Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Community and Family Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Syst Rev. 2024 Jul 24;13(1):194. doi: 10.1186/s13643-024-02617-x.
Polycystic ovary syndrome (PCOS) is a prevalent and complex endocrine disorder that affects women of reproductive age. It has significant implications for female endocrine function, reproductive health, and metabolic disturbances, including insulin resistance, impaired glucose tolerance, and dyslipidemia. Studies have shown that decreased heart rate variability (HRV), a marker of autonomic dysfunction, is associated with adverse cardiovascular events. Recent research has focused on investigating autonomic function in PCOS, and some studies have suggested altered autonomic drive in these patients. The aim of this systematic review and meta-analysis was to evaluate cardiac autonomic function by analyzing HRV in women with PCOS.
This systematic review was prepared using PRISMA reporting guidelines. The databases searched were PubMed, Scopus, Web of Science, and Cochrane. Risk of Bias was assessed using ROBINS-I for non-RCTs. The GRADE approach was employed to evaluate the level of certainty in the evidence for each outcome. In order to identify the underlying cause of high heterogeneity, a subgroup analysis was conducted. Sensitivity analysis was checked. A random effect model was used and calculated a pooled standardized mean difference (SMD) with a 95% confidence interval (CI).
Seventeen articles were included in the final analysis, varied in quality, ranging from a "low" to a "high risk of bias". Combined analyses indicated a notable decrease in HRV among individuals with PCOS compared to the control group. Significant changes were observed in SDNN (SMD: -0.763, 95%CI [-1.289 to -0.237], p=0.004), PNN50 (SMD: -1.245, 95%CI [-2.07, -0.419], p=0.003), LF/HF ratio (SMD: 0.670, 95%CI [0.248, 1.091], p=0.002), HFnu (SMD: -0.873, 95%CI [-1.257, -0.489], p=0.000), LFnu (SMD: 0.840, 95%CI [0.428, 1.251], p=0.000) and TP (SMD: -1.997, 95%CI [-3.306, -0.687], p=0.003). The heterogeneity was partially explained by types of study design. Subgroup analysis revealed significant alterations of HRV in normal-weighted and overweight PCOS cases. Conversely, no significant changes in HRV were observed in obese PCOS cases.
The findings of this meta-analysis provide evidence suggesting diminished HRV in individuals with PCOS compared to non-PCOS control group.
多囊卵巢综合征（PCOS）是一种常见且复杂的内分泌疾病，影响育龄妇女。它对女性内分泌功能、生殖健康和代谢紊乱有重要影响，包括胰岛素抵抗、糖耐量受损和血脂异常。研究表明，心率变异性（HRV）降低，即自主神经功能障碍的标志物，与不良心血管事件相关。最近的研究集中在研究 PCOS 中的自主神经功能，一些研究表明这些患者的自主神经驱动发生改变。本系统评价和荟萃分析的目的是通过分析 PCOS 妇女的 HRV 来评估心脏自主神经功能。
本系统评价按照 PRISMA 报告指南进行。检索的数据库包括 PubMed、Scopus、Web of Science 和 Cochrane。非随机对照试验采用 ROBINS-I 评估偏倚风险。使用 GRADE 方法评估每个结局的证据确定性水平。为了确定高异质性的根本原因，进行了亚组分析。检查了敏感性分析。使用随机效应模型，并计算了具有 95%置信区间（CI）的合并标准化均数差（SMD）。
最终分析纳入了 17 篇文章，质量参差不齐，从“低”到“高”风险偏倚不等。综合分析表明，与对照组相比，PCOS 患者的 HRV 明显降低。SDNN（SMD：-0.763，95%CI [-1.289 至-0.237]，p=0.004）、PNN50（SMD：-1.245，95%CI [-2.07，-0.419]，p=0.003）、LF/HF 比值（SMD：0.670，95%CI [0.248，1.091]，p=0.002）、HFnu（SMD：-0.873，95%CI [-1.257，-0.489]，p=0.000）、LFnu（SMD：0.840，95%CI [0.428，1.251]，p=0.000）和 TP（SMD：-1.997，95%CI [-3.306，-0.687]，p=0.003）均有显著变化。异质性部分由研究设计类型解释。亚组分析显示，正常体重和超重 PCOS 患者的 HRV 有显著变化。相反，肥胖 PCOS 患者的 HRV 无显著变化。
荟萃分析的结果表明，与非 PCOS 对照组相比，PCOS 患者的 HRV 降低。
