The Psychological and Physiological Effects of Acute Occupational Stress in New Anesthesiology Residents

Abstract Background: Occupational stress in resident physicians has profound implications for wellness, professionalism, and patient care. This observational pilot trial measured psychological and physiological stress biomarkers before, during, and after the start of anesthesia residency. Methods: Eighteen physician interns scheduled to begin anesthesia residency were recruited for evaluation at three time points: baseline (collected remotely before residency in June 2013); first-month visit 1 (July); and follow-up visit 2 (residency months 3 to 5, September–November). Validated scales were used to measure stress, anxiety, resilience, and wellness at all three time points. During visits 1 and 2, the authors measured resting heart-rate variability, responses to laboratory mental stress (hemodynamic, catecholamine, cortisol, and interleukin-6), and chronic stress indices (C-reactive protein, 24-h ambulatory heart rate and blood pressure, 24-h urinary cortisol and catecholamines, overnight heart-rate variability). Results: Thirteen interns agreed to participate (72% enrollment). There were seven men and six women, aged 27 to 33 yr. The mean ± SD of all study variables are reported. Conclusion: The novelty of this report is the prospective design in a defined cohort of residents newly exposed to the similar occupational stress of the operating environment. Because of the paucity of literature specific to the measures and stress conditions in this investigation, no data were available to generate a priori definition of primary outcomes and a data analytic plan. These findings will allow power analysis for future design of trials examining occupational stress and stress-reducing interventions. Given the importance of physician burnout in our country, the impact of chronic stress on resident wellness requires further study.

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The Effects of the Medical Pause on Physiological Stress Markers among Health Care Providers: A Pilot Randomized Controlled Trial

Western Journal of Nursing Research ◽

10.1177/01939459211027657 ◽

2021 ◽

pp. 019394592110276

Author(s):

Ebru Cayir ◽

Tim Cunningham ◽

Ryne Ackard ◽

Julie Haizlip ◽

Jeongok Logan ◽

...

Keyword(s):

Blood Pressure ◽

Health Care ◽

Heart Rate ◽

Heart Rate Variability ◽

Health Care Providers ◽

Physiological Stress ◽

Intervention Group ◽

Control Group ◽

Care Providers ◽

The Impact

Contemplative practices promote well-being, work engagement and resilience among health care providers. We examined the impact of The Pause, a brief contemplative intervention, on health care providers’ physiological stress response. Participants were randomly assigned to either The Pause or the control group. They participated in a high-fidelity, stressful medical simulation. Following the simulation, intervention group practiced The Pause. Outcome measures were heart rate variability, heart rate, and blood pressure. We adjusted for baseline physiological variables, sociodemographic variables, self-care practices, and perceived stress. Participants in the intervention group had a standard deviation of the normal-to-normal RR intervals (heart rate variability indicator) that was 13.8 (95% CI 4.0, 23.5; p < .01) points higher than those in the control group. There were no significant effects of The Pause on heart rate or blood pressure. The Pause may reduce stress reactivity, increase heart rate variability, and enhance resilience in health care providers.

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Stres na delovnem mestu in variabilnost srčne frekvence

Slovenian Medical Journal ◽

10.6016/zdravvestn.1063 ◽

2015 ◽

Vol 84 (1) ◽

Author(s):

Martin Rauber ◽

Marjan Bilban ◽

Radovan Starc

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Nervous System ◽

Autonomic Nervous System ◽

Occupational Stress ◽

Heart Beat ◽

Stress Reaction ◽

Autonomic Nervous ◽

Measurable Parameter ◽

The Impact

Brief description of the article: This article considers heart rate variability as a measurable parameter of stress reaction and present recent studies that examined the impact of occupational stress on heart rate variability and thus autonomic nervous system.ABSTRACT Stress is a complex psychoneuroendocrinological and immune response of an individual to stressogenic factor. The most important contemporary stressogenic factors are mental, psycho-social and socio-economic stressors. This especially holds true for occupational stress. Many symptoms and signs of disease are associated with chronic occupational stress. Among those are cardiovascular diseases, metabolic and psychiatric disorders.This article describes different stressogenic factors that lead to occupational stress and two conceptual models of occupational stress (Karasek’s Demand/Control Model and Siegrist’s Effort-Reward Imbalance Model). Reaction to stress can be measured in various ways. This article summarizes the physiology of heart beat regulation and presents heart rate variability as a measurable parameter of stress reaction. Heart rate variability gives us an insight into autonomic modulation of the heart and functioning of the entire autonomic nervous system. This article presents the latest results of larger studies that examined the impact of occupational stress on heart rate variability and various mechanisms that lead to end-organ damage due to changes in autonomic nervous system as a result of work stress. Subjects exposed to chronic stress have significantly lower heart rate variability compared with subjects unaffected by stress. Researches have shown that reduced heart rate variability reliably predicts mortality among health adults, as well as morbidity and mortality in patients after acute myocardial infarction, in patients with chronic heart failure and mortality in patients with chronic kidney disease.

