Sex-dependent cardiovascular variations in response to basic music features

Abstract Background Music based interventions are gaining recognition as adjunctive medicine and a safe way to modulate cardiovascular function 1; but music-induced autonomic modulation remains an understudied area. Little is known about sex differences in music response, an important step towards precision heart medicine. While some studies have shown sex based variations in emotion and psychophysiological response to music 2,3, such differences during music listening have yet to be investigated. Purpose To study differences in female and male cardiovascular response to variations in tempo and loudness. Methods Concentrating on cardiovascular function parameters, study of females and males was conducted with fast/slow and loud/soft music. The target variables were features derived from ECG signals and systolic and diastolic blood pressure (SBP, DBP) values. The cohort included 26 females (age=44.16±22.34yrs) and 26 males (age=46.56±19.96yrs). Participants listened to different versions of western classical music, in their original and digitally altered form to span a range of tempi and loudness, rendered on a reproducing piano 4. Simultaneously, ECG signals and continuous BP values were acquired during 5-min silence and ~40-min music periods. The ECG signals are processed, extracting RR and QT intervals (/ cardiac cycle), providing information about the heart’s rhythmic activity and the impact of external stimuli on the heart, respectively. The BP values were used to evaluate PP (pulse pressure) (SBP-DBP), an indicator of arterial stiffness; and mid-BP ((SBP+DBP)/2), a measure of overall arterial BP/cardiac cycle. The four cardiovascular features were normalised by dividing them by their initial silence values. Results The normalised values vary with music tempo and loudness relative to silence. During soft and slow music, RR decreased for females but increased for males, with normalised values 0.98±0.02 and 1.16±0.2 (p=0.012), respectively; the standard deviation was also greater for males. With loud and fast music, the RR and QT increased—mean normalised values were 1.001±0.07 and 1.013±0.32, respectively—for females and decreased—0.92±0.02 and 0.94±0.06, respectively—for males (p=0.039). The BP features fluctuated more than ECG features. The mean normalised PP was 0.5589±0.41 for females compared to 0.95±0.12 for males (p=0.015). The mean normalised mid-BP was 1.19±0.06 for males compared to 1.05±0.13 for females (p=0.19). The mean normalised PP and mid-BP were generally 1 for males (showing increase) and 1 for females (decrease). Conclusions Reactivity to music is more pronounced in male listeners compared to females. In females and males, BP features changes were more pronounced—greater magnitude and more significance—than for ECG signatures. Moreover, loud music affects males more whereas fast music affects females. The results underscore the importance of considering sex differences when using music for diagnostic or therapeutic purposes.Graphs Tables