{"id":49385,"date":"2023-06-30T10:46:00","date_gmt":"2023-06-30T10:46:00","guid":{"rendered":"https:\/\/biomedpharmajournal.org\/?p=49385"},"modified":"2023-07-11T06:26:31","modified_gmt":"2023-07-11T06:26:31","slug":"impact-of-heart-rate-variability-on-physiological-stress-systematic-review","status":"publish","type":"post","link":"https:\/\/biomedpharmajournal.org\/staging\/vol16no2\/impact-of-heart-rate-variability-on-physiological-stress-systematic-review\/","title":{"rendered":"Impact of Heart Rate Variability on Physiological Stress: Systematic Review"},"content":{"rendered":"\n

Introduction<\/strong><\/p>\n\n\n\n

The heart generates an electrical signal called an electrocardiogram (ECG). The electrical impulse drives the human heart’s muscles to compress and decompress blood in a similar cardiac cycle. cardiac cycle1<\/sup>. The ECG signal is a useful tool for a variety of non-invasive biomedical applications, including heart rate estimation, heart rate monitoring, emotion recognition, biometric identification, and cardiac anomaly diagnosis 2,3<\/sup>. The electrodes can be used to identify electrical impulses coming from different parts of the heart4<\/sup>. The ECG measures heart rates and rhythms, including irregular or regular heartbeats5,6<\/sup>. Heart rate variability (HRV) is the term used to describe the time gap between subsequent heartbeats, and the standards were established by the Taskforce of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology two decades ago7<\/sup>. HRV analysis is a tool for assessing cardiovascular processes in close touch with the parasympathetic system, whose activity is observed non-invasively because it is connected to the body’s heart rate and muscular activity8<\/sup>. HRV analysis has utilized both linear and nonlinear techniques 9<\/sup>.By revealing the difference between consecutive heartbeats and the interval between them, this fluctuation can provide an evaluation of a person’s autonomic nervous system activity10,11<\/sup>. For determining autonomic alterations in a range of functional and clinical problems, it is one of the most straightforward, non-invasive, and accurate tests available12<\/sup>. HRV has been regarded as declining when sympathetic activity increases, parasympathetic activity decreases, or both13,14<\/sup>. Stress, according to Hans Selye, is “a response to changing intended to maintain the homology or stability that the body has managed to maintain despite the stimuli intended to undermine the body’s ability to maintain both mental and physical homeostasis and stabilization”15<\/sup>. In addition, stress was described as a maladaptive condition that results in acute or long-term psychological, behavioral impairment, and physical  because sympathetic nervous system is overactive 16<\/sup>. Due to a number of challenges, finding stress biomarkers is still a difficult effort for academics and physicians. The absence of agreement on the concept of stress is one barrier. Furthermore, there is a lack of a thorough structure for comprehending how organisms interact with their environments and modify to changing conditions 17<\/sup>. There isn’t yet a single universal method for assessing stress. Numerous research has looked at biological markers (such as cortisol and amylase) and used established stress measuring techniques (such as body change position and psychological evaluations of stress). The sympathetic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis are the main pathways via which psychological stress affects the body 18<\/sup>. The SNS and parasympathetic nervous system, in conjunction with the ANS, quickly promotes physiological changes (PNS). The sympathetic response to stress, also known as the “fight-or-flight reaction,” is encouraged by the PNS by reducing the inhibitory effect19<\/sup>. The HPA axis, which is activated during the stress response, causes a number of endocrine changes to begin with the production of corticotropin-releasing hormone from the hypothalamus20<\/sup>. By blocking or suppressing the SNS and HPA axis, the PNS specifically plays a significant role in reducing the stress response in people. Stress is linked to changes in autonomic activity that interfere with homeostatic mechanisms19<\/sup>. An indicator of stress and stress susceptibility may be the parasympathetic tone measurement. Additionally, stasis, a sign of immediate physiological discomfort, is the absence of endogenous variability in peripheral neurally mediated systems, such as the heart rate. A growing number of studies are also being done on stress and cardiovascular variability (HRV). The variability of heartbeat periods is known as HRV21<\/sup>. HRV is a measure of how quickly the heart can react to various physiological and external cues22<\/sup>. Low HRV indicates a heart rate that is monotonously consistent. Furthermore, decreased HRV is associated with lowered regulatory and homeostatic autonomic nervous system (ANS) performance, which reduces the body’s ability to react to both stimuli both internal and external23<\/sup>. In various clinical settings, the HRV is a non-invasive ECG technique that can be utilized to quantify ANS (e.g., during psychological stress assessments)24<\/sup>. Assuming that HRV is a trustworthy indicator of stress, many researchers have conducted studies in which stress was measured using HRV. Few research have, however, confirmed whether HRV is a reliable stress indicator9<\/sup>.<\/p>\n\n\n\n

