By Chaunie Brusie, RN, BSN

With a background in technology and big data, scientist Azizi A. Seixas, PhD, has made innumerable contributions to sleep health and medicine overall. 

But despite his long list of accomplishments (and accolades), Seixas is insistent that his work—and successes—can be summarized by a simple word: innovation. 

“I want to be able to tackle some of our most challenging healthcare, wellness, and life science questions, and I believe innovation is the way to do that,” Seixas says. As interim inaugural chair of the department of Informatics and Health Data Science at the University of Miami Miller School of Medicine, founding director of The Media and Innovation Lab (“The MIL”), associate director of the Center for Translational Sleep and Circadian Sciences, and director of Population Health Informatics at the Institute for Data Science and Computing, Seixas frequently peers through a sleep research lens. 

He employs innovation to look for processes to solve problems, focusing on health data to drive solutions. “It gives us an opportunity to really position sleep and circadian rhythms and biology in a whole different light,” he says.

Sleep Health

For Seixas, an interest in sleep health was stoked during a National Heart, Lung, and Blood Institute training program for underrepresented minorities in science, technology, engineering, and medicine. The program targeted behavioral medicine and sleep, and it introduced Seixas to how sleep impacts health outcomes and vice versa. 

Since then, much of his focus has been on sleep health, disparities in sleep, and the connection of sleep quality to health conditions and measurable biomarkers. 

Sleep is an “enigma,” he says, because it’s the one health behavior with a literal unconscious component. While there are factors you can control about sleep, at some point, “the body gets to take over and say, ‘Hey, I’m in charge now,’” Seixas says. So he focuses on ways scientists and sleep physicians can improve sleep, as well as educating on how the general public perceives the importance of sleep. 

“It’s a balance between science and pop culture,” he says. 

In his work as the founding director of The MIL, Seixas and his team provide sleep health education in innovative ways, from video animation education to integrating artificial intelligence (AI) text to video instructions for study participants to leveraging social media to training peer health educators on sleep apnea treatments. 

“That’s a component in the treatment and solution continuum,” Seixas says. “That can increase access, then an acceptance of treatments, and then adherence.”

Personalized Population Health

In keeping with his mission of innovation, Seixas and his team focus on research and interventions at the ground level.

“Some of the work that we’ve done may not be in New England Journal of Medicine because it’s very folksy,” he says. “By that same means, we talk to community members wherever they are, whether they’re at a church or a synagogue or a mosque or go to their homes or a barber shop or a beauty salon or a laundromat or wherever—that’s where we go.”

Much of Seixas’ work has focused on the Black and Hispanic communities, where his research has uncovered significant health disparities in sleep, including quality, efficiency, timing, and circadian rhythms.¹ Seixas believes innovation is necessary to both recognize and try to bridge research gaps. 

“Focus more on precision and personalized population health,” says. “That’s a framework that I coined, and that has been the framework and the lens through which you look at all of our work—making it personalized at the population level.”

For example, one investigation in people who had a first stroke used machine learning to develop a predictive classification model of stroke, which clinicians could potentially use to personalize behavioral stroke prevention strategies. While the traditional population health-based approach is to prescribe every patient the same behavioral strategies: the blanket finding that more than 10 minutes of moderate or vigorous physical activity, about 5 to 6 times per week, and 7 to 8 hours of sleep is linked with lower self-reported stroke prevalence. But because several sleep duration and physical activity combinations were linked with reduced stroke risk in the study, Seixas posits that stroke prevention recommendations can be personalized.² 

If a woman can’t get 7 to 8 hours of sleep (due to occupational, social, and/or personal demands), her personalized stroke prevention strategy could be to engage in vigorous physical activity for 31 to 60 minutes six times a week. But a man who gets 7 to 8 hours of sleep may be advised that he only needs to engage in moderate physical activity five times a week—to have the same risk of a future stroke as the woman who sleeps less.²

Joining Seixas at peering through a personalized population health lens are colleagues including Girardin Jean-Louis, PhD. Their Determinants of Insufficient Sleep in Rural-Urban Settings (DORMIR) Study focuses on urban and rural sleep disparities, specifically the cardiovascular disease disparities among urban and rural Latinos. 

“We find that racial-ethnic minorities in rural areas are even more forgotten than urban racial-ethnic minorities,” Seixas says. “We want to give the voiceless a voice, and we do that through our research and through our advocacy.”

Seixas is big on personalization as both a component and driver of healthcare because he has seen its impacts. “Even though research says you have to be rigorous and systematic when you’re doing work in a community, you have to be flexible,” he says. “Leadership is best executed in poetry and prose, and that’s how we do our science. Science is best executed in poetry and prose. Prose has a very descriptive protocol to make it clear to people, but it’s not just what you say, it’s how you say it and when you say it. That’s the poetry and that’s how we do our research.”

