March 3, 2026

Heart rate variability as a non-invasive biomarker of autonomic dysfunction in amyotrophic lateral sclerosis: A systematic review and meta-analysis

Puntos clave

Heart rate variability serves as an important biomarker for detecting autonomic dysfunction.
The analysis indicates that ALS patients show notably reduced heart rate variability, linking it to disease progression.

PICO estructurado

Does amyotrophic lateral sclerosis (ALS) alter heart rate variability (HRV) compared to healthy controls?

Población

Patients with amyotrophic lateral sclerosis (ALS) (14 studies included in qualitative synthesis, 8 in quantitative analysis)

Intervención

Amyotrophic lateral sclerosis (ALS) disease state (exposure)

Comparador

Healthy control groups

Resultado

Heart rate variability (HRV) alterations measured by frequency-domain (LF, HF, LF/HF ratio) and time-domain (RMSSD, SDNN, pNN50%) parameterssurrogate

Patients with ALS demonstrate significant reductions in key time-domain and frequency-domain HRV parameters, suggesting HRV may serve as a valuable non-invasive biomarker for autonomic dysfunction and cardiorespiratory complications in this population.

Resumen

OBJECTIVE This study assessed heart rate variability (HRV) alterations in amyotrophic lateral sclerosis (ALS) patients compared to healthy control groups using both frequency-domain and time-domain HRV parameters. METHODS A systematic review and meta-analysis were conducted using studies retrieved from PubMed, Embase, Web of Science, and Cochrane Library databases up to November 13, 2024. Fourteen studies were included in the qualitative synthesis and eight in the quantitative analysis. RESULTS ALS patients exhibited significantly reduced Low Frequency (LF) and High Frequency (HF) HRV parameters compared to healthy controls (p < 0.001 and p = 0.02, respectively). Time-domain parameters also showed significant reductions: RMSSD (p < 0.001), SDNN (p < 0.001), and pNN50% (p = 0.01). Despite an overall decrease in HRV, the LF/HF ratio did not show a statistically significant difference (p = 0.12). CONCLUSION Patients with ALS demonstrate autonomic dysfunction, evidenced by significant reductions in key time-domain (RMSSD, SDNN, pNN50%) and frequency-domain (LF, HF) parameters, suggesting impaired parasympathetic modulation. HRV may serve as a valuable, non-invasive biomarker for the early detection and management of cardiorespiratory complications in ALS.

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