Bulletin of Rehabilitation MedicineBulletin of Rehabilitation MedicineВестник восстановительной медицины2078-19622713-2625National Medical Research Center for Rehabilitation and Balneology70327810.38025/2078-1962-2026-25-2-63-76ArticlesСтатьиReview ArticleHeart rate variability in stress assessment and autonomic regulation: current state of the art, clinical applications and outlook. A literature ReviewВариабельность сердечного ритма в оценке стресса и автономной регуляции: современное состояние метода, клинические применения и перспективы. Обзор литературыhttps://orcid.org/0000-0002-4185-5502LykovYuri A.ЛыковЮрий Александрович
Russian Federation

PhD (Med.), Senior Researcher, Department of Neurorehabilitation and Clinical Psychology

кандидат медицинских наук, старший научный сотрудник, отдел нейрореабилитации и клинической психологии

kuzyukovaaa@nmicrk.ruhttps://orcid.org/0000-0002-9275-6491KuzyukovaAnna A.КузюковаАнна Александровна
Russian Federation

PhD (Med.), Leading Researcher, Head of the Unit of Neurorehabilitation and Clinical Psychology

кандидат медицинских наук, ведущий научный сотрудник, заведующий отделом нейрореабилитации и клинической психологии

kuzyukovaaa@nmicrk.ruhttps://orcid.org/0000-0003-1886-124XMarchenkovaLarisa A.МарченковаЛариса Александровна
Russian Federation

D.Sc. (Med.), Associate Professor, Head of the Office of Scientific Research, Chief Researcher, Unit of Somatic Rehabilitation, Reproductive Health and Active Longevity, Professor at the Department of Restorative Medicine, Physical Therapy and Medical Rehabilitation

доктор медицинских наук, доцент, руководитель научно-исследовательского управления, главный научный сотрудник, отдел соматической реабилитации, репродуктивного здоровья и активного долголетия, профессор кафедры восстановительной медицины, физической терапии и медицинской реабилитации

kuzyukovaaa@nmicrk.ruhttps://orcid.org/0000-0001-5530-1538KorolevYury N.КоролевЮрий Николаевич
Russian Federation

D.Sc. (Med.), Professor, Chief Researcher, Unit of the Study the Mechanisms of Action of Physical Factors

доктор медицинских наук, профессор, главный научный сотрудник, отдел изучения механизмов действия физических факторов

kuzyukovaaa@nmicrk.ruhttps://orcid.org/0000-0002-2440-9244RozhkovaElena A.РожковаЕлена Анатольевна
Russian Federation

D.Sc. (Biol.), Chief Researcher, Department of Biomedical Technologies

доктор биологических наук, главный научный сотрудник, отдел биомедицинских технологий

kuzyukovaaa@nmicrk.ruhttps://orcid.org/0000-0002-4872-3377ZubarevaNatalia N.ЗубареваНаталия Николаевна
Russian Federation

D.Sc. (Econ.), Associate Professor, Director General

доктор экономических наук, доцент, генеральный директор

kuzyukovaaa@nmicrk.ruNational Medical Research Center for Rehabilitation and BalneologyНациональный медицинский исследовательский центр реабилитации и курортологии Минздрава России2304202625263762402202630032026Copyright ©; 2026, Lykov Y.A., Kuzyukova A.A., Marchenkova L.A., Korolev Y.N., Rozhkova E.A., Zubareva N.N.Copyright ©; 2026, Лыков Ю.А., Кузюкова А.А., Марченкова Л.А., Королев Ю.Н., Рожкова Е.А., Зубарева Н.Н.2026Lykov Y.A., Kuzyukova A.A., Marchenkova L.A., Korolev Y.N., Rozhkova E.A., Zubareva N.N.Лыков Ю.А., Кузюкова А.А., Марченкова Л.А., Королев Ю.Н., Рожкова Е.А., Зубарева Н.Н.https://creativecommons.org/licenses/by-nc-sa/4.0https://journals.eco-vector.com/2078-1962/article/view/703278

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.

ВВЕДЕНИЕ. Вариабельность сердечного ритма (ВСР) является неинвазивным физиологическим показателем, отражающим состояние автономной регуляции и баланс симпатических и парасимпатических влияний со стороны вегетативной нервной системы. В последние годы ВСР активно используется для оценки острого и хронического стресса, а также при диагностике тревожных и депрессивных расстройств, суицидального риска и для некоторых неврологических заболеваний.

ЦЕЛЬ. Провести анализ современных представлений о ВСР как объективном маркере стрессовых состояний и автономной регуляции, оценить ее диагностические возможности при психических и неврологических расстройствах, а также определить методологические ограничения и перспективы клинического применения.

МАТЕРИАЛЫ И МЕТОДЫ. Выполнен обзор литературы за 2015–2025 гг. по базам данных PubMed, Medline, Scopus, Web of Science и eLIBRARY.RU с использованием ключевых слов: heart rate variability, HRV, стресс, автономная нервная система, тревога, депрессия, суицидальное поведение, неврологические заболевания, носимые устройства.

ОСНОВНОЕ СОДЕРЖАНИЕ ОБЗОРА. Обобщены данные о физиологических механизмах формирования ВСР, методах регистрации и анализе временных, частотных и нелинейных показателей. Наиболее воспроизводимым признаком стресс-индуцированной дисрегуляции является снижение параметров, отражающих вагусную модуляцию сердечного ритма. Снижение ВСР выявляется при тревожных и депрессивных расстройствах, суицидальности, эпилепсии, болезни Паркинсона, черепно-мозговой травме и других неврологических состояниях и ассоциируется с неблагоприятным прогнозом. Вместе с тем ВСР не является специфическим маркером симпатической активности или уровня стресса и зависит от условий регистрации, дыхания, возраста, медикаментозной терапии и сопутствующей патологии.

ЗАКЛЮЧЕНИЕ. ВСР представляет собой информативный показатель автономной регуляции и стресс-индуцированных изменений, однако ее клиническая интерпретация требует учета методологических ограничений и использования в составе комплексной, персонализированной оценки функционального состояния.

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