The purpose of this meta-analysis is to assess studies\nthat support the use of heart rate variability (HRV) as an indicator of stress.<\/p>\n\n\n\n

Materials and Method<\/strong><\/p>\n\n\n\n

Study period and its type<\/strong><\/p>\n\n\n\n

Retrospective meta-analysis between January 2013 to January\n2023, on psychological stress using HRV measurement.<\/p>\n\n\n\n

Study selection criteria and research strategy<\/strong><\/p>\n\n\n\n

The research motors used were:  PubMed, Elsevier, Google Scholar, and other motors, and Keywords were: (“Autonomic Nervous System\u201d, And “Heart Rate Variability”, And “Electrocardiogram”, and “body postures”, and “stress”). Published research across all languages were included in the investigations. The requirements for each study’s inclusion were that it involved human subjects to employ HRV as an objective indicator of psychological stress and assess any HRV variables derived from frequency-time-based or frequency-based measurements in order to determine the degree of HRV reactivity. The study also included secondary literature and other articles that offered theoretical justification for the selection of HRV like a stress indication or the part played by the ANS in relation to heart rate and psychological stress. From database Scopus the search options were “keywords, abstract and title\u201d. There was a total of 181 articles that we located in the databases (51, 69, 38, and 23 articles found in PubMed, Elsevier, Google Scholar, and other motors)25,26<\/sup>. 171 of the articles were eliminated from our analysis of the data (Figure 3) which includes the reasons for elimination. Finally, after analyzing the data, we chose 10 articles.<\/p>\n\n\n\n

Exclusion Criteria<\/strong><\/p>\n\n\n\n

Following the search, we eliminated papers outside the\nchosen time period, studies involving the animal, and studies that were similar\nto our topic but went in a different direction. In accordance with the GraphPad\nPrism 9 paradigm, we conducted a meta-analysis. Only 10 articles were described\nusing the removal criteria shown in the chart below (Figure 3).<\/p>\n\n\n\n

Statistical analysis<\/strong><\/p>\n\n\n\n

For\nthe statistical study, we used two different programs, each of which has its\nown benefits and features.GraphPad Prism 9: for repeatability and exclusion\ncriteria, as well as for plotting publishing years and areas.SPSS for\ntabulation, data collecting, data comparison, and numerical entry.<\/p>\n\n\n\n

Results<\/strong><\/p>\n\n\n\n

Studies on stress using HRV published between 2013 and 2023<\/strong><\/p>\n\n\n\n

We\nplotted the number of studies published during the selected period 2013-2023 (Figure1).\nThe majority of studies occurred in 2016, followed by 2013, 2021, 2014, 2020\nand 2023.<\/p>\n\n\n\n

The number of Studies that were published in various nations within the same period that we found (Figure 2). Four investigations were conducted in India, two in Brazil, one each in Belgium, Mexico, Morocco, and the United States.<\/a><\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 1: Studies concerning HRV witch measure physiological stress between 2013 and 2023<\/strong><\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n\n
\"\"<\/td>\n\n

Figure 2: The number of research that have been published in various countries between 2013 and 2023.<\/strong><\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Characteristics of the studies incriminated<\/strong><\/p>\n\n\n\n

The diagram\nbelow provides an overview of the key traits of the ten papers that were part\nof this systematic evaluation (Figure 3). The foundation for each study was\nanalytical surveys and investigations of physiological stress utilizing HRV\nmeasurements.<\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Figure 3: Flow chart for studies selection using GraphPad Prism, demonstrates the number of articles included in physiological stress literature search, as well as how we processed the articles and the elimination criteria used.<\/strong><\/p>\n

Click here to view Figure<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Psychological stressors Studies on the response of heart\nrate variability in human healthy individuals:<\/strong><\/p>\n\n\n\n

