Heart Rate Variability and Anxiety in a Pediatric Sample Experiencing Chronic Unexplained Nausea

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The Ohio State University

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Background: Anxiety disorders have been identified as an area of public health concern due to their high prevalence and comorbidities. Previous studies have found a correlation between anxiety symptoms and low respiratory sinus arrythmia (RSA), a component of heart rate variability (HRV). RSA is an index of the parasympathetic nervous system which is responsible for bodily regulation during times of rest. A common comorbidity of anxiety disorders is gastrointestinal (GI) distress. Furthermore, there is also evidence that individuals facing chronic nausea and gastrointestinal problems commonly exhibit anxiety and a lowered RSA. Due to the relationship between RSA, anxiety, and GI distress, HRV monitoring wearable devices may prove to be an effective public health measure to monitor these conditions. A daily record of RSA values may provide insight into the severity of those conditions and effectiveness of treatment protocols. Methods: HRV and anxiety data was obtained from a group of 96 children and adolescents participating in a study concerning chronic unexplained nausea. HRV data was collected using the Firstbeat Bodyguard 2, a wearable sensor that records a participant's electrocardiogram (ECG). Sitting respiratory sinus arrythmia (RSA) and heart period (HP) were collected. Anxiety was coded from medical records using clinical diagnoses, health care provider notes, and validated self-report questionnaires (Patient-Reported Outcomes Measurement Information System; PROMIS). Analyses were performed in R comparing the anxiety positive and negative groups against sitting RSA and HP. Results: There was a trending effect toward lower sitting RSA in the anxiety positive group (mean difference = 0.56ln(ms2)), but the statistical tests were non-significant (t(95)=1.77, p=.09). HP and anxiety were not significantly associated (mean difference = 37.32ms, t(95)=1.20, p=0.23). Conclusion: The analyses performed do not appear to indicate a formal relationship between low HRV and anxiety in adolescents with chronic nausea. Despite non-significant results, there is evidence that HRV can be indicative of a variety of illnesses. Wearable sensors are low-cost, convenient, and widely available for HRV tracking, but more research is needed to understand how they can be used to provide meaningful results for monitoring anxiety.