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Meta-Analysis
. 2023 Dec;33(6):821-841.
doi: 10.1007/s10286-023-00969-3. Epub 2023 Aug 4.

Day and night heart rate variability using 24-h ECG recordings: a systematic review with meta-analysis using a gender lens

Beatrice De Maria #  1 , Monica Parati #  1   2 , Laura Adelaide Dalla Vecchia  3 , Maria Teresa La Rovere  4
Affiliations
Meta-Analysis

Day and night heart rate variability using 24-h ECG recordings: a systematic review with meta-analysis using a gender lens

Beatrice De Maria et al. Clin Auton Res. 2023 Dec.

Abstract

Purpose: Increasing evidence demonstrates that gender-related factors, and not only biological sex, are relevant in the physiological and pathophysiological mechanisms of the cardiovascular system, including the cardiac autonomic regulation. Sex and gender may also affect daytime and night-time cardiac autonomic control. This meta-analysis aimed to provide a comparison between healthy women and men on heart rate variability using 24-h ECG recordings pointing out sex- and gender-related factors.

Methods: A systematic search was conducted to include studies focusing on both sex and gender differences related to heart rate variability indices in the time and frequency domains. Descriptive data were extracted by two independent reviewers. For each index, standardized mean differences with 95% confidence intervals were computed and a pooled estimate using a fixed- or random-effects model was applied.

Results: Twenty-seven studies were included in the meta-analysis. The results showed that only seven studies reported some information about gender-related factors. Concerning sex-related differences, women had a shorter mean RR interval and lower variability of the time domain indices than men. Sex-related differences concerning frequency domain indices were more evident during night-time compared to daytime.

Conclusion: The characterization of gender-related factors in the study of heart rate variability using 24-h ECG recordings is still sporadic and underexplored. The meta-analysis results could not conclusively support a significant increase of high frequency power in women, although women showed a reduced total power and low frequency to high frequency ratio. There is a strong need for considering heart rate variability in relation to gender-related variables.

Keywords: Gender difference; Heart rate variability; Night; Sex difference.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
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Flowchart of the study selection process
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Time domain indices—24 h
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Frequency domain indices—24 h
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Time domain indices—daytime
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Frequency domain indices—daytime
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Time domain indices—night-time
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Frequency domain indices—night-time
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Results of meta-regression analyses on SDNN
See this image and copyright information in PMC

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