Issue 25-2, 2026

Review

https://doi.org/https://doi.org/10.38025/2078-1962-2026-25-2-63-76

Heart Rate Variability in Stress Assessment and Autonomic Regulation: Current State of the Art, Clinical Applications and Outlook. A Literature Review

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ORCIDYuri A. Lykov, ORCIDAnna A. Kuzyukova*, ORCIDLarisa A. Marchenkova, ORCIDYury N. Korolev, ORCIDElena A. Rozhkova, ORCIDNatalia N. Zubareva

National Medical Research Center for Rehabilitation and Balneology, Moscow, Russia


ABSTRACT

INTRODUCTION.  Heart rate variability (HRV) is a noninvasive physiological marker reflecting autonomic regulation and the balance between sympathetic and parasympathetic influences. HRV is increasingly being used to assess acute and chronic stress, as well as in the diagnosis of anxiety and depressive disorders, suicidal risk and for some neurological diseases.

AIM.  To analyze modern ideas about HRV as an objective marker of stressful conditions and autonomous regulation, evaluate its diagnostic capabilities for mental and neurological disorders, as well as identify methodological limitations and prospects for clinical application.

MATERIALS AND METHODS.  A literature review was conducted using PubMed, Medline, Scopus, Web of Science and eLIBRARY.RU databases, covering publications from 2015 to 2025. The search terms that were used included heart rate variability, HRV, stress, autonomic nervous system, anxiety, depression, suicidal behavior, neurological diseases, and wearable devices.

MAIN CONTENT OF THE REVIEW.  Data on physiological mechanisms of HRV formation, recording techniques, and analysis of time-domain, frequency-domain, and nonlinear parameters were summarized. The most reproducible feature of stress-related dysregulation is reduced indices reflecting vagal modulation of heart rate. Decreased HRV has been observed in individuals with anxiety and depressive disorders, suicidal tendencies, epilepsy, Parkinson’s disease, traumatic brain injury and other neurological conditions. It is also associated with an adverse prognosis. However, HRV is not a specific marker of sympathetic activity or stress level and is strongly influenced by recording conditions, respiration, age, medication, and comorbidity.

CONCLUSION.  HRV is an informative indicator of autonomic regulation and stress-related alterations; however, its clinical interpretation requires consideration of methodological constraints and integration into comprehensive, personalized assessment models.


KEYWORDS: heart rate variability, stress, autonomic regulation, autonomic dysregulation, anxiety disorders, depressive disorders, suicidality, neurological diseases, wearable devices

FOR CITATION: Lykov Yu.A., Kuzyukova A.A., MarchenkovaL.A., Korolev Yu.N., Rozhkova E.A., Zubareva N.N. Heart Rate Variability in Stress Assessment and Autonomic Regulation: Current State of the Art, Clinical Applications and Outlook. A Literature Review. Bulletin of Rehabilitation Medicine. 2026; 25(2):63–76. https://doi.org/10.38025/2078-1962-2026-25-2-63-76 (In Russ.).

FOR CORRESPONDENCE:

Anna A. Kuzyukova, E-mail:  kuzyukovaaa@nmicrk.ru,  anna_kuzyukova@mail.ru


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