The effects of auditory stimulation on heart rate variability in healthy individuals with normal hearing and with hearing loss: a systematic review and meta-analysis

Silva, Bárbara Cristiane Sordi; Araújo, Eliene Silva; Valenti, Vitor Engrácia; Jacob, Lilian Cássia Bórnia; Alvarenga, Katia de Freitas

doi:10.1590/2317-1782/20242023111en

person Bárbara Cristiane Sordi Silva

design and delineation of the study · analysis and interpretation of the data · elaboration of the article or critical review for relevant intellectual content in addition to final approval of the version to be presented for publication

schoolDepartamento de Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.

0000-0002-3627-0112

person Eliene Silva Araújo

design and delineation of the study · analysis and interpretation of the data · elaboration of the article or critical review for relevant intellectual content in addition to final approval of the version to be presented for publication

schoolDepartamento de Fonoaudiologia, Universidade Federal do Rio Grande do Norte – UFRN - Natal (RN), Brasil.

0000-0002-3675-4651

person Vitor Engrácia Valenti

design and delineation of the study · analysis and interpretation of the data · elaboration of the article or critical review for relevant intellectual content in addition to final approval of the version to be presented for publication

schoolDepartamento de Fonoaudiologia, Faculdade de Filosofia e Ciências, Universidade Estadual Paulista – UNESP - Marília (SP), Brasil.

0000-0001-7477-3805

person Lilian Cássia Bórnia Jacob

design and delineation of the study · analysis and interpretation of the data · elaboration of the article or critical review for relevant intellectual content in addition to final approval of the version to be presented for publication

schoolDepartamento de Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.

0000-0003-1947-7506

person Katia de Freitas Alvarenga

design and delineation of the study · analysis and interpretation of the data · elaboration of the article or critical review for relevant intellectual content in addition to final approval of the version to be presented for publication

schoolDepartamento de Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP - Bauru (SP), Brasil.

0000-0002-7847-3225

Conflict of interests: nothing to declare.

Correspondence address: Bárbara Cristiane Sordi Silva Departamento de Fonoaudiologia, Faculdade de Odontologia de Bauru – FOB, Universidade de São Paulo – USP Al. Octávio Pinheiro Brisolla, 9-75, Bauru (SP), Brasil, CEP: 17012-901. E-mail:
sordis@hotmail.com

Author (year)	Population
Lee et al.(³⁰)	16 individuals, 6 males and 10 females, mean age 25.9±6.4 years, with normal hearing and no medical history of hypertension. Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Systolic blood pressure (BP) < 140 mmHg or diastolic BP < 90 mmHg. Two subjects were excluded for presenting with BP > 140/90 mmHg.
Roque et al.(²³)	21 individuals, female, age range of 18-30 years (25.2±3), from a similar socioeconomic background. Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Non-smoking individuals. Individuals with prior experience with musical instruments and classical ballet music and/or those who reported liking heavy metal and baroque musical styles were excluded from the studies. Individuals without hearing disorders.
Roque et al.(¹⁹)	40 individuals, female, age range of 18-35 years (25.9±4). Divided into two groups. Group 1: 21 individuals and Group 2: 19 individuals. Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Individuals with prior experience with musical instruments and classical ballet music and/or those who reported liking heavy metal and baroque musical styles were excluded from the studies. Individuals without hearing disorders.
Amaral et al.(²⁴)	21 individuals, male, age range of 18-25 years (21.8±2). Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Non-smoking individuals. Individuals with prior experience with musical instruments and classical ballet music and/or those who reported liking heavy metal and baroque musical styles were excluded from the studies. Individuals without hearing disorders.
Amaral et al.(²⁵)	16 individuals, male, age range of 18-25 years (20.7±3). Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Body mass index < 35 kg/m². Non-smoking individuals. Individuals with prior experience with musical instruments and classical ballet music and/or those who reported liking heavy metal and baroque musical styles were excluded from the studies. Individuals without hearing disorders.
Silva et al.(²⁷)	11 individuals, male, age range of 18-25 years (20.1±3). Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Individuals with prior experience with musical instruments and classical ballet music and/or those who reported liking heavy metal and baroque musical styles and individuals with prior experience with music therapy were excluded. Individuals without hearing disorders.
Silva and Guida(²⁸)	12 healthy individuals, male, age range of 18-30 years (21.7±3). Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Individuals with prior experience with musical instruments and classical ballet music and/or those who reported liking heavy metal and baroque musical styles were excluded from the studies. Individuals without hearing disorders.
Amaral et al.(²⁶)	28 healthy individuals, female, age range of 18-25 years (20.9±2.2). Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. To prevent effects related to sexual hormones, women on days 11-15 and on days 21-25 after the first day of their menstrual cycle were not included. Individuals without hearing disorders.
Nogueira et al.(²⁹)	22 individuals, female, age range of 18-30 years (20.8±2.7). Healthy individuals who did not have cardiopulmonary, psychological, and neurological disorders, without endocrine disorders, or other impairments preventing execution of the research protocol and were not receiving treatment with medications that influence cardiac autonomic regulation. Body mass index < 35 kg/m². Systolic blood pressure (BP) < 140 mmHg or diastolic BP < 90 mmHg. To prevent effects related to sexual hormones, women on days 11-15 and on days 21-25 after the first day of their menstrual cycle were not included. Individuals without hearing disorders.

