Oura Ring Gen 4 sensor data, not clinical measurementsN=1 case study, not validated for clinical decisionsHEV diagnosed Mar 18; Day 223 post-ruxolitinibMore
Consumer wearable data can support exploratory review only. The HEV diagnosis, temporally confounded with treatment start, remains a material confounder.

Anomaly Detection

ML-powered analysis: Matrix Profile, Isolation Forest, LSTM Autoencoder, SPC, tsfresh+DBSCAN
Anomaly Days
Elevated
29.0
Above 90th percentile
Feb 9 Detection
Detected
3/5
60% method agreement (N=1)
High Severity
Detected
21.0
Score >= 0.7
Moderate
Detected
235.0
Score 0.4-0.7
23% higher mean anomaly score after ruxolitinib (223 days)
Data period: 2026-01-08 to 2026-10-24 (292 days) · Known acute event: 2026-02-09
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Validation: February 9 Event

Methods Detected
Sufficient
3/5
Method Agreement (N=1)
Strong
60%

Detection results per method:

Matrix ProfileIsolation ForestLstm AutoencoderSpcTsfresh

The Feb 8-9, 2026 event is a clinically confirmed acute episode (HR spike to 113 bpm mean, RMSSD drop to 5.0 ms, readiness score 29). All anomaly detectors are validated against this event.

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Anomaly Timeline

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Statistical Process Control (SPC)

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LSTM Autoencoder - Training Curve

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Top Anomalies (Ensemble Scoring)

#DateEnsemble ScoreRMSSD (ms) HR (bpm)EfficiencyReadinessMethods (score > 0.5)
12026-07-110.9348.010658%394/5
22026-07-100.90219.813078%754/5
32026-02-09 **0.8735.011076%294/5
42026-05-310.85035.983-%634/5
52026-04-080.7919.111267%505/5
62026-02-100.78313.094-%-4/5
72026-06-040.77426.08458%654/5
82026-05-300.76623.59173%644/5
92026-06-020.75230.28175%663/5
102026-08-230.74922.89468%462/5
112026-07-170.74730.710084%703/5
122026-09-130.73917.77668%473/5
132026-06-010.73839.28784%803/5
132026-06-010.73839.28782%803/5
142026-08-250.73635.88388%684/5
152026-05-210.73325.49888%603/5

** = known acute event. Methods (score > 0.5) is a soft support count and is not the same as strict Feb 9 detection validation above.

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Clinical Interpretation

Summary

Five independent anomaly detection algorithms were run retrospectively on 292 days of biometric data from the Oura Ring (Jan-Mar 2026).

Validation Against Known Event

3 of 5 methods detected the acute event on Feb 8-9, 2026. The event ranks as #3 in ensemble anomaly scoring.

This event showed dramatic HRV collapse (RMSSD 5.0 ms), mean heart rate 113.9 bpm during sleep, and readiness score 29/100 with recovery index 4/100 - consistent with acute autonomic destabilization.

Top 5 Anomalies

  1. 2026-07-11
  2. 2026-07-10
  3. 2026-02-09
  4. 2026-05-31
  5. 2026-04-08

Clinical Relevance

Baseline RMSSD ~10 ms is critically low (parasympathetic deficiency threshold (Kleiger 1987 / Bigger 1992): 15 ms, population median: 49 ms, typical post-HSCT: 25-40 ms). Any further decline represents severe autonomic stress. Mean nightly heart rate >89 bpm meets IST criteria (>90 bpm at rest).

Limitations

  • Only 1 known positive event for validation (no specificity/PPV calculation possible)
  • LSTM autoencoder has limited training data (292 days) - results should be interpreted cautiously
  • Oura Ring measurements are not medical devices and have inherent noise
  • tsfresh analysis depends on the number of HR data points per night (varies significantly)
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Method Summary

MethodRuntimeFeb 9 DetectedDetails
Matrix Profile15.24sNo6 signals x windows
Isolation Forest0.33sYes30 anomalies / 292 days
Lstm Autoencoder6.3sYes22 anomalies, threshold=0.5586
Spc0.01sYesShewhart + CUSUM + EWMA
Tsfresh0.29sNo10 features, 1 outliers