In each of ten publications selected, the findings and traits from the previous ten years that discussed heart rate variability and how it relates to stress were looked. We examined the following factors for each study: the topic, the country, the year of publication, the number of participants, their age, the stress assessment, the heart rate variability measurements, the most notable findings, the parameters that changed significantly, and the sources that served as the basis for this research. Less studies were undertaken in 2014, 2020, and 2023, while the majority were conducted in 2013, 2016, and 2021. Four of the research founded in India, two in Brazil, one each in the United States, M\u00e9xico, Belgium, and Morocco (Table 1).<\/p>\n\n\n\n\n\n
\"\"<\/td>\n\n

Table 1: Studies on the response of the human heart rate variability to psychological stressors in healthy individuals<\/strong><\/p>\n

Click here to view Table<\/a><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Tables\n2 and 3 list the key HRV variables. The North American Society of Pacing and\nElectrophysiology (NASPE) and the Task Force of the European Society of\nCardiology (ESC) outlined and set criteria for HRV measurement, physiological\ninterpretation, and clinical usage in 1996.[36].<\/p>\n\n\n\n

Table 2: Time-domain of Heart rate variability (HRV) [36]<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Variable<\/strong><\/p>\n<\/td>\n

\n

Units<\/strong><\/p>\n<\/td>\n

\n

Description<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

SDNN<\/strong><\/p>\n<\/td>\n

\n

ms<\/p>\n<\/td>\n

\n

Standard deviation NN intervals<\/p>\n<\/td>\n<\/tr>\n

\n

SDANN<\/strong><\/p>\n<\/td>\n

\n

ms<\/p>\n<\/td>\n

\n

Standard deviation of the Mean of NN intervals for all 5-minute<\/p>\n<\/td>\n<\/tr>\n

\n

RMSSD<\/strong><\/p>\n<\/td>\n

\n

ms<\/p>\n<\/td>\n

\n

square root of mean of successive differences between NN heartbeats<\/p>\n<\/td>\n<\/tr>\n

\n

SDNN index<\/strong><\/p>\n<\/td>\n

\n

ms<\/p>\n<\/td>\n

\n

the average of all the NN intervals’ standard deviations for every five minutes of a 24-hour HRV.<\/p>\n<\/td>\n<\/tr>\n

\n

NN50 count<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

The average of times per hour that the difference between two consecutive normal sinus (NN) intervals is greater than 50 ms.<\/p>\n<\/td>\n<\/tr>\n

\n

pNN50<\/strong><\/p>\n<\/td>\n

\n

%<\/p>\n<\/td>\n

\n

The NN50 divided by total number NN intervals<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Table 3: Heart rate variability (HRV) frequency-domain measures[36]<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

 <\/strong><\/p>\n<\/td>\n

\n

Variable        <\/strong><\/p>\n<\/td>\n

\n

Units<\/strong><\/p>\n<\/td>\n

\n

Description  Frequency<\/strong><\/p>\n<\/td>\n

\n

range<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Short time (5 min)<\/strong><\/p>\n<\/td>\n

\n

Total<\/strong> power<\/strong><\/p>\n<\/td>\n

\n

ms2<\/sup><\/p>\n<\/td>\n

\n

Variation of NN intervals across the temporal section<\/p>\n<\/td>\n

\n

\u2248\u22640.4 Hz<\/p>\n<\/td>\n<\/tr>\n

\n

VLF  <\/strong><\/p>\n<\/td>\n

\n

ms2<\/sup><\/p>\n<\/td>\n

\n

VLF Power range<\/p>\n<\/td>\n

\n

\u22640.04 Hz<\/p>\n<\/td>\n<\/tr>\n

\n

LF<\/strong><\/p>\n<\/td>\n

\n

ms2<\/sup><\/p>\n<\/td>\n

\n

LF Power range<\/p>\n<\/td>\n

\n

0.04\u20130.15 Hz<\/p>\n<\/td>\n<\/tr>\n

\n

LF<\/strong> norm<\/strong><\/p>\n<\/td>\n

\n

nu<\/p>\n<\/td>\n

\n

LF normalized units LF\/(total power-VLF)\u00d7100<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

