Utility of Belun Ring platform for the diagnosis of obstructive sleep apnea: a systematic review and meta-analysis.

PURPOSE: Level 1 polysomnography (PSG) is considered the gold standard test for diagnosing obstructive sleep apnea (OSA). The Belun Ring platform, a recently FDA-approved wearable device, is a potential alternative to PSG for diagnosing OSA. We conducted this systematic review and meta-analysis to assess the diagnostic accuracy of the Belun Ring Platform compared to PSG in adults.

METHODS

A systematic search of PubMed and Embase was conducted from database inception till 8th July 2025 to identify studies comparing the Belun Ring Platform with PSG in adults. A meta-analysis was performed to estimate the pooled diagnostic test characteristics.

RESULTS

Four prospective studies involving 339 patients (mean age 54.6 years; 62% males) were included. For diagnosing moderate-to-severe OSA (AHI ≥ 15), the Belun Ring showed pooled sensitivity of 0.92 [95% confidence interval (CI): 0.86-0.96], specificity of 0.81 [95% CI: 0.73-0.87], positive likelihood ratio of 4.84 [95% CI: 3.33-7.03], negative likelihood ratio of 0.10 [95% CI: 0.05-0.17], and diagnostic odds ratio of 50.36 [95% CI: 24.7-102.65]. For AHI ≥ 5, sensitivity was 0.97 [95% CI: 0.91-0.99], but specificity was lower at 0.18 [95% CI: 0.05-0.50]. For severe OSA (AHI ≥ 30), sensitivity was 0.66 [95% CI: 0.40-0.85], with a high specificity of 0.95 [95% CI: 0.91-0.97].

CONCLUSION

We conclude that the Belun Ring platform demonstrates high sensitivity for detecting OSA and excellent specificity (though poor sensitivity) for severe OSA, supporting its utility as an effective tool for diagnosing OSA in adults with suspected moderate to severe disease. It shows good diagnostic accuracy for moderate-to-severe OSA, but limited specificity for mild OSA, supporting its use as an adjunct to type I PSG for diagnosis of OSA.