Author	Intervention, Comparison, and Outcomes
Author	Auditory stimulation	HRV assessment
Lee et al.(³⁰)	Transducer: TDH-39 earphone, binaural presentation of the auditory stimuli. Type of auditory stimuli: white noise. Duration of auditory stimuli: 5 minutes. Intensity: 50, 60, 70, and 80 dB, presented in a random sequence, with 2-minutes intervals between intensities.	Equipment: ECG, amplifier, and analog converter (Model SS1C). Sampling rate: 256 Hz. Duration of HRV measurements in the presence of auditory stimuli: 5 minutes. Indices measured: Frequency domain: VLF (< 0.04 Hz), LF (0.04-0.15 Hz), HF (0.15-0.40 Hz), and LF/HF.
Roque et al.(²³)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of auditory stimulus: 4 minutes and 50 seconds and 5 minutes and 15 seconds. Intensity: approximately 70-80 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of auditory stimuli: 5 minutes. Indices measured: Time domain: SDNN, pNN50, RMSSD. Frequency domain: LF (0.04-0.15 Hz), HF (0.15-0.40 Hz), and LF/HF.
Roque et al.(¹⁹)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal, baroque musical styles and white noise. Duration of auditory stimulus: 4 minutes and 50 seconds, 5 minutes and 5 minutes and 15 seconds. Intensity: approximately 70-80 dB and 90 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Indices measured: Groups 1 and 2 – Geometric analysis, Group 2 – Time domain and frequency domain. Time domain: SDNN, pNN50, RMSSD. Frequency domain: LF (0.04-0.15 Hz), HF (0.15-0.40 Hz), and LF/HF. Geometric analysis: RRTri, TINN, SD1, SD2, and SD1/SD2.
Amaral et al.(²⁴)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of auditory stimulus: 4 minutes and 50 seconds and 5 minutes and 15 seconds. Intensity: blocks of 60-70 dB, 70-80 dB, and 80-90 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of auditory stimuli: 4 minutes and 50 seconds. Indices measured: Time domain: SDNN, pNN50, RMSSD. Frequency domain: LF (0.04-0.15 Hz), HF (0.15-0.40 Hz), and LF/HF.
Amaral et al.(²⁵)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of auditory stimulus: 4 minutes and 50 seconds and 5 minutes and 15 seconds. Intensity: blocks of 60-70 dB, 70-80 dB, and 80-90 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of auditory stimuli: 4 minutes and 50 seconds and 5 minutes. Indices measured: Geometric analysis: RRTri, TINN, SD1, SD2, and SD1/SD2.
Silva et al.(²⁷)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of auditory stimulus: 4 minutes and 50 seconds and 5 minutes and 15 seconds. Intensity: 64-85 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of auditory stimuli: 5 minutes. Indices measured: Geometric analysis: RRTri, TINN, SD1, SD2, and SD1/SD2.
Silva and Guida(²⁸)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of auditory stimulus: 4 minutes and 50 seconds and 5 minutes and 15 seconds. Intensity: 64-85 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of auditory stimuli: 5 minutes. Indices measured: Geometric analysis: RRTri, TINN, SD1, SD2, and SD1/SD2.
Silva and Guida(²⁸)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of auditory stimulus: 4 minutes and 50 seconds and 5 minutes and 15 seconds. Intensity: 64-85 dB, with 5-minute intervals between intensities.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of auditory stimuli: 5 minutes. Indices measured: Geometric analysis: RRTri, TINN, SD1, SD2, and SD1/SD2.
Amaral et al.(²⁶)	Transducer: insert earphones, binaural presentation of the auditory stimulus. Type of auditory stimulus: heavy metal and baroque musical styles. Duration of the auditory stimulus: unspecified. Intensity: blocks of 60-70 dB, 70-80 dB, and 80-90 dB.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 256 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence of auditory stimuli: 10 minutes. Duration of HRV measurements in the presence of the auditory stimulus: 10 minutes. Indices measured: Time domain: SDNN, pNN50, RMSSD. Frequency domain: LF (0.04-0.15 Hz), HF (0.15-0.40 Hz), and LF/HF.
Nogueira et al.(²⁹)	Transducer: insert earphones, binaural presentation of the auditory stimuli. Type of auditory stimuli: heavy metal musical style. Duration of the auditory stimuli: 5 minutes and 15 seconds. Intensity: 75-84 dB, approximately.	Equipment: Polar RS800CX heart rate monitor. Sampling rate: 1000 Hz. At least 1000 RR intervals were used for analysis and only series with more than 95% sinus beats were included. Duration of HRV measurements in the absence and presence of the auditory stimulus: 20 minutes each. Indices measured: Time domain: SDNN/RMSSD. Frequency domain: LF (0.04-0.15 Hz), HF (0.15-0.40 Hz), and LF/HF. Geometric analysis: RRTri, TINN, SD1, SD2, and SD1/SD2.