HF<\/strong><\/p>\n<\/td>\n

\n

ms2<\/sup><\/p>\n<\/td>\n

\n

HF Power range<\/p>\n<\/td>\n

\n

0.15\u20130.4 Hz<\/p>\n<\/td>\n<\/tr>\n

\n

HF norm<\/strong><\/p>\n<\/td>\n

\n

nu<\/p>\n<\/td>\n

\n

HF  normalized units HF\/(total power-VLF)\u00d7100<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n

\n

LF\/HF<\/strong><\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n

\n

Ratio of   LF \/HF<\/p>\n<\/td>\n

\n

 <\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Studies used HRV measurement in the\ntime-frequency domain<\/strong><\/p>\n\n\n\n

A study\npublished in Belgium in 2013, HRV Data were collected for five minutes with\nsalivary cortisol at a rate of four samples per day for two days, by filling\nout a stress-related questionnaire [27]. Where the questionnaire contains the emotions, problems\nand negative events of a group of children with an average age of 10 [27].<\/p>\n\n\n\n

By\nmeasuring (RMSSD, HF), it was shown that they are linked to anger, anxiety, and\nsadness, which means a decrease in parasympathetic activity. Additionally, a\nhigher ratio of low frequency to high frequency is linked to feelings of\nconcern, anger, and anxiety. Using multilevel modeling, it was found that HRV\npatterns with reduced parasympathetic activity were also related with higher\ncortisol levels, a larger cortisol stimulus-response, and a steeper daily drop.<\/p>\n\n\n\n

A Study in India (2014), A study\ninvolving 50 male young adults was done. Young adult males who changed their\nposture from supine to sitting to standing revealed substantial variations in\nheart rate variability measures such the mean R-R interval, mean LF, and mean\nHF. With changes in posture from lying to sitting to standing, there is a\ncorrelation between a drop in parasympathetic tone and an uptick in sympathetic\nimpact.<\/p>\n\n\n\n

Another study conducted in India\nin 2016 used the HRV and Stroop test as a method to examine the relationship\nbetween mental stress and the cardiovascular autonomic nervous system response\nto mental stress. During the Stroop Color Word Test, they examined the mean RR\ninterval, blood pressure, and HRV markers (SCWT). 50 healthy participants\nin all took part in this investigation.<\/p>\n\n\n\n

When compared to the resting\ncondition, a statistically significant change in heart rate, RR interval, and\nblood pressure was seen during the stressful condition. Each of the healthy\nperson’s HRV parameters (SDNN, RMSSD, NN50, PNN50, LF, HF, and LF\/HF) were\nsensitive to stress. When compared to women, men were more vulnerable to\nstress.<\/p>\n\n\n\n

In the USA (2016), Data were\ngathered from 909 volunteers who ranged in age between 35 to 85. During\ntelephone interviews conducted on 8 consecutive evenings, participants\ndiscussed unpleasant emotions and small stressful situations. On a different\noccasion, HRV was assessed using an electrocardiogram (ECG) signal during\na laboratory-based psychophysiology routine while the subject was at repose. To\nassess the correlations of HRV parameters: HF, RMSSD, and SDRR and daily\nstress processes, regression models have been utilized.  Stressor frequency was observed to be\nunrelated to HRV. Individuals with higher reported stressor severity, however,\nexhibited lower resting SDRR. All three HRV indicators were considerably lower\nin those with greater affective reactivity to stresses. Additionally, a lower\nRMSSD was associated with a cumulative daily negative effect.<\/p>\n\n\n\n

Another study In India (2016),\nthe Physiology Department researchers did a cross-sectional analytical\ninvestigation. First-year MBBS medical students who volunteered were 150 (78\nfemale and 72 male). The stress questionnaire used by medical students was used\nto evaluate the stressors. Using an ECG, a short-term HRV recording was\ndone.  By employing an automated blood\npressure monitor, the oscillometric approach was used to capture the basal\nheart rate (BHR), diastolic blood pressure (DBP), and systolic blood pressure\n(SBP).  <\/p>\n\n\n\n

According to the findings, more\nfemale pupils than male students fell into the group of high and severe stress.\nWith the exception of LFnu, which dramatically rose, all of the frequency\ndomain indexes (HF, HFnu, LF, and TP) decreased as stress intensity raised. The\ncumulative stress score significantly correlated with all of the HRV measures\nand coefficient of variation parameters as the level of stress increased.<\/p>\n\n\n\n

