Continuous heart rate variability monitoring, stress and recovery in doctors: a systematic review and meta-analysis.

BACKGROUND

Burnout is a rising concern among doctors. Heart rate variability (HRV), a non-invasive measure of autonomic nervous system activity, can reflect physiological states of sympathetic (stress) and parasympathetic (recovery) nervous system activity.

AIMS: This review aims to evaluate how continuous ambulatory HRV monitoring has been used to understand patterns of stress and recovery in doctors.

METHODS

The study protocol was preregistered (PROSPERO CRD42023413282). A comprehensive search was conducted. Studies were eligible if they reported at least one HRV parameter combined with at least one contextual or psychological assessment over a 24-hour period in a doctor population. Methodological quality was assessed using the Joanna Briggs Institute risk of bias assessment for case reports and the Standard for Reporting Diagnostic Accuracy in HRV studies STARDHRV.

RESULTS

We identified 805 records of which seven studies met the inclusion criteria. Meta-analysis was carried out for five different HRV parameters. Studies were conducted in seven different countries, ranged in participant numbers from 12 to 54 and each used a different HRV measurement device. There was a statistically significant difference in HRV between stress and recovery periods with four of these five parameters; root mean square of successive differences SMD = -0.63, P = 0.005, standard deviation of the NN (inter-beat) intervals SMD = -1.05, P = 0.001, low frequency (LF) Standard Mean Difference (SMD) = 0.54, P = 0.01, LF/high frequency (HF) SMD = 0.69, P = 0.006. The quality of studies was moderate at best.

CONCLUSIONS

Continuous HRV monitoring may offer a viable method for tracking stress and recovery patterns that may contribute to burnout.