TL;DR: How can I know if the SpO2 reading is in fact taken in optimal conditions ?

I wanted a new watch for exercise tracking, so I looked at Apple Watch 6. I was also excited about this SpO2 feature that the Apple Watch 6 has, even if I really don't need it. This feature is the main new feature that they are marketing their watch with. Just check out their web page and it is basically the headline for the watch. Also, in these covid themes, this is suiting, right ? So I bought the watch, and I know that this is not for "medical use". I am 35 years old and fit, I am very healthy and I exercise almost every day, and there is nothing wrong with me as I know. I tried the feature, and it always read between 87 - 91, suggesting that I might be hypoxic. Or in these times, considering my good health, that I might have COVID-19. I knew that this is probably not accurate, but what if the watch is right ? I developed a concern over a few hours, and I went out late at night to a pharmacy and bought a 100 euro medical grade pulse oximeter (SpO2). In that way, I could know for sure if I had to see a doctor to check if I have an unknown heart or lung issue, and yes, I could sleep at night if the oximeter says so! And guess what! My SpO2 is at 99%, steadily. Perfect! I kept taking readings with the SpO2 meter on my finger at the same time as with the watch, and the watch said that I had hypoxia almost all the time, while the SpO2 meter said I had 99% SpO2. I tried different tightnesses of the strap (tight, loose, in between), and I put the watch at different positions on my wrists, and further up on my forearm to get a larger contact surface, all kinds of things I tried. My pulse was between 60 - 90 bpm, and I was in room temperature, and had normal body temperature. However, sometimes the watch said I had 100%. And the next reading showed for example 90%.

So, basically, this gave me a lot of unnecessary concern. Apple customer service said that "well, it is not intended for medical use, so there is nothing we can do". I went through (spent 3 hours) everything with customer service, the HW diagnostics and the watch is perfectly fine, and there is nothing more they can do. They claim that erroneous reading might be because you are moving your arm or something like that a little bit. But how can you know ? Am I supposed to assume that low readings are because of the watch not touching the skin in the exact right way in optimal conditions ? How can I know if the reading is in fact taken in optimal conditions ?

What if someone is sick with COVID-19 and have hypoxia without knowing it, and the watch shows 100% ? Maybe that will make them delay their visit to the doctor and get worse ? Of course they might be aware that it is not a "medical device", but still, it can affect their perception and decision. And what is the point having such a feature if it doesn't work ?

In my case, I wasted 100 euros, hours of my time, and as I see it now, money on a watch. I want to return it because of this, but I can't because I bought it in a third party store. Apple basically says that it is my problem. It is not intended for medical use, and if someone has a concern, they should see a doctor. Well, it did indeed gave me concern, and for nothing. If it was not for the watch, I would not waste money on an oximeter or consulting a doctor - for nothing! What is the point with that ? I am sitting there with a watch with a main feature that doesn't work, and that tries to give me anxiety, and it is my problem.

But - worse, is that people might get erroneous assurances for their SpO2 levels. That could be in the worst case fatal in the time of COVID-19.

  • I’m voting to close this question because there doesn't seem to be a question here. – Lizzan Oct 1 '20 at 10:55
  • For example : "How can I know if the reading is in fact taken in optimal conditions ?" – user1511956 Oct 1 '20 at 11:00
  • I would say the question would work better if it’s about three sentences long. You could then post an answer with all the backstory or how you come to your conclusion on what you do with the watch once you get an answer to how to determine if the results are properly calibrated. See How to Ask and tour if no good answers surface in a week or so... – bmike Oct 1 '20 at 12:37

As much as I understand your frustration, Apple mentions the limits in the small print at the bottom of https://www.apple.com/watch/:

Blood Oxygen app measurements are not intended for medical use, including self-diagnosis or consultation with a doctor, and are only designed for general fitness and wellness purposes.

  • Yes, I am aware of that, but that doesn’t answer the question at all – user1511956 Oct 2 '20 at 9:03
  • @user1511956 You are expecting something from Blood Oxygen measurements for which the functionality hasn't been designed. So even under (unknown) best conditions the result will not provide medical value. – nohillside Oct 2 '20 at 9:20
  • Yes, exactly, it should be more explicit that the feature doesn't really work. It is easy to think that it does. – user1511956 Oct 2 '20 at 11:09

I have had similar conversations with people about other aspects of Apple Watch - heart rate not matching expectations, people comparing their activity with another and feeling the calories or heart rate or distance travelled aren't the same, so hopefully some of that perspective can help you and others.

I find the largest value for my health data is longitudinal tracking of my stats with my watch and my band. Yes - an instant value is nice when perfect, but over time, those measurements are easier to trust as you see how they vary.

Each of us has different mechanics, melanin pigmentation, and bone structure. The watch is a sensor and it surely aims to get a good result, but your results will naturally be different from mine. What doesn't change is your results day after day and week after week with the same sensor will give you good information how your body is changing.

Specifically, pulse rate and SpO2 are visual sensors, so band tightness, interference due to body hair, transdermal fat content, skin pigmentation, current moisture levels, and your specific capillary structure and location of anterior arteries and veins on your watch bearing wrist should affect the readings. I'm sure Apple tried to control for this, but the variation in humans is going to make some people have larger error than others. Hopefully you are able to get decent results once you control for the elements you have control over.

This error and confirmation of accuracy happens all the time in physiological labs for any medical measurement. The instruments are almost always very precise (measuring temperature to a tenth of a degree) but not always accurate - three devices all read 37.2° (or 99.0° in a few countries).

Same with estimating your stride length - if you are training against yourself - it doesn't matter if the reality is your steps are 1.4m and it's measures 1.2m if you're just looking at how far you go compared to yesterday and if you went further or faster than you did in the workout yesterday. Basically, don't overlook the value in longitudinal data even if it's not absolutely perfect.

My hunch is nailing the calibration is what's expensive and pricey (like building several redundant sensors). Many instruments that are cleared for medical use have formal calibration procedures, which is one reason the Apple Watch isn't cleared for that level of diagnosis. It lacks the ability to perform a calibration step if you determine it's not precise and accurate enough for you.

Also, this assumes the watch is perfect and the sensors are perfect. If over time you can't get a good pulse read / SpO2 read - maybe Apple would exchange it, but I'd hate for you to go through a swap if the device is working as designed and it's just not what you need where your body and Apple's design meet.

  • Well, the problem with "longitudinal tracking" is that my daily range of SpO2 values are usually always down to 90, or even less sometimes (which is wrong). Thus, that makes the feature useless. It is basically saying that my range is between "possibly seriously sick to perfectly all right". Simple measurements are often 10 percent off when comparing to a real oximeter. A couple of percentages in difference in SpO2 is significant.You cannot play around with that. That is completely different than a step length of 1.2 m vs 1.4 m, or a couple of BPM in heart rate for example. – user1511956 Oct 2 '20 at 18:26
  • If those are your results, I can see how you're disappointed @user1511956 I'm not saying you're wrong - just what I value from the watch. Using it for some time so I can know the confidence I place in any of it's health / fitness / environmental measurements. – bmike Oct 2 '20 at 18:52

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