Exploratory repeated-measures study of examination stress and heart rate variability in medical students

BACKGROUNDExamination stress is common among college students and may be accompanied by anxiety, sleep disturbances, and changes in autonomic regulation.Short-term heart rate variability (HRV) is a noninvasive physiological measure that may provide complementary insight into cardiac autonomic regulation during stress. AIMTo explore changes in anxiety, sleep insufficiency, and short-term HRV during examination stress and their associations in medical students.(unadjusted P = 0.028), whereas the unadjusted correlation between low/high frequency (LF/HF) and self-reported GAD-7 scores did not reach statistical significance (P = 0.053).After FDR correction for multiple correlations, only the association between sleep insufficiency and self-reported GAD-7 scores remained significant (FDR-adjusted P < 0.001).In the multivariable regression model, greater sleep insufficiency was independently associated with higher self-reported GAD-7 scores (P < 0.001), and LF/HF was negatively associated with the GAD-7 self-report score (P = 0.015). CONCLUSIONEW was associated with higher levels of self-reported anxiety and more severe sleep insufficiency, but no overall significant changes were observed in the measured shortterm HRV parameters.Exploratory EW analyses suggest that LF/HF may be associated with individual differences in anxiety severity after adjustment for other variables, although this association was not significant in the unadjusted correlation analysis; however, further validation is needed.