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Quantitative evaluation of stress in Japanese anesthesiology residents based on heart rate variability and psychological testing

  • Kohshi Hattori
  • Masaaki AsamotoEmail author
  • Mikiya Otsuji
  • Nobuko Ito
  • Satoshi Kasahara
  • Yoko Hashimoto
  • Yoshitsugu Yamada
Original Research

Abstract

Clinical anesthesiologists, particularly residents, work in stressful environments. However, evidence-based physiological and psychological tests to evaluate stress are still lacking. In this single-center study of 33 residents, we investigated the relationship between heart rate variability (HRV), which had the potential to screen residents’ stress levels using Holter electrocardiography (ECG) and psychological mood as assessed by the Profile of Mood States (POMS) questionnaire. HRV analysis revealed 2 findings. Firstly, standard deviation of the average of 5-min normal-to-normal R–R intervals (SDANN) was significant lower than that of same-aged healthy volunteers (69.3 ± 27.9 vs. 137.0 ± 43.0 ms, P < 0.05), which indicated suppression of autonomic nervous system activity throughout their work. Secondly, at induction of anesthesia, significant higher low frequency/high frequency ratio (LF/HF ratio: 1.326 vs. 0.846; P < 0.05) and lower HF (3326 vs. 5967 ms2; P < 0.05) and lower standard deviation of normal-to-normal R–R intervals (SDNN: 50.5 vs. 79.4 ms; nervous system was suppressed at the induction of anesthesia: expected to be the most stressful period of their work. On the other hand, deviation scores of POMS questionnaire elucidated that all the residents were within normal range of psychological mood, and without any significant diurnal changes with respect to total mood disturbance deviation (TMD) scores (48 vs. 47; P = 0.368). HRV elucidated physiological stress among anesthesiology residents quantitatively by evaluating autonomic nervous activities, especially at induction of anesthesia. These changes in HRV could be observed regardless of psychological mood.

Keywords

Heart rate variability Autonomic nervous system Psychological mood Perioperative stress monitoring Working environment of anesthesiology residents 

Abbreviations

AH

Anger-hostility

ANS

Autonomic nervous system

CB

Confusion-bewilderment

DD

Depression-dejection

ECG

Electrocardiography

F

Friendship

FFT

Fast Fourier transform

FI

Fatigue-inertia

HF

High frequency

HRV

Heart rate variability

LF

Low frequency

LF/HF

Low frequency/high frequency

PNS

Parasympathetic nervous system

POMS

Profile of mood states

SDANN

Standard deviation of the average of 5-min normal-to-normal R-R intervals

SDNN

Standard deviation of the normal-to-normal R-R intervals

SNS

Sympathetic nervous system

TA

Tension-anxiety

TMD

Total mood disturbance

TP

Total power

VA

Vigor-activity

Notes

Acknowledgements

We are grateful to everyone who helped us successfully complete this research study, especially Kanji Uchida of the Department of Anesthesia and Pain Relief Center at The University of Tokyo Hospital, for providing logical and objective guidance for our study and statistical advice, and serving as the chairman of the resident educational working group in our department.

Author contributions

KH contributed to conceptualization, data collection, formal analysis, methodology and preparing the manuscript. MA contributed to conceptualization, data collection and editing the manuscript, MO contributed to statistical support. NI helped data collection and approved the final manuscript. SK attested the psychological mood evaluation. YH helped data collection. YY helped conduct the study as the supervisor and approved the final manuscript.

Funding

This study was funded by Grants-in-Aid for Scientific Research (KAKENHI) No. 26670244.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Institutional review board

This study was reviewed and approved by the ethics committee of The University of Tokyo, Faculty of Medicine (Tokyo, Japan, #10699). This study was also registered to University hospital Medical Information Network Clinical Trial Registry (Tokyo, Japan #UMIN000019247).

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Copyright information

© Springer Nature B.V. 2019

Authors and Affiliations

  1. 1.Department of Anesthesiology and Pain Relief CenterThe University of Tokyo HospitalTokyoJapan
  2. 2.Department of AnesthesiologyTokyo Teishin HospitalTokyoJapan
  3. 3.Department of NeuropsychiatryThe University of Tokyo HospitalTokyoJapan

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