Finally study In India (2020), Ten individuals’ data were\ncollected in three different body positions. Data sets were collected when\nindividuals were resting, seated, and standing. The R-peak obtained from the ECG\nis used to analyze the HRV, three body positions are used to evaluate linear\nHRV variables using various time- and frequency-domain indexes, including HFnu,\nLFnu, LF\/HF, RMSSD, RR, HR, SDNN, pNN50, and NN50. All parameters refer to a\nchange in HRV, which alters PSN and SNS due to a change in body posture.<\/p>\n\n\n\n

Table 4: Studies that used HRV measurement in the time-frequency domain<\/strong><\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Authors<\/strong><\/p>\n<\/td>\n

\n

Year<\/strong><\/p>\n<\/td>\n

\n

No.of patients<\/strong><\/p>\n<\/td>\n

\n

Age Range or Mean<\/strong>\u00b1<\/strong>SD<\/strong><\/p>\n<\/td>\n

\n

Stress assessment<\/strong><\/p>\n<\/td>\n

\n

Measured HRV parameters<\/strong><\/p>\n<\/td>\n

\n

Main results<\/strong><\/p>\n<\/td>\n

\n

changed significantly<\/strong><\/p>\n<\/td>\n

\n

P.V<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Michels et al.<\/p>\n<\/td>\n

\n

2013<\/p>\n<\/td>\n

\n

334<\/p>\n<\/td>\n

\n

5\u201310<\/p>\n<\/td>\n

\n

auto symptoms of stressful situations (problems,events , and emotions)<\/p>\n<\/td>\n

\n

Short-term:
LFnu, HFnu, LF, HF, LF\/HF, RMSSD, pNN50<\/p>\n<\/td>\n

\n

Children exhibit signs of stress when their HRV is low (reduced parasympathetic activity).<\/p>\n<\/td>\n

\n

HF, LF\/HF, RMSSD<\/p>\n<\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Sanhita Rajan Walawalkar<\/p>\n<\/td>\n

\n

2014<\/p>\n<\/td>\n

\n

50  <\/p>\n<\/td>\n

\n

18- 25<\/p>\n<\/td>\n

\n

Body positions Change<\/p>\n<\/td>\n

\n

Short-term:  LF, HF, LFnu, HFnu, LF\/HF, Mean RR, TP, RMSSD, Mean HR, SDNN,NN50, PNN50,<\/p>\n<\/td>\n

\n

postural changes from laying to sitting to standing are associated with a decrease in parasympathetic activity and an increase in sympathetic activity.<\/p>\n<\/td>\n

\n

LF, HF, Mean RR<\/p>\n<\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Chiranjeevi Kumar et al<\/p>\n<\/td>\n

\n

2016<\/p>\n<\/td>\n

\n

50<\/p>\n<\/td>\n

\n

28.5\u00b10.71<\/p>\n<\/td>\n

\n

Stroop Test<\/p>\n<\/td>\n

\n

Short-term : RMSSD, SDNN, HR, NN50 RR, PNN50, TP, HF HFnu, LF, LFnu, LF\/HF<\/p>\n<\/td>\n

\n

All healthy participants’ HRV measurements were sensitive to stress.<\/p>\n<\/td>\n

\n

RR, HR, RMSS D,<\/p>\n

SDNN, HF, LF, LF\/HF<\/p>\n<\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Nancy L. Sin et al<\/p>\n<\/td>\n

\n

2016<\/p>\n<\/td>\n

\n

909<\/p>\n<\/td>\n

\n

35-85<\/p>\n<\/td>\n

\n

Interviews telephonic reported negative influence and minor stress<\/p>\n<\/td>\n

\n

Short-term: HF,RMSSD, SDNN,<\/p>\n<\/td>\n

\n

HRV was not correlated with stressor frequency. but, both 3 HRV measures were decreased in those with greater affective reactions to stresses.<\/p>\n<\/td>\n

\n

HF, RMSSD, SDNN<\/p>\n<\/td>\n

\n

P>0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Pushpanathan Punita et al<\/p>\n<\/td>\n

\n

2016<\/p>\n<\/td>\n

\n

150<\/p>\n<\/td>\n

\n

medical student volunteers<\/p>\n<\/td>\n

\n

stress questionnaire for medical students<\/p>\n<\/td>\n

\n

Short term: RR, SDNN, RMSSD, pNN50, NN50, HF, HFnu, LF, LFnu, TP, LF\/HF,<\/p>\n

 <\/p>\n<\/td>\n

\n

all parameters of the frequency domain were decreased with an increase in the stress intensity with the exception of LFnu, which substantially raised.<\/p>\n<\/td>\n

