Perceived Subjective Stress and its Association with 5-min Electrocardiogram-based Heart Rate Variability in Middle-aged Women of an Urban Area of West India.

BACKGROUND

Midlife health poses stress to women. Perceived Stress Scale (PSS) score allows subjective assessment of perceived stress whereas heart rate variability (HRV) gives electrocardiogram (ECG)-based quantification of cardiac autonomic function, but the relation between these two is scarcely studied. Hence, the association between PSS and HRV was studied in middle-aged women.

METHODOLOGY

A cross-sectional study was done in midlife premenopausal ( = 51), perimenopausal ( = 59), and postmenopausal ( = 82) women. Perceived stress was interviewed by PSS score. ECG-based 5 min HRV was done by Variowin HR Software for frequency domain, time domain, and geometric HRV parameters. PSS and HRV were further compared or associated in subgroups, taking < 0.05 as statistically significant.

RESULTS

HRV was reduced in all three groups which had a prevalence of PSS grade 0, 1, 2 44%, 53%, and 3%, respectively, without intergroup difference. Diabetic and/or hypertensive subgroups exhibited reduced HRV than nondiabetic nonhypertensive subgroups. No significant correlation was found between PSS score and HRV parameters in either group. HRV did not associate with PSS grade-based subgroups in pre-, peri-, or postmenopausal stage.

CONCLUSION

Lack of HRV to perceived subjective stress association was observed in 40-55-year-old women with mild confounding by diabetes and/or hypertension. We suggest HRV total power and low-frequency: high-frequency ratio as best HRV parameters and consideration of age, reproductive health stage, and presence of comorbidities as a weak confounder for both HRV and PSS studies of middle-aged women. Further studies are warranted to consolidate the utility of HRV and PSS for the assessment of these two different types of stress.