletes, Oxygen and how much is available to the muscles in the blood is a very important measure.   One that I had hoped that Apple had provided.  And yes, it is possible to measure SpO2 on an ongoing basis during movement (you just need a secure sensor) and I'm surprised that Apple didn't do that (similar to how they measure heart rate during exercise).   I suspect that the lack of it may be due to limitations of battery life.  But, that's just a guess.

    For myself:  I had planned on buying a Series 6.  But, without a pulse ox that can measure my levels during exercise, I will wait.
    edited October 2020 tmay
  • Reply 19 of 32
    GeorgeBMacGeorgeBMac Posts: 11,421member
    This is precisely what I was arguing in the other thread where people insisted that Apple should declare you have symptoms of COVID-19 — they *can't* for these specific reasons. Told you, dummies.

    Actually, decreased Sp)2 levels are a late sign of Covid.   Increased heart rate predicts it earlier as the cardiorespiratory system try to compensate for the lung's inability to remove CO2 and oxygenate the blood.

    There had actually been proposals to gather mass resting heart rate data by geographic area from FitBits and Apple Watches in order to predict viral hotspots -- such as "resting heart rates increased 10% in Tulsa.   We need increase precautions in that area."
  • Reply 20 of 32
    StrangeDaysStrangeDays Posts: 12,879member
    inotrope said:
    I wonder if Apple could* combine Pulse oximetry and ECG with the sleep app. This could be interesting in indicating a risk of Obstructive Sleep Apnoea. Indeed, add in microphone snore/apnoea sensing on the 'phone (like popular sleep tracking apps have) and this could be really useful in indicating risk - correlate with a Health App based Epworth Sleepiness Score and already entered anthropomorphic data and could identify many presently undiagnosed OSA suffers (or at least highlight a risk and prompt a physician review). It's very under diagnosed!

    *I bet they've thought of this!
    I read somewhere it does blood oxygen readings during your sleep. Mine doesn’t arrive for another week so I can’t say. 
    It does, and doesn't require any coordination with the sleep app which I don't use (still using Sleep++ for now). Just looked up my data and you can highlight all data from during periods of sleep, etc.
    I have AutoSleep as well, but have been using the Apple sleep app since release as my primary. You can keep and use both, and while AutoSleep has more data points to review, such as HR and deep sleep and noise, etc, it is also more fidgety and (by nature) more complex. Even after years of use I still have to review/correct its interpretations of when I'm sleeping. I like how Apple's sleep app just kicks in at bedtime, turns off my display for me, and can present the night's or week's sleep summary right on my Watch. 
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