Impact of Prescribed and Self-Selected Music Interventions on Stress, Sleep, Heart Rate Variability, and Brain Connectivity in Surgeons: A Multimodal Feasibility Randomized Trial Using 7-Tesla fMRI and Wearable Actigraphy (Preprint)

BACKGROUND Background: Stress, sleep deprivation, and burnout are significant safety risks for acute care surgeons, negatively impacting performance, well-being, and clinical outcomes. OBJECTIVE Objective: This pilot randomized controlled trial aimed to measure the neurophysiological effects of prescribed and self-selected music interventions on surgeon stress, burnout, and neurophysiological responses using a multimodal protocol that integrated functional MRI, wearable biosensor monitoring, and psychological self-assessments. METHODS Methods: Full-time attending surgeons at a quaternary care hospital were invited to participate in a three-armed trial (1:1:1 block allocation). The intervention groups were instructed to listen to 30 minutes (minimum 15) of either prescribed music (PM) or self-selected music (SSM) daily at bedtime for six weeks, reflecting real-world conditions. PM comprised original compositions based on elements promoting perceived relaxation from a prior study. The control arm did not listen to music in the 30 minutes prior to bed. Allocation was concealed from the recruiting investigator; the fMRI technicians, the statistician, and all lead investigators were blinded to patient groups until completion of analyses. Functional connectivity patterns were measured using fMRI at baseline and six weeks while all participants listened to simulated ICU noise, PM, and SSM. Secondary outcomes included continuous actigraphy data for sleep quality and self-reported measures of anxiety, sleep quality, and burnout using validated scales (State-Trait Anxiety Inventory, Pittsburgh Sleep Quality Index, and Maslach Burnout Inventory). RESULTS Results: Twenty-two surgeons were assessed; the demands of the fMRI and data collection schedule led three to decline and two (originally allocated to PM) not to finish baseline measures; six PM, five SSM, and six controls received allocated intervention; two PM participants were withdrawn for nonadherence and missing follow-up data and one control missed follow-up collection due to scheduling. One control participant experienced transient vertigo in fMRI. Trends in fMRI data indicated both intervention groups experienced less negative emotional arousal and anxiety, with physical tension reduced in the PM group. The PM group exhibited reduced stress response in the frontal lobes when exposed to ICU alarms, suggesting diminished attentional response to the high-stress auditory environment, compared to control. However, lack of statistical significance and baseline variability entail cautious interpretation. Observations of sleep quality were mixed, and no statistically significant differences in stress surveys were observed. CONCLUSIONS Discussion: Both music interventions showed trends toward positive changes in neurophysiological responses, suggesting potential benefits in reducing surgeon stress. However, due to the small sample size, mixed or non-significant secondary outcome results, and the exploratory nature of this study, findings should be considered preliminary. Further research with larger, diverse cohorts will be needed to confirm these trends, refine both the intervention approach and recruitment strategies, and determine whether objective compositional elements or personal familiarity with music drive the mechanisms of potential positive effects. CLINICALTRIAL ClinicalTrials.gov Registration: NCT05980429