Innovation in Health Technology

Part of what Seixas says is his team’s “claim to fame”—for which it won the Tipping Point Award from Malcolm Gladwell and T-Mobile—is the construction of a remote health monitoring system called The MILbox (“MIL” stands for The Media and Innovation Lab), a physical box comprised of Internet of Things (IoT) devices, including smartwatches, an actigraph, a FitBit, an ambulatory blood pressure monitor, an air quality device, and a ring-based on cardiopulmonary coupling science. The MILbox is sent to a participant’s home, where the devices capture sleep and wake activities over seven days. The devices also monitor cardiometabolic clinical blood biomarkers to create a health profile.

“We believe in real-world data,” Seixas says. “More of healthcare occurs outside of our brick-and-mortar healthcare system and our research facilities. I want to study people in their natural habitat.” The team is already halfway to its goal of distributing 1,500 MILboxes. 

His team’s work utilizing health data has expanded in the AI sphere, where they have introduced augmented reality cognitive assessment tools, including identifying 800 digital biomarkers that can predict mild cognitive impairment and dementia six to 10 years ahead of symptoms onset.³ 

“That’s the precision of personalized population health framework,” Seixas says. “It’s like a translation of taxonomies and a continuum starting with discovery. Can we find unique, novel etiologies of disease? And we try and do that through a variety of different ways, from traditional devices, self-reports to IoT devices as well as wearables?” 

Seixas a “big thinker” and has novel approaches to data collection, says his colleague Alberto R. Ramos, MD, MS, FAAN, FAASM, a professor of Clinical Neurology and the research director of the sleep medicine program at the University of Miami, who has worked with Seixas for over a decade. “He has brought a very, very novel way of thinking about how to deal with sleep problems,” Ramos says. “It’s important to do everything in a very controlled laboratory setting within the hospital or research center, but health and disease happen ‘out there’ for a lot of people, so he has figured ways to reproducibly and accurately obtain a lot of data from participants in their own environment.”

Ramos is partnering with Seixas on applying innovation to “21st-century issues.” He explains, “We are in very exciting times because preserving brain health is going to be extremely important and sleep is a great venue to know how healthy your brain is and potentially modify [sleep] to improve brain health.”

A goal for an overall picture of health, adds Seixas, is to create a “digital twin” from individual, long-term, and continuous head-to-toe health data combined with machine learning to construct predictive models. AI can be applied to an individual’s digital twin to test treatments in a simulated world, so a physician could then provide each patient with a recommendation calculated to produce the best outcome for him or her personally in the real world—instead of prescribing treatments based on outcomes across a general population. 

Digital twin technology could also provide detailed health insights, including big-picture health analysis such as identifying declining brain health, as well as smaller-scale warnings, such as when someone is going to get a cold or even if they’re in store for a poor night of sleep. 

“That’s where the precision medicine approach comes from,” Seixas says.

Public Advocacy

For his innovation and work in the digital health space, Seixas was recently awarded the Presidential Early Career Award for Scientists and Engineers, presented by President Biden. 

“This is huge for our school and the university and for sleep as well,” Seixas says. “I’m blessed and honored to be a part of the wonderful team that we have and the incredible work that we’re doing. We’ve just started to scratch the surface here.”

The work Seixas has done intersecting health data with solutions for the future is represented in one of his other passion projects, the Harmoni Alliance, which aims to leverage health data to improve the aging experience. Although the group was not able to secure initial grant funding, Seixas believes the group’s mission is needed because it hopes to serve as a way to invest in technology and data, especially for low and middle-income countries. 

“That’s where a lot of my public advocacy comes from because the global south represents 80% of the world’s population, and yet most of the technology that we create only bears in mind the global north,” he says. “There are tremendous opportunities, not just in terms of health, but in terms of sleep, because sleep health disparities aren’t just confined to the United States.”

And at the core of all he does, Seixas believes innovation is simply a means to serving others. 

“We have methodological and disease domain expertise, but underneath it all, we’re really here to serve,” he says.

References

1. Narcisse MR, Refinetti R, Seixas A, et al. 0615 Racial/ethnic and sex differences in circadian rest-activity rhythm patterns: Findings from a sample of the US population. Sleep. 2023 May. 46(suppl_1):A270

2. Seixas AA, Henclewood DA, Williams SK, et al. Sleep duration and physical activity profiles associated with self-reported stroke in the United States: Application of Bayesian belief network modeling techniques. Front Neurol. 2018 Jul 19;9:534.

3. Seixas AA, Rajabli F, Pericak-Vance MA, et al. Associations of digital neuro-signatures with molecular and neuroimaging measures of brain resilience: The altoida large cohort study. Front Psychiatry. 2022 Aug 9;13:899080.

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