Author	Outcomes (p-values)
Lee et al.(³⁰)	White noise: frequency domain – LF(ms²): p < 0.01. Only the control was significantly lower than white noise at intensities between 50–80 dB (p < 0.05). HF(ms²): p = 0.74 and LHR: p < 0.01*.
Roque et al.(²³)	Baroque and heavy metal: time domain – SDNN: p = 0.12, RMSSD: p = 0.8, pNN50: p = 0.9. Frequency domain – LF(ms²): p = 0.025*(heavy metal), HF(ms²): p = 0.1, LF(n.u.): p = 0.8, HF(n.u.): p = 0.8, LF/HF: p = 0.7.
Roque et al.(¹⁹)	Group 1: Baroque and heavy metal: geometric analysis – RRTri: p = 0.03, TINN: p = 0.2. Poincaré plot – SD1: p = 0.09, SD2: p = 0.04, SD1/SD2: p = 0.56. Group 2: baroque, heavy metal, and white noise: geometric analysis – RRTri: p = 0.1, TINN: p = 0.1. Poincaré plot – SD1: p = 0.5, SD2: p = 0.09, SD1/SD2: p = 0.39. Time domain – SDNN: p = 0.37, RMSSD: p = 0.3, pNN50: p = 0.17. Frequency domain – LF(ms²): p = 0.12, LF(n.u.): p = 0.2, HF(ms²): p = 0.19, HF(n.u.): p = 0.04*(white Noise), LF/HF: p = 0.08.
Amaral et al.(²⁴)	Time domain: (i) heavy metal – RMSSD: p = 0.5, pNN50: p = 0.4, SDNN: p = 0.47. (ii) Baroque – RMSSD: p = 0.7, pNN50: p = 0.6, SDNN: p = 0.6. Frequency domain: (i) heavy metal – HF(ms²): p = 0.5, LF(ms²): p = 0.6, HF(n.u.): p = 0.45, LF(n.u.): p = 0.67, LF/HF: p = 0.5. (ii) baroque – HF(ms²): p = 0.56, LF(ms²): p = 0.77, HF(n.u.): p = 0.45, LF(n.u.): p = 0.54, LF/HF: p = 0.58.
Amaral et al.(²⁵)	Geometric analysis: (i) heavy metal – RRTri: p = 0.4, TINN: p = 0.6. Poincaré plot – SD1: p = 0.4, SD2: p = 0.4, SD1/SD2: p = 0.5. (ii) baroque – RRTri: p = 0.3, TINN: p = 0.5. Poincaré plot – SD1: p = 0.5, SD2: p = 0.6, SD1/SD2: p = 0.4.
