Literature Review: Heart Rate Variability as a Biomonitoring of Occupational Stress PDF

Literature Review: Heart Rate Variability as a Biomonitoring of Occupational Stress Kajian Pustaka: Variabilitas Denyut Jantung sebagai Biomonitoring Stress Kerja Annes Waren1 Muhammad Ilyas2 1Occupational Medicine Cluster, D...

Literature Review: Heart Rate Variability as a Biomonitoring of Occupational Stress Kajian Pustaka: Variabilitas Denyut Jantung sebagai Biomonitoring Stress Kerja Annes Waren1 Muhammad Ilyas2 1Occupational Medicine Cluster, Department of Community Medicine Faculty of Medicine, Universitas Indonesia 2Division of Occupational Medicine, Department of Community Medicine, Faculty of Medicine, Universitas Indonesia 1,2Jalan Pegangsaan Timur No.16, Menteng, Central Jakarta 10320 Indonesia ABSTRACT Introduction: Occupational stress is a modern epidemic. In terms of stress assessment, tools such as questionnaires are believed to be more subjective, especially in the assessment of stress in the workplace, while of course an objective assessment of stress also needs to be carried out. Objective examination for occupationalsstress will be very useful in the occupationalhhealth settings, which can early detect stress at work and prevent the long term effects. Therefore, this literature review aims to investigate the role of HRV in determining occupational stress. Methods: The searching methods used were PubMed and Google Scholar to find related journals about occupational stress and HRV, published in English. The articlessthatmmet the inclusion criteria were analysed basedoonothesstudy design, study population, occupationalsstressaand HRV assessment based on the Centre of Evidence-based Medicine, the University of Oxford for therapy study. Moreover, sample size varied from 8 to 1788. Results: It was found that there are three studies that fit the criteria, which are one systematic review study, one longitudinal study, and one cross-sectional study. The main finding from those articles was that occupational or job stress is found to be associated with lowered HRV value. Conclusion: HRV can be recommended for practicing occupational physicians and company doctors to identify the core areas of work- related stress. Keywords: biomonitoring, heart rate variability, coccupational stress ABSTRAK Pendahuluan: Stress kerja merupakan epidemi modern. Dalam hal penilaian stres kerja, banyak digunakan analisis psikometri pada stressor tempat kerja tanpa pengukuran fisiologis. Pemeriksaan objektif dari stres kerja akan berguna dalam layanan kesehatan kerja sehubungan dengan pencegahan dini efek stres jangka panjang yang merugikan. Tujuan dari tinjauan literatur ini adalah untuk mempelajari penelitian-penelitan sebelumnya mengenai hubungan antara stres kerja dan HRV, untuk mengetahui peran HRV dalam menentukan stres kerja. Metode: PubMed dan Google Scholar adalah mesin pencari yang digunakan untuk menemukan jurnal terkait stres kerja dan HRV yang diterbitkan dalam bahasa Inggris. Artikel yang terpilih dianalis menurut rancangan penelitian, populasi studi, penilaian stres kerja dan HRV berdasarkan Pusat Kedokteran berbasis Bukti Universitas Oxford untuk studi terapi. Besar sampel bervariasi mulai dari 8 hingga 1788. Hasil: Kami mendapatkan tiga artikel yang memenuhi kriteria. Temuan utama dari semua artikel tersebut adalah bahwa stres kerja yang tinggi terkait dengan penurunan HRV. Simpulan: Penilaian HRV dapat direkomendasikan untuk praktek dokter okupasi dan dokter perusahaan untuk menentukan sumber permasalahan dari stress kerja. Kata kunci: biomonitoring, kerja, stress, variabilitas denyut jantung Corresponding Author: INTRODUCTION Annes Waren Email: [email protected] Occupational or job stress is a chronic condition Telephone: +6281371407061 recognized as a risk for a variety of behavioural and psychological disorders/.Thus, epidemiology understanding, alternative preventions, and interventions are highly needed (Quick and Henderson, 2016). ©2021 IJOSH All right reserved. Open access under CC BY NC–SA license doi:10.20473/ijosh.v10i2.2021.273-279 Received February 07, 2021, received in revised form April 20, 2021, Accepted May 28, 2021, Published: April 2021 274 The Indonesian Journal of Occupational Safety and Health, Volume 10, Issue 2, August 2021: 273-279 Long‐term work stress has been associated out the role of HRV in determining occupational with various health