ORIGINAL RESEARCH article
Front. Neurol.
Sec. Sleep Disorders
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1513395
Association of heart rate variability with preoperative acute insomnia in patients scheduled for elective surgery
Provisionally accepted
- 1Graduate School of Hebei University of Traditional Chinese Medicine, Shijiazhuang, China
- 2Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei Technology Innovation Center of TCM Spleen and Kidney Diseases, Shijiazhuang, Hebei Province, China
- 3Office of Physician-Patient Communication, Hebei Provincial Hospital of Traditional Chinese Medicine, Shijiazhuang, China
- 4Department of Hepatobiliary Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Objective: Heart rate variability (HRV), which reflects the balance of the sympathetic and parasympathetic systems, is associated with insomnia. However, its relationship with preoperative acute insomnia has not yet been investigated. This study aimed to assess the associations of HRV characteristics with preoperative acute insomnia.Methods: This study enrolled 563 patients who were scheduled for elective surgery. Preoperative clinical characteristics, including demographics, the apnea‒hypopnea index (AHI), HRV characteristics, and sleep quality data, were recorded.Results: Among the 563 patients included, 78.5% met the criteria for insomnia. Age (P=0.005), AHI score (P<0.001), and AHI stage (P<0.001) were positively associated, whereas education level (P=0.004) was negatively associated with preoperative acute insomnia. In terms of HRV characteristics, low-frequency (LF) (P=0.012) and high-frequency (HF) (P=0.011) were positively associated with preoperative acute insomnia. Multivariate logistic regression analyses screened out the variables associated with preoperative acute insomnia, including education level (P=0.028, odds ratio (OR)=0.603), AHI score (P<0.001, OR=1.068), standard deviation of all normal NN intervals (SDNN) (P=0.004, OR=0.956), the root mean square of the successive differences (rMSSD) (P=0.001, OR=1.130), NN50 count divided by the total number of all NN intervals (pNN50) (P=0.006, OR=0.893), ultra-low-frequency (ULF) (P=0.003, OR=1.000), LF/HF ratio (P=0.018, OR=0.608), and HF ratio (P=0.072, OR=0.953). Receiver operating characteristic analysis revealed that the combination of these variables had good predictive value for preoperative acute insomnia, with an area under the curve of 0.750.Conclusion: Preoperative acute insomnia is a prevalent issue and is associated with an imbalance in the sympathetic/parasympathetic system. A predictive model based on HRV characteristics may improve the management of preoperative acute insomnia.
Keywords: Preoperative acute insomnia, Heart rate variability, predictive model, receiver operating characteristic, nomogram
Received: 18 Oct 2024; Accepted: 16 Apr 2025.
Copyright: © 2025 Zhao, Liang, Hou, Zhu, Liu, Hao and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wei Hao, Department of Anesthesiology, Hebei Provincial Hospital of Traditional Chinese Medicine, Hebei Technology Innovation Center of TCM Spleen and Kidney Diseases, Shijiazhuang, Hebei Province, China
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