PONE-D-24-04849Artificial Intelligence Augmented Home Sleep Apnea Testing Device Study (AISAP study)PLOS ONE

Dear Dr. Sharma,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

==============================

ACADEMIC EDITOR: 

•  Hard Recommendations:
• Please mention name of the device if possible.
• The introduction should be made stronger by mentioning recent research that AI can fill the gap of underdiagnosis of sleep disorders. The discussion and conclusion can be made stronger by mentioning that this AI augmented WVU device can help in development of clinical prediction models that rely on accurate oxygen desaturation index (ODI) especially in cardiac patients planning to have cardiac procedures such as CABG or other procedure. 
• SUGGESTIONS:
• The discussion section could further explore how the WVU device might be integrated into clinical care pathways for sleep apnea. What are the potential benefits and challenges of implementing this device in practice?
• Commenting on cost-effectiveness: If data are available, the authors could discuss the potential cost-effectiveness of the WVU device compared to traditional HSAT. This is an important consideration for adoption of new technology.
• Expanding the limitations section: The authors could mention any potential limitations related to the AI algorithm, such as the need for external validation on other datasets or the potential for bias if the training data were not representative.
• Discussing future directions
• Enhancing figures: While the figures are clear, some additional annotations or labels could help guide the reader's interpretation.

==============================

Please submit your revised manuscript by May 16 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Harpreet Singh Grewal

Academic Editor

PLOS ONE

Journal requirements:

When submitting your revision, we need you to address these additional requirements.

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and

https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Thank you for stating the following financial disclosure:

“This work is supported in part by funds from the National Science Foundation (NSF: Award # 2125872)”

At this time, please address the following queries:

a) Please clarify the sources of funding (financial or material support) for your study. List the grants or organizations that supported your study, including funding received from your institution.

b) State what role the funders took in the study. If the funders had no role in your study, please state: “The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.”

c) If any authors received a salary from any of your funders, please state which authors and which funders.

d) If you did not receive any funding for this study, please state: “The authors received no specific funding for this work.”

Please include your amended statements within your cover letter; we will change the online submission form on your behalf.

3. In the online submission form, you indicated that your data will be submitted to a repository upon acceptance.  We strongly recommend all authors deposit their data before acceptance, as the process can be lengthy and hold up publication timelines. Please note that, though access restrictions are acceptable now, your entire minimal  dataset will need to be made freely accessible if your manuscript is accepted for publication. This policy applies to all data except where public deposition would breach compliance with the protocol approved by your research ethics board. If you are unable to adhere to our open data policy, please kindly revise your statement to explain your reasoning and we will seek the editor's input on an exemption.

4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information.

5. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Data Access: the authors have not made all data fully available without restriction. In the Data Availability statement, the authors state:

"Data are available from the WVU Institutional Data Access / Ethics Committee (contact via email) for researchers who meet the criteria for access to confidential data"

This indicates there are some restrictions on openly sharing the underlying data. Researchers can request access through the WVU Institutional Ethics Committee, but would need to meet certain criteria to obtain the confidential data.

Minor Refinements:

Expanding the introduction: The authors could provide a bit more context on the current limitations of home sleep apnea testing (HSAT) devices and the potential advantages of the WVU device. This would help highlight the significance of their work.

Providing more details on the WVU device: The methods section could include some additional technical specifications about the WVU device, such as the specific sensors used, sampling rates, or key components of the AI algorithm. This would allow readers to better understand and potentially replicate the technology.

Reporting confidence intervals: In addition to the point estimates for accuracy, sensitivity, specificity, etc., the authors could report 95% confidence intervals. This would provide a measure of the precision of these estimates.

Discussing implications for clinical practice: The discussion section could further explore how the WVU device might be integrated into clinical care pathways for sleep apnea. What are the potential benefits and challenges of implementing this device in practice?

Commenting on cost-effectiveness: If data are available, the authors could discuss the potential cost-effectiveness of the WVU device compared to traditional HSAT. This is an important consideration for adoption of new technology.

Expanding the limitations section: The authors could mention any potential limitations related to the AI algorithm, such as the need for external validation on other datasets or the potential for bias if the training data were not representative.

Discussing future directions: The conclusion could outline some key next steps for research, such as validating the device in a larger, more diverse population or conducting studies on the impact of the device on patient outcomes.

Enhancing figures: While the figures are clear, some additional annotations or labels could help guide the reader's interpretation. For example, labeling the sensitivity and specificity directly on the ROC curves.

Reviewer #2: Dear authors, thanks for bringing this research to show the importance of new device capable of measuring oxygen level in people with different skin colors with fair and comparable accuracy with FDA approved device. It would be great to mention the name and model of FDA approved device. The introduction can be made stronger by mentioning recent research that AI can fill the gap of underdiagnosis of sleep disorders. The discussion and conclusion can be made stronger by mentioning that this AI augmented WVU device can help in development of clinical prediction models that rely on accurate oxygen desaturation index (ODI) especially in cardiac patients planning to have cardiac procedures such as CABG or other procedure. There are minor typo errors such as full stop after PPG at one place. The date format in methods can be modified to US standard. Otherwise, well written article!

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: Yes: Ankit Virmani

Reviewer #2: Yes: Ram K Verma

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Artificial Intelligence Augmented Home Sleep Apnea Testing Device Study (AISAP study)

PONE-D-24-04849R1

Dear Dr. Sharma,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Harpreet Singh Grewal

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: