ArticleApplied psychophysiology and biofeedback2026
From Subjective to Objective: The Bedside Value of HRV in AssessingChronic Pain Complicated by Emotionaland Sleep Issues.
Article in Applied psychophysiology and biofeedback, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
To test whether brief bedside photoplethysmography-derived heart-rate variability (PPG-HRV) provides objective information about pain, sleep, and affect in adults with chronic pain, and whether sleep moderates the pain-emotion association. We conducted a cross-sectional study of consecutive inpatients with chronic pain (duration ≥ 3 months) admitted to an orthopedics/traumatology service from March 31 to September 28, 2025. Adults (≥ 18 years; right-handed) were excluded for severe internal disease or acute trauma, major psychiatric disorders, marked cognitive impairment, or recent use of anxiolytics/hypnotics. At admission, 5-min fingertip PPG-HRV was recorded under standardized bedside conditions, with artifact correction, stationarity checking, and quality-control screening applied before analysis. Outcomes were the Brief Pain Inventory-Short Form (BPI-SF), Hamilton Depression Rating Scale (HAMD-24), Hamilton Anxiety Rating Scale (HAMA-14), and a composite "sleep problems" index computed as the mean of z-scored HAMD insomnia items and the BPI-SF sleep-interference item. Analyses included correlations, cross-validated random-forest regression incorporating logarithmically transformed HF power (lnHF), and Hayes' PROCESS Model 1 testing sleep as a moderator of the pain→emotion pathway. A total of 172 patients were enrolled (37.2% men; mean age 59.2 years). lnHF was significantly associated with HFnorm, pain, sleep disturbance, and depression, but not anxiety. Random-forest models showed the strongest predictive performance for sleep disturbance (R
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