\n

RR, RMSSD, SDNN, pNN50,  NN50, HF ,HFnu<\/p>\n

, LF, LF\/HF, TP<\/p>\n

 <\/p>\n<\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Prashant  et al<\/p>\n<\/td>\n

\n

2020<\/p>\n<\/td>\n

\n

10<\/p>\n<\/td>\n

\n

20-25<\/p>\n<\/td>\n

\n

Body Postures change<\/p>\n<\/td>\n

\n

Short-term: TP, LF, HF, LF\/HF, HR, RMSSD, SDNN, pNN50<\/p>\n<\/td>\n

\n

All parameters refer to a change in HRV, which alters PSN and SNS due to a change in body posture.<\/p>\n<\/td>\n

\n

HR, SDNN,<\/p>\n

RMSSD, pNN50, LF\/HF<\/p>\n<\/td>\n

\n

–<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Studies used HRV measurement in the\nfrequency domain <\/strong><\/p>\n\n\n\n

A study\nin M\u00e9xico (2013), compared the outcomes of DFA and HRV using the scaling\nparameter alpha and the area beneath the low frequency spectrum. The evaluation\nincluded 57 healthy women aged between 40 and 60. Data was gathered using an\nECG in the sitting position for ten minutes, followed by three minutes of a\nstress test and three minutes of an ECG in the sitting position.<\/p>\n\n\n\n

assessing\nthe psychological stress response to the Stroop test in short-term recordings.\nAs opposed to DFA, which offers details concerning a more delayed response in\nthe final stage of the paradigm, HRV is sensitive to different stages of the\nparadigm employed. The HRV provides a quick reply to psychological stress\n(resting state).<\/p>\n\n\n\n

In\nBrazil (2021), After cardiopulmonary exercise testing, the study examined\nwhether cardiorespiratory fitness had an impact on cardiovascular autonomic\nrecovery. Where Sixty volunteers were split into three groups based on their\nlevel of cardiorespiratory fitness: high, moderate, and low. <\/p>\n\n\n\n

Prior\nto and following a cardiopulmonary activity test, HRV parameters, BPV, and\nBRS  were conducted. Lower baseline HR\nvalues and shorter HR recovery times were seen in the groups with increased\ncardiorespiratory fitness. The spectral analysis of HRV revealed that\nlow-frequency (LF) oscillations in absolute units and high-frequency (HF)\noscillations in both absolute and normalized units decreased when resting and\nrecovering periods were compared. Additionally, it revealed a rise in LF\noscillations of blood pressure. In light of the findings, it can be said that,\nin contrast to HR recovery, cardiorespiratory fitness has no impact on the\ncardiovascular autonomic modulations that occur following cardiopulmonary\nexercise testing.<\/p>\n\n\n\n

Another investigation in Brazil (2021),\nEight to twelve-year-old children were divided into two groups, according to their gender, age, peak\noxygenation consumption, and their body mass index. Heart rate\nvariability (HRV) assessments of spectral, symbolic, and complexity were\nperformed on both groups while their postures changed in order to compare how\nmuch stress and anxiety they were experiencing.<\/p>\n\n\n\n

 According to the finding When stress\/anxiety\nlevels were assessed using data from the questionnaire, the p-DCD group\ndisplayed higher stress symptoms than the TD group, although HRV studies\nrevealed no differences between the two groups. Both groups demonstrated\nparasympathetic dominance in the supine position and sympathetic dominance in\nthe upright position.<\/p>\n\n\n\n

In\nMorocco (2023), The recordings of fifteen student volunteers. For five minutes,\ndata were gathered in both the supine and standing positions. The RR-peak,\nwhich is also necessary for HRV analysis, is evaluated using the R-peak\nacquired from an ECG. Two body locations are used to interpret linear HRV values\nusing various time-domain indices and frequency-domain indices. The researchers\nfound that the RR interval is longer in the supine position than in the\nstanding position, and that the heart rate is higher in the standing position\nthan in the more relaxed supine posture. This has an impact on the ANS and\ntiredness index readings, starting from the supine position where they are low\nbefore rising in the standing position.<\/p>\n\n\n\n

