Human-Centered AI in Sleep Health Management: Scoping Review of Stakeholder Perspectives and Co-Design Practices

Abstract

Abstract Background Sleep disorders represent a significant public health burden associated with cardiovascular and neurocognitive morbidities. While AI technologies offer potential for personalized sleep medicine, clinical integration remains limited. This translational disparity is often attributed to a lack of human-centered design, specifically insufficient stakeholder engagement in the development and implementation of these technologies. Current research frequently prioritizes algorithmic performance over usability and patient trust. Objective This scoping review systematically maps the extent and nature of human-centered AI (HCAI) research within sleep medicine across different AI modalities, evaluating how diverse stakeholders are involved in the design, validation, and implementation of AI tools, including patients, clinicians, and technologists. Methods Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, we searched 8 databases (PubMed, Web of Science, Embase, Scopus, IEEE Xplore, ACM Digital Library, APA PsycINFO, and CINAHL) for literature published up to June 18, 2026. We identified primary research describing the design, development, or evaluation of AI technologies for sleep health with explicit human-centered components. Included studies (n=34) were categorized based on AI technology type and the method of stakeholder engagement. Data were extracted and synthesized using a thematic analysis approach. Results Based on the included studies, the analysis reveals an uneven distribution of research focus across technological domains as descriptive patterns rather than definitive trends. Research on generative AI (GenAI) is predominantly restricted to downstream expert auditing of output accuracy (comprising 7/11, 64% of GenAI studies), with a noticeable gap in upstream participatory design involving patients. Conversely, deep learning research primarily focuses on technical explainable AI methods to address algorithmic opacity for clinicians, yet lacks progression to real-world clinical implementation. Mobile health and wearable technologies (17/34, 50%) demonstrate the most balanced HCAI ecosystem, evidencing a complete translational cycle from upstream co-design to downstream clinical implementation. Furthermore, an emerging trend is observed where AI is evolving from an automated diagnostic tool into an interactive therapeutic agent, with recent studies indicating that lay users may perceive responses from large language models as more empathetic than those from physicians. Conclusions Lacking formal quality appraisal, our findings reflect research activity patterns rather than confirmed clinical effectiveness. Nevertheless, this scoping review innovatively applies the HCAI framework to the sleep AI lifecycle. Unlike existing reviews prioritizing algorithmic performance metrics over usability, clinical workflow integration, and patient trust, this study systematically maps these essential sociotechnical factors. It contributes to the field by revealing distinct methodological disparities and the urgent need for upstream participatory design, particularly for GenAI. In the real world, establishing standardized protocols for human-AI interaction, ensuring algorithmic transparency, and addressing demographic biases are essential to foster the clinical trust required for effective AI adoption.