Silva et al.(²⁷)	Time domain: (i) heavy Metal – RMSSD: p = 0.8, pNN50: p = 0.8, SDNN: p = 0.7. (ii) baroque – RMSSD: p = 0.75, pNN50: p = 0.67, SDNN: p = 0.76. Frequency domain: (i) heavy metal – HF(ms²): p = 0.64, LF(ms²): p = 0.71, HF(n.u.): p = 0.79, LF(n.u.): p = 0.68, LF/HF: p = 0.9. (ii) baroque – HF(ms²): p = 0.8, LF(ms²): p = 0.5, HF(n.u.): p = 0.76, LF(n.u.): p = 0.7, LF/HF: p = 0.82.
Silva and Guida(²⁸)	Baroque and heavy metal: geometric analysis – RRTri: p = 0.04(heavy metal), TINN: p = 0.07. Poincaré plot – SD1: p = 0.09, SD2: p = 0.03(heavy metal), SD1/SD2: p = 0.076.
Amaral et al.(²⁶)	Time domain: (i) heavy metal – RMSSD: p = 0.97, pNN50: p = 0.98, SDNN: p = 0.01(80-90dB). (ii) baroque – RMSSD: p = 0.65, pNN50: p = 0.89, SDNN: p = 0.34. Frequency domain: (i) heavy metal – HF(ms²): p = 0.11, LF(ms²): p = 0.04(60-70dB), HF(n.u.): p = 0.82, LF(n.u.): p = 0.83, LF/HF: p = 0.86. (ii) baroque – HF(ms²): p = 0.73, LF(ms²): p = 0.03*(60–70dB), HF(n.u.): p = 1.00, LF(n.u.): p = 0.99, LF/HF: p = 0.95.
Nogueira et al.(²⁹)	Heavy metal: Time domain – SDNN: p = 0.11, RMSSD: p = 0.1, SDNN/RMSSD: p = 0.34, pNN50: p = 0.12. Frequency domain – LF(ms²): p = 0.06, LF(n.u.): p = 0.071, HF(ms²): p = 0.26, HF(n.u.): p = 0.07, LF/HF: p = 0.05*. Geometric analysis – RRTri: p = 0.11, TINN: p = 0.077. Poincaré plot – SD1: p = 0.1, SD2: p = 0.1, SD1/SD2: p = 0.45.

Certainty assessment								Effect		Certainty
Outcomes	Nº of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	Relative (95% CI)	Absolute (95% CI)	Certainty
RMSSD	6	observational studies	not serious	not serious	not serious	not serious	none	-	MD 2.54 lower (4.88 lower to 0.21 lower)	⨁⨁◯◯ Low
HF(n.u)	6	observational studies	not serious	not serious	not serious	not serious	none	-	MD 0.67 higher (1.88 lower to 3.22 higher)	⨁⨁◯◯ Low
SD1	4	observational studies	not serious	not serious	not serious	not serious	none	-	MD 0.49 lower (3.53 lower to 2.54 higher)	⨁⨁◯◯ Low

[1] Caption: BP = Blood pressure