Table 5: Studies used HRV measurement in the frequency domain<\/strong>.<\/p>\n\n\n\n\n\n\n\n\n\n
\n

Authors<\/strong><\/p>\n<\/td>\n

\n

Year<\/strong><\/p>\n<\/td>\n

\n

No. of patients<\/strong><\/p>\n<\/td>\n

\n

Age Range or Mean<\/strong>\u00b1<\/strong>SD<\/strong><\/p>\n<\/td>\n

\n

Stress assessment<\/strong><\/p>\n<\/td>\n

\n

Measured HRV parameters<\/strong><\/p>\n<\/td>\n

\n

Main results<\/strong><\/p>\n<\/td>\n

\n

changed significantly<\/strong><\/p>\n<\/td>\n

\n

P.V<\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

M. Vargas-Luna et  al<\/p>\n<\/td>\n

\n

2013<\/p>\n<\/td>\n

\n

57<\/p>\n<\/td>\n

\n

 40-60<\/p>\n<\/td>\n

\n

3-minute stoop test<\/p>\n<\/td>\n

\n

Short-term: HF, LF<\/p>\n<\/td>\n

\n

HRV responds quickly to psychological stress.<\/p>\n<\/td>\n

\n

HF, LF<\/p>\n

\n<\/p><\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Facioli  et al<\/p>\n<\/td>\n

\n

2021<\/p>\n<\/td>\n

\n

60<\/p>\n<\/td>\n

\n

Rang( 18-45)<\/p>\n<\/td>\n

\n

cardiopulmonary exercise test<\/p>\n<\/td>\n

\n

Short-term HR, LF, LFnu, HF, HFnu, LF\/HF<\/p>\n<\/td>\n

\n

Cardiovascular autonomic regulation is unaffected following a test of cardiopulmonary endurance<\/p>\n<\/td>\n

\n

HR<\/p>\n<\/td>\n

\n

–<\/p>\n<\/td>\n<\/tr>\n

\n

Daniel T  et al<\/p>\n<\/td>\n

\n

2021<\/p>\n<\/td>\n

\n

30 boys<\/p>\n<\/td>\n

\n

Rang ( 8\u201312)<\/p>\n<\/td>\n

\n

Stress questionnaire<\/p>\n

during posture changes.<\/p>\n<\/td>\n

\n

Short-term HF, LF, LF\/HF<\/p>\n<\/td>\n

\n

Data from the questionnaire indicated that the p-DCD group had more stress symptoms than the TD group did, although HRV analyses revealed no differences between the two groups. Both groups demonstrated parasympathetic dominance in the supine position and sympathetic dominance in the upright position.<\/p>\n<\/td>\n

\n

Non<\/p>\n<\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n

\n

Amr Farhan  et al<\/p>\n<\/td>\n

\n

2023<\/p>\n<\/td>\n

\n

15 (10M,5F)<\/p>\n<\/td>\n

\n

Rang ( 19\u201340)<\/p>\n<\/td>\n

\n

Body position Change<\/p>\n<\/td>\n

\n

Short-term HF, LF, LF\/HF<\/p>\n<\/td>\n

\n

When changing positions from supine to standing, the values of HRV change (increase), which in turn causes the stress index to change (raise), which in turn causes a change (value rise) in the autonomic nervous system.<\/p>\n<\/td>\n

\n

HF, LF, LF\/HF<\/p>\n<\/td>\n

\n

P<0.05<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n\n\n

Clinical uses for HRV<\/strong><\/strong><\/p>\n\n\n\n

HRV\ncan be utilized as an objective measure of stress and mental health in light of\nobservations of HRV change related to stress and existing neurobiological\nresearch. Due to the enormous range of psychiatric disorders’ origins and\nsymptoms, it is difficult to acquire consistent biological measurements in\npatients with mental illness. Thus, a patient’s psychosocial and medical\nhistories Should have been considered equally when analyzing HRV results.<\/p>\n\n\n\n