problems such as cardiovascular stress regarding whether or not it can help the diseases, musculoskeletal disorders, inflammation occupational health doctors to identify work-related process, infection disease, obesity, diabetes, and stress. sleep disorders. Meta-analysis study by Steptoe et al. has reported that high job strain elevated the METHODS risk of coronary artery disease by 34% (Steptoe and Kivimäki, 2013). The searching method used Pubmed and Google In terms of stress assessment, tools such Scholar to find related journals about Occupational as questionnaires are believed to be more Stress and Heart Rate Variability. The searching subjective, especially in the assessment of stress method was performed on December 23rd 2020. The in the workplace, although of course an objective words to find were "Occupational Stress", "Work assessment of stress also needs to be carried out. Stress", "Job Stress", "Heart Rate Variability", and Therefore, Panari et al. recommend to combine "HRV". methods of subjective and objective measures to The search strategy is shown in a flowchart assess stress, which will in turn give the researchers (Figure 1). The author scanned every ten articles or doctors a comprehensive picture of the patient's from Pubmed (by titles and abstracts) to exclude condition (Panari et al., 2012) unrelated articles on the first phase of the selection. HRV is one of the promising biological markers. Duplicated articles from Google Scholar were then More and more commercial devices nowadays removed. After the selection, the critical appraisal provide an automatic measurement of heart rate was done using several aspects based on the Centre variability, making it easier for researchers and of Evidence-based Medicine, the University of doctors to diagnose or determine patients' condition Oxford for therapy study. or research subjects (Speer et al., 2020). The sample size in these three studies varied Many studies have focused on Heart Rate between 8, 85 and 1788. Moreover, the mean age Variability (HRV) in healthy participants. However, ranged from 31 to 41 years. A total of 10 articles less is known about the association between were analysed in the systematic review studies; occupational stress or stress at work and HRV nine studies were cross-sectional studies, while one values. Therefore, this literature review aims to find was carried out with an observational study design PubMed (n=453) Google Scholar (n=81) Inclusion Records after duplicate criteria: English removed (n=384) article , cross Full text articles sectional study, excluded: not case-control relevant articles study, cohort Records screened (n=42) (n= 31), case study, report studies systematic (n=5), review Full text articles selected inaccessible (n= 3) articles (n=2) 1 Systematic Review Study 1 Longitudinal Study 1 Cross-sectional Study Figure 1. Searching Strategy Flowchart  Annes Waren and Muhammad Ilyas, Heart Rate Variability as a Biomonitoring of Occupational Stress… 275 with one year follow up. In the systematic review Advanced Table 1. Critical Appraisal of the studies, the subjects were healthcare workers, factory Articles workers, media workers, workers in consumer goods Critical Appraisal of Longitudinal Study by Low and production, workers in aeroplane manufacturing, McCraty (2018) Validity Table 1. Critical Appraisal of the Articles Level of Evidence 4 Critical Appraisal of the Systematic Review by Sussanna Workers from large companies Jarvelin-Pasanen, Sanna Sinikallio and Tarvainen (2018) who had regular working hours of 40 hours a week, but workers who Validity Representative consumed drugs that could affect Level of Evidence 2a Populations Group heart rate in the 2 hours before the Yes, the studies examined HRV examination were not included representative populations group, in this study Representative including workers from varied In this study, HRV was calculated Populations Group industries such as health care Reference Standard using time domain parameters workers, factory workers, and white- Used according to the recommendation of collar workers the Task Force Reference Standard Yes, almost all studies reported used There was no independent comparison Used the Task Force Guidelines Independent and blinding in this study since the The authors independently reviewed Comparison and survey data were self-reported, and Independent the title, abstract, full