Heart rate variability as a measure of mental stress in surgery: a systematic review
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REVIEW
Heart rate variability as a measure of mental stress in surgery: a systematic review Anne‑Fleur The1 · Iris Reijmerink1 · Maarten van der Laan1 · Fokie Cnossen2 Received: 1 June 2019 / Accepted: 6 February 2020 © The Author(s) 2020
Abstract Purpose There is increasing interest in the use of heart rate variability (HRV) as an objective measurement of mental stress in the surgical setting. To identify areas of improvement, the aim of our study was to review current use of HRV measurements in the surgical setting, evaluate the different methods used for the analysis of HRV, and to assess whether HRV is being measured correctly. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and MetaAnalyses (PRISMA). 17 studies regarding HRV as a measurement of mental stress in the surgical setting were included and analysed. Results 24% of the studies performed long-term measurements (24 h and longer) to assess the long-term effects of and recovery from mental stress. In 24% of the studies, artefact correction took place. Conclusions HRV showed to be a good objective assessment method of stress induced in the workplace environment: it was able to pinpoint stressors during operations, determine which operating techniques induced most stress for surgeons, and indicate differences in stress levels between performing and assisting surgery. For future research, this review recommends using singular guidelines to standardize research, and performing artefact correction. This will improve further evaluation of the long-term effects of mental stress and its recovery. Keywords Heart rate variability · Mental stress · Surgery · Occupational stress Abbreviations HRV Heart rate variability PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyses PSD Power spectral density IBI Interbeat intervals Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00420-020-01525-6) contains supplementary material, which is available to authorized users. * Fokie Cnossen [email protected] 1
Division of Vascular Surgery, Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands
Department of Artificial Intelligence, Bernoulli Institute of Mathematics, Computer Science and Artificial Intelligence, Faculty of Science and Engineering, University of Groningen, Nijenborgh 4, 9747 AG Groningen, The Netherlands
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SDNN Standard deviation of IBI SDANN Standard deviation of the average IBI RMSSD Square root of the mean squared differences of successive IBIs NN50 Number of interval differences of successive IBIs larger than 50 ms LF Low frequency, 0.04–0.15 Hz HF High frequency, 0.15–0.4 Hz VLF Very low frequency LF/HF ratio Ratio of low frequency/high frequency
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Normal-to-normal beat interval data All intervals between adjacent R waves in the QRS complexes resulting from sinus node depolarizations TP Total power HFnu High-frequency component in normalized uni
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