As\nopposed to specific mental diseases or disease states, Heart Rate Variability can\nbe seen as a tool that represents the activity of heart and overall auto- nomic\nhealth. While researching stress using HRV in therapeutic practice, objective\nand physiological evaluations as well as self-reporting should be included\nbecause stress is a concept with both biological and psychological components. Many\nresearch have indicated a correlation between HRV and mental wellness. These\nfindings are challenging to interpret, though, because HRV is linked to a\nvariety of stress variables, stress duration, personal coping mechanisms, and\nlifestyle behaviors. Respiration ,  body posture, circadian rhythms, non-modifiable\nfactors as sex, age, and genetics, factors of lifestyle are modifiable like metabolism\ndisease, smoke, exercise, and obese, and alcohol use, and additional factors as\nmedication (such as stimulants, betablockers, and anticholinergics) can all\nhave an impact on HRV results[37] [38]. A three-stage\nstress response paradigm was proposed by Hans Seyle. The fight-or-flight\nresponse of the organism to a stressor and activation of the SNS constitute the\nstage one, known as the “alarm reaction stage.” During the second\nstage, referred to as the “resistance stage,” the body adapts to the\nstressor. The body focuses all of its energy on the stressor when The PNS\nassists several physiological processes in returning to normal throughout this\nphase. The organism appears normal on the outside, but the levels of blood\nsugar, cortisol, and adrenalin are still high[39] [40]. If a stressor\npersists longer than the body can handle it, the organism exhausts its\nresources and becomes vulnerable to illness event death. When the acquired\nresistance or adaptability is no longer present, the “exhaustion\nstage” is achieved. This three-stage procedure should be kept in mind when\ninterpreting HRV results in a clinical environment to determine how severe a\npatient’s stress level is. Stress alters physiological function at each level,\nwhich is reflected in variations in HRV. While assessing the connection between\nHRV and stress, it is essential to comprehend the full autonomic context and\ntake into account a patient’s medical and mental history due to the variety of\nprobable stressors and distinctive stress reactions.<\/p>\n\n\n\n

Discussion<\/strong>:<\/strong><\/strong><\/p>\n\n\n\n

In this\ndata analysis on stress and its relation with HRV, we selected 10 articles\ncarried out over the last 10 years. HRV is responsive to modifications in\nautonomic nervous system (ANS) activity (i.e., alterations in the\nParasympathetic and Sympathetic) brought on by stress. <\/p>\n\n\n\n

In\norder to control human neurophysiological activities, the ANS is crucial. In\nlatest years, HRV analysis has grown significantly in significance as a method\nfor examining ANS activity and as a crucial early marker for detecting both\nphysiological and pathological states. An effort was undertaken to investigate\nhow stress affected heart rate variability as training adaptation and heart\nrate variability in elite endurance athletes.<\/p>\n\n\n\n

The\nmajority of studies found that HRV features changed in response to stress that\nwas caused in a variety of methods. Reduced of PNS activity, which is shown by\na decreasing in the Height Frequency and an increasing in the Low Frequency,\nwas the reason most frequently cited as being responsible for changes in HRV\nfeatures. HRV activities may also be influenced by a flexible network of brain\nregions that are dynamically structured in reaction to environmental cues.<\/p>\n\n\n\n

According\nto neuroimaging research, brain areas associated with the assessment of\nstressors might act as a mediator between HRV and reduced threat perception. In\nclinical settings, the HRV can be a tool that serves to demonstrate cardiac\nactivity and overall voluntary health as opposed to mental illness or specific\npathological conditions. As a result, it is crucial to take into account the\npatient’s psychological and medical history as well as the general autonomic\ncontext when assessing the association between stress and HRV.<\/p>\n\n\n\n

Conclusions <\/strong><\/p>\n\n\n\n

Due to the non-invasive nature,\nsimplicity, strong reproducibility, and prognostic information that heart rate\nvariability analysis provides regarding stress, it has grown in importance as a\ntechnique to evaluate ANS. The sympathetic nervous system’s parasympathetic and\nsympathetic functions have been studied using HRV, which has proven to be a\nuseful technique. In conclusion, the findings support the use of HRV for the\nobjective assessment of both stress and mental health, and according to\nneurobiological evidence, stress responses have an effect on HRV.<\/s><\/strong><\/p>\n\n\n\n

Conflict of Interest<\/strong><\/p>\n\n\n\n

There is no conflict of interests in association with the material presented in this paper.<\/p>\n\n\n\n

Funding Source<\/strong><\/p>\n\n\n\n

This study did not receive any funding.<\/p>\n\n\n\n

References<\/strong><\/p>\n\n\n\n

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