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Predictive Value of Subacute Heart Rate Variability for Determining Outcome Following Adolescent Concussion

Journal of Clinical Medicine ◽

10.3390/jcm10010161 ◽

2021 ◽

Vol 10 (1) ◽

pp. 161

Author(s):

Colt A. Coffman ◽

Jacob J. M. Kay ◽

Kat M. Saba ◽

Adam T. Harrison ◽

Jeffrey P. Holloway ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Cognitive Performance ◽

Predictive Value ◽

System Integration ◽

Sports Medicine ◽

Clinical Symptoms ◽

Physiological Stress ◽

Neurological Dysfunction ◽

Neurobehavioral Function

Objective assessments of concussion recovery are crucial for facilitating effective clinical management. However, predictive tools for determining adolescent concussion outcomes are currently limited. Research suggests that heart rate variability (HRV) represents an indirect and objective marker of central and peripheral nervous system integration. Therefore, it may effectively identify underlying deficits and reliably predict the symptomology following concussion. Thus, the present study sought to evaluate the relationship between HRV and adolescent concussion outcomes. Furthermore, we sought to examine its predictive value for assessing outcomes. Fifty-five concussed adolescents (12–17 years old) recruited from a local sports medicine clinic were assessed during the initial subacute evaluation (within 15 days postinjury) and instructed to follow up for a post-acute evaluation. Self-reported clinical and depressive symptoms, neurobehavioral function, and cognitive performance were collected at each timepoint. Short-term HRV metrics via photoplethysmography were obtained under resting conditions and physiological stress. Regression analyses demonstrated significant associations between HRV metrics, clinical symptoms, neurobehavioral function, and cognitive performance at the subacute evaluation. Importantly, the analyses illustrated that subacute HRV metrics significantly predicted diminished post-acute neurobehavioral function and cognitive performance. These findings indicate that subacute HRV metrics may serve as a viable predictive biomarker for identifying underlying neurological dysfunction following concussion and predict late cognitive outcomes.

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Mindfulness meditation, well-being, and heart rate variability: A preliminary investigation into the impact of intensive Vipassana meditation

International Journal of Psychophysiology ◽

10.1016/j.ijpsycho.2013.06.017 ◽

2013 ◽

Vol 89 (3) ◽

pp. 305-313 ◽

Cited By ~ 122

Author(s):

Jonathan R. Krygier ◽

James A.J. Heathers ◽

Sara Shahrestani ◽

Maree Abbott ◽

James J. Gross ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Mindfulness Meditation ◽

Preliminary Investigation ◽

Well Being ◽

Vipassana Meditation ◽

The Impact

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Heart Rate Variability Biofeedback in Grandmothers Raising Grandchildren: Effects on Stress, Emotions, and Cognitions

Biofeedback ◽

10.5298/1081-5937-41.3.06 ◽

2013 ◽

Vol 41 (3) ◽

pp. 144-149 ◽

Cited By ~ 9

Author(s):

Jaclene A. Zauszniewski ◽

Tsay-Yi Au ◽

Carol M. Musil

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Perceived Stress ◽

Repeated Measures ◽

Negative Emotions ◽

Pilot Trial ◽

Heart Rate Variability Biofeedback ◽

Grandmothers Raising Grandchildren ◽

Depressive Cognitions ◽

Reducing Stress

Over one million American grandmothers raise grandchildren, and many experience stress that may be alleviated by biofeedback. This pilot trial of 20 grandmothers used a pretest-posttest design with repeated measures to test the effects of heart rate variability (HRV) biofeedback on perceived stress, negative emotions, and depressive cognitions. Significant decreases in stress, negative emotions, and depressive cognitions were found. Biofeedback is thus potentially effective for reducing stress and depressive thoughts and feelings in grandmothers raising grandchildren, and the intervention warrants further testing.

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THE IMPACT OF STRESS ON HEART RATE VARIABILITY OF ON-CALL PHYSICIANS

CHEST Journal ◽

10.1378/chest.128.4_meetingabstracts.277s-a ◽

2005 ◽

Vol 128 (4) ◽

pp. 277S

Author(s):

Stavros E. Mountantonakis ◽

Dimitrios A. Moutzouris ◽

Craig McPherson

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

The Impact

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Abstract P315: Increase in Stress May Contribute to Lower Heart Rate Variability in Healthy Young Subjects

Circulation ◽

10.1161/circ.125.suppl_10.ap315 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Amanda C Costa ◽

Ana Gabriela C Silva ◽

Cibele T Ribeiro ◽

Guilherme A Fregonezi ◽

Fernando A Dias

Keyword(s):

Cardiovascular Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Healthy Volunteers ◽