text of the Blinding the results depended on the effort and Comparison and journals and conducted discussions if honesty of each participant Blinding there were disagreement Importance Importance A significant negative correlation Measurement of Measurements of outcome varied. was found between stress and HRV Outcome Measurement of The length of the recording of HRV values Outcome varied from short term (5-10 minutes) Applicability to long term (48 hours) Yes, the test methods are described Applicability in details and easy to be replicated. Test methods are Test methods are The subjects filled up the online The measurements and analysis described in detail described in detail questionnaires, and then the of HRV used by the studies are and easy to be and easy replicated researcher performed an HRV summarized in the tables. replicated assessment of the subjects using the Critical Appraisal of Longitudinal Study by Langelotz et emWave Pro Plus al. (2008) Validity and white-collar workers. Meanwhile, eight Level of Evidence 2b surgical residents and specialists participated in the Representative Eight surgeons with a 24-hour longitudinal study, and 85 workers from a company Populations Group surgical shift took part in this study participated in a cross-sectional study. Reference Standard The researchers measured HRV using Used guidelines from the Task Force RESULTS Independent There was no independent comparison Comparison and and blinding in this study From the online search results, it was found that Blinding there were three studies that fit the inclusion and Importance exclusion criteria, namely one systematic review The authors used Visual analogue study by Järvelin-Pasanen, Sinikallio, and Tarvainen scale scores to assess occupational (2018), one longitudinal study and one cross- by Measurement of stress. Several time domain Outcome parameters were used to measure Langelotz et al. (2008), sectional study by McCraty, HRV 2018). After a critical appraisal, it was found that Applicability those articles were valid (Table 1). Yes, the HRV measurement methods The levels of evidence are important Test methods are are described thoroughly. Researchers components of evidence-based medicine. Therefore, described in detail used a portable automatic device to the author assessed the evidence level of each and easy replicated assess HRV at specific times and selected articles based on the Centre for Evidence- specific conditions Based Medicine (Burns, Rohrich and Chung, 2011). 276 The Indonesian Journal of Occupational Safety and Health, Volume 10, Issue 2, August 2021: 273-279 Table 2. Summary of Main Results of the Studies HRV, which is a computer software that collects Regarding the Relationship between pulse data. The subject's heart rate information Occupational Stress and HRV Values was obtained by attaching a pulse sensor to the subject's fingertips or earlobe, and then the software Authors Main Results translated the information into a graphic, which Lowered HRV was found (Järvelin-Pasanen, Sinikallio, allowed the researcher or author to watch in real to be associated with and Tarvainen, 2018) time how thoughts and emotions were affecting the occupational stress Longitudinal study subject’s heart rhythms. The average duration for After a 24 hours shift, each HRV monitor session was 7 minutes in the (Langelotz et al., 2008) HRV parameters increased resting period. significantly, suggesting Almost all studies reviewed explicitly increased levels of relaxation reported to have applied the recommendations of Cross-sectional study the task force by Malik et al. (1996) in measuring A negative correlation was (Low and McCraty, 2018) found between stress and HRV values. Järvelin-Pasanen, Sinikallio, and HRV measurement Tarvainen (2018) reported thathheighteneddjob stress was found to be associated with lowered HRV values, specificallywwith reduced The first selected article was from Järvelin-Pasanen, parasympatheticsactivation. Sinikallio, and Tarvainen (2018), included in level Meanwhile, based on the results of study 2a research category with homogeneity of cohort conducted by Langelotz et al.. (2008), SDNN, studies. The second selected article was from RMSSD, and pNN50, which were parameters of Langelotz et al. (2008), included in level 2b research the time domain increased significantlyoover224 category which is an individual cohort study, and hours (p=.003, p