TY - JOUR
T1 - Reduced heart rate variability in patients with medically unexplained physical symptoms
T2 - A meta-analysis of HF-HRV and RMSSD
AU - Vreijling, Sarah R.
AU - Troudart, Yael
AU - Brosschot, Jos F.
N1 - Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021
Y1 - 2021
N2 - Objective:Medically unexplained physical symptoms (MUPS) and related syndromes are common and place a substantial burden on both patients and society. Chronic psychological distress and dysregulation of the autonomic nervous system may be common factors associated withMUPS, although previous studies have reported mixed results. The aims of this meta-analysis are to provide an updated synthesis of studies investigating heart rate variability (HRV) indices associated with autonomic nervous system functioning in three common MUPS syndromes and to explain inconsistencies in previous study findings. Methods: Literature search yielded 58 studies comparing HRV indices of reduced parasympathetic activity of healthy individuals with those of patients with chronic fatigue syndrome (npatients = 271), irritable bowel syndrome (npatients = 1005), and fibromyalgia (npatients = 534). Separate random-effects meta-analyses were conducted on studies measuring root mean square of successive differences (RMSSD) and high-frequency HRV (HF-HRV). Results: Regardless of syndrome type, patients had significantly lower RMSSD (k = 22,Hedges g = -0.37 [-0.53 to -0.21], p < .001) and HF-HRV (k = 52, Hedges g = -0.69 [-1.03 to -0.36], p < .001) than did healthy individuals. Sample age and publication year explained a substantial variation in RMSSD, whereas controlling for confounders in statistical analyses explained variation in HF-HRV. Conclusions: Lower RMSSD and HF-HRVin patients withMUPS versus healthy controls indicates that autonomic nervous system dysregulation, particularly lower parasympathetic activity, may play a role in patients with these conditions. This conclusion may have important implications for the underlying mechanisms and treatment of MUPS and related syndromes.
AB - Objective:Medically unexplained physical symptoms (MUPS) and related syndromes are common and place a substantial burden on both patients and society. Chronic psychological distress and dysregulation of the autonomic nervous system may be common factors associated withMUPS, although previous studies have reported mixed results. The aims of this meta-analysis are to provide an updated synthesis of studies investigating heart rate variability (HRV) indices associated with autonomic nervous system functioning in three common MUPS syndromes and to explain inconsistencies in previous study findings. Methods: Literature search yielded 58 studies comparing HRV indices of reduced parasympathetic activity of healthy individuals with those of patients with chronic fatigue syndrome (npatients = 271), irritable bowel syndrome (npatients = 1005), and fibromyalgia (npatients = 534). Separate random-effects meta-analyses were conducted on studies measuring root mean square of successive differences (RMSSD) and high-frequency HRV (HF-HRV). Results: Regardless of syndrome type, patients had significantly lower RMSSD (k = 22,Hedges g = -0.37 [-0.53 to -0.21], p < .001) and HF-HRV (k = 52, Hedges g = -0.69 [-1.03 to -0.36], p < .001) than did healthy individuals. Sample age and publication year explained a substantial variation in RMSSD, whereas controlling for confounders in statistical analyses explained variation in HF-HRV. Conclusions: Lower RMSSD and HF-HRVin patients withMUPS versus healthy controls indicates that autonomic nervous system dysregulation, particularly lower parasympathetic activity, may play a role in patients with these conditions. This conclusion may have important implications for the underlying mechanisms and treatment of MUPS and related syndromes.
KW - Chronic fatigue syndrome
KW - Chronic stress responses
KW - Fibromyalgia
KW - Heart rate variability
KW - Irritable bowel syndrome
KW - Medically unexplained physical symptoms
UR - http://www.scopus.com/inward/record.url?scp=85098674327&partnerID=8YFLogxK
U2 - https://doi.org/10.1097/PSY.0000000000000874
DO - https://doi.org/10.1097/PSY.0000000000000874
M3 - Review article
C2 - 33065584
SN - 0033-3174
VL - 83
SP - 2
EP - 15
JO - Psychosomatic medicine
JF - Psychosomatic medicine
IS - 1
ER -