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Reviews in Cardiovascular Medicine  2021, Vol. 22 Issue (3): 845-852     DOI: 10.31083/j.rcm2203090
Systematic Review Previous articles | Next articles
Accurate and early detection of sleepiness, fatigue and stress levels in drivers through Heart Rate Variability parameters: a systematic review
Alexandru Burlacu1, 2, 3, *, †(), Crischentian Brinza1, 2, †, Adrian Brezulianu4, 5, *(), Adrian Covic1, 3, 6
1'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iasi, Romania
2Department of Interventional Cardiology - Cardiovascular Diseases Institute, 700503 Iasi, Romania
3Academy of Medical Sciences, 030167 Bucharest, Romania
4Tehnical University of Iasi 'Gheorghe Asachi', 700050 Iasi, Romania
5GreenSoft Ltd, 700137 Iasi, Romania
6Nephrology Clinic, Dialysis, and Renal Transplant Center—'C.I. Parhon' University Hospital, 700503 Iasi, Romania
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Sleepiness, fatigue, and stress in drivers are the leading causes of car crashes. In the late two decades, there is an endeavor to monitor vital signs, stress levels, and fatigue using adapted sensors supported by technological advances. To the best of our knowledge, this systematic review is the first to investigate the role of HRV measurement for sleepiness, fatigue, and stress level monitoring in car drivers. A search was performed in PubMed, Embase, and Cochrane databases using prespecified keywords. Studies were considered for inclusion if they reported original data regarding the association between different HRV measurements and drivers' sleepiness, fatigue, or stress levels. Of the retrieved 749 citations, 19 studies were finally included. The sensibility and specificity of HRV significantly varied across studies, respectively 47.1%–95% and 74.6%–98%. Accuracy was also different, ranging from 56.6% to 95%. Nevertheless, in real-world conditions, confounding factors could affect sympathovagal tone and HRV. Multiple HRV parameters measurement rather than one parameter approach seems to be the optimal strategy for evaluating the vigilance state in drivers that it would be possible to achieve a good performance. As all studies were observational, data should be confirmed in randomized controlled trials. In conclusion, HRV represents a potentially valuable marker for sleepiness, fatigue, and stress monitoring in car drivers. HRV measurements could be implemented in future clinical models and sensors to detect early sleepiness and fatigue and prevent car crashes. More studies with larger populations are needed to support this evidence.
Key words:  Heart rate variability      Drivers      Fatigue      Sleepiness      Stress detection      Systematic review     
Submitted:  08 July 2021      Revised:  17 July 2021      Accepted:  26 July 2021      Published:  24 September 2021     
MySMIS 107124/Romanian Academy of Medical Sciences and European Regional Development Fund
*Corresponding Author(s): (Alexandru Burlacu); (Adrian Brezulianu)   
About author:  These authors contributed equally.

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Alexandru Burlacu, Crischentian Brinza, Adrian Brezulianu, Adrian Covic. Accurate and early detection of sleepiness, fatigue and stress levels in drivers through Heart Rate Variability parameters: a systematic review. Reviews in Cardiovascular Medicine, 2021, 22(3): 845-852.

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