Perceived Stress ◽

Low Frequency ◽

Statistical Correlation ◽

Total Power ◽

The Impact ◽

Nonparametric Correlation

Background: Stress is one of the risk factors for cardiovascular disease and decreased heart rate variability is associated to increased mortality in some cardiac diseases. The aim of the study was to assess the impact of perceived stress on cardiac autonomic regulation in young healthy volunteers. Methods: 35 young healthy volunteers (19 to 29 years old, 6 men) from a Brazilian population were assessed for perceived stress by the translated and validated Perceived Stress Scale (PSS, 14 questions) and had the R-R intervals recorded at rest on supine position (POLAR RS800CX) and analyzed (5 minutes, Kubius HRV software) by Fast-Fourier Transform for quantification of Heart Rate Variability (HRV). Results: Average data (±SD) for age, heart rate, BMI, waist circumference and percentage of body fat (%BF) were: 21.3±2.7 years; 65.5±7.9 bpm; 22.3±1.9 Kg/m 2 ; 76.0±6.1 cm and 32.1±6.6%; respectively. The mean score for the PSS-14 was 23.5±7.2 and for the HRV parameter as follow: SSDN=54.8±21.2ms; rMSSD=55.9±32.2ms; low-frequency (LF)= 794.8±579.7ms 2 ; High-frequency (HF)= 1508.0±1783.0 ms 2 ; LF(n.u.)= 41.1±16.2; HF(n.u.)= 58.9±16.2; LF/HF=0.89±0.80 and Total power (TP)= 3151±2570ms 2 . Spearman nonparametric correlation was calculated and there was a significant correlation of PSS-14 scores and LF (ms 2 ) (r=−0.343; p= 0.044). Other HRV variables did not shown significant correlation but also had negative values for Spearman r (TP r=−0.265, p=0.124; HF r=−0.158; SSDN r=−0.207; rMSSD r=−0.243, p=0.160). LF/HF and LF(n.u.) did not correlate to PSS-14 having Spearman r very close to zero (LF/HF r=−0.007, p=0.969; LF(n.u.) r=−0.005, p=0.976). No correlation was found for HRV parameters and BMI and there was a trend for statistical correlation of %BF and LF (ms 2 ) (r=−0.309, p=0.071). Conclusions: These data demonstrate a possible association of perceived stress level and HRV at rest. Changes in LF can be a consequence of both sympathetic and parasympathetic activity, however, analyzing the other variables HF, TP, SSDN and rMSSD (all negative Spearman r) and due to the lack of changes in LF/HF ratio and LF(n.u.) we interpret that increased stress may be associated to decrease in overall heart rate variability. These changes were seen in healthy individuals and may point out an important mechanism in cardiovascular disease development.

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Photoplethysmography (PPG)-determined heart rate variability (HRV) and extracellular water (ECW) in the evaluation of chronic stress and inflammation

HORMONES ◽

10.1007/s42000-021-00341-y ◽

2022 ◽

Author(s):

George P. Chrousos ◽

Nektaria Papadopoulou-Marketou ◽

Flora Bacopoulou ◽

Mariantonietta Lucafò ◽

Andrea Gallotta ◽

...

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Chronic Stress ◽

Extracellular Water

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249 Overnight heart rate variability depends on age, gender, and day of the week: a field observation using a smart bed platform

SLEEP ◽

10.1093/sleep/zsab072.248 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A100-A101

Author(s):

Shawn Barr ◽

Kwanghyun Sohn ◽

Gary Garcia

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Physiological Stress ◽

Large Population ◽

Population Level ◽

Large Set ◽

Sleep State ◽

Cross Sectional ◽

Day Of The Week ◽

Broad Interest

Abstract Introduction Heart rate variability (HRV) is commonly used to assess the activity of the autonomic nervous system (ANS). ANS function changes, reflected in HRV, result from factors including lifestyle, aging, cardiorespiratory illnesses, sleep state, and physiological stress. Despite broad interest in HRV, few studies have established normative overnight HRV values for a large population. To better understand population level HRV changes, ecologically-valid, overnight sleep SDNN (standard deviation of all normal heartbeat intervals, lower HRV is reflected by lower SDNN) values have been analyzed for a large sample of Sleep Number 360 smart bed users. Methods Overnight SDNN values were obtained over the course of 18.2M sleep sessions from 379,225 sleepers (48 ± 14.7 sessions/user). 50.9 percent of sleepers were female. The age was normally distributed with mean ± SD of 52.8 ± 12.7 years (range 21 to 84). Heartbeat intervals used to compute SDNN were extracted from a ballistocardiogram (BCG). BCG-based HRV estimation during sleep has previously been validated against ECG-based HRV with an R-square of 0.5. Results Using a Generalized Linear Model, significant cross-sectional associations with SDNN were observed for three variables of interest: age, gender, and day-of-the-week. For sleepers under 50, SDNN declined at a rate of about 2.1 ms/year, then leveled off for sleepers aged 50-65, and increased slightly thereafter. Women under 50 displayed lower, more slowly declining, SDNN values than men, but this trend reversed for sleepers over 50. Throughout the week, SDNN values followed a U-shaped (women) or L-shaped (men) pattern, where values were highest during the weekend and lowest at mid-week. Conclusion Using a smart bed to unobtrusively measure overnight SDNN values for a large set of sleepers in an ecologically valid environment, reveals significant effects of age, gender, and day of the week on overnight SDNN. Support (if any):

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