What question did this study set out to answer?

The aim is to examine the relationship between heart rate variability and autonomic regulation in COPD patients.

April 24, 2026Open Access

Correlation of Heart Rate Variability as a Measure of Autonomic Dysregulation in Stable Chronic Obstructive Pulmonary Disease

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Stable Chronic Obstructive Pulmonary Disease (COPD) (n=47). Intervention: Heart rate variability (HRV) assessment. Primary outcome: Correlation between HRV parameters and BODE index or GOLD classification.

Key Result

In patients with stable COPD, heart rate variability parameters showed no significant correlation with disease severity or BODE index, though time-domain measures negatively correlated with disease duration.

Key Points

The aim is to examine the relationship between heart rate variability and autonomic regulation in COPD patients.
Patients recruited using convenience sampling
Data collected via sociodemographic assessments, SGRQ, spirometry, 6MWT, and HRV
Data analyzed with standard statistical methods
No significant correlation between BODE index and HRV parameters
Negative association found between COPD duration and HRV time-domain parameters
Significant negative correlation between SGRQ impact score and SDNN

Study Design

Type

Observational (n=47)

Multicenter

Structured PICO

Population

47 patients aged ≥40 years with stable COPD (physician diagnosis, smoking history >10 pack-years), mean age 63.98, 89.4% male. Excluded: history of asthma, pneumonia, active tuberculosis, chronic respiratory failure, coronary artery disease, congestive heart failure, chronic kidney disease, obstructive sleep apnea, malignancy, coexisting type 2 diabetes mellitus, electrolyte disturbances, psychological comorbidities, and acute exacerbation within 2 weeks.

Intervention

Heart rate variability (HRV) assessment using a five-minute ambulatory ECG recording

Outcome

Association between HRV and clinical characteristics of COPD (BODE index and GOLD classification severity)surrogate

In patients with stable COPD, heart rate variability parameters correlate with disease duration and symptom burden, but not with conventional measures of disease severity such as GOLD staging or the BODE index.

Limitations

Small sample size (N = 47) and single-center design limit statistical power
Cross-sectional, exploratory, and observational nature precludes causal inference
HRV assessment was based on short-term recordings rather than 24-hour monitoring
Potential confounders were not fully adjusted for through multivariable analysis due to small sample size
Predominance of male participants limits generalizability
Absence of a healthy control group

Abstract

Background: Chronic obstructive pulmonary disease (COPD) affects not only the lungs but also the cardiovascular system and other organs, contributing to high morbidity and mortality. Recent studies suggest that patients with COPD exhibit autonomic dysfunction, which may increase the risk of cardiovascular mortality. Therefore, early detection and close monitoring of autonomic dysfunction in COPD patients are essential. Methods: Patients were recruited using a convenience sampling method. Data on sociodemographic characteristics were collected, and assessments included the St. George’s Respiratory Questionnaire (SGRQ), spirometry, six-minute walk test (6MWT), and heart rate variability (HRV). Data were analyzed using standard statistical methods. Results: A total of 47 patients were included in the study. Sociodemographic variables, habitual and environmental factors, spirometric characteristics, and clinicophysiological profiles were analyzed in relation to COPD parameters. No significant correlation was found between the body mass index, airflow obstruction, dyspnea, and exercise capacity (BODE) index and HRV parameters, nor between COPD severity and HRV frequency- and time-domain measures. However, a significant negative association was observed between the duration of COPD and HRV time-domain parameters. Specifically, COPD duration was negatively correlated with the root mean square of successive differences between normal heartbeats (rMSSD; r = -0.324, p = 0.026). Additionally, a significant negative correlation was found between the SGRQ impact score and standard deviation of NN intervals (SDNN). Conclusion: These findings support the concept that autonomic dysregulation is an integral component of COPD pathophysiology. HRV is a simple, non-invasive biomarker for assessing autonomic nervous system function in patients with COPD and may help identify those at increased cardiovascular risk. Incorporating HRV evaluation, particularly through standardized long-term monitoring, into routine clinical assessment may enhance disease stratification, prognostication, and personalized management.

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