Key result
Schizophrenia linked to ~2x higher LF/HF ratio versus relatives, indicating altered sympathovagal balance.
Why the study?
Altered HRV reflecting autonomic dysregulation has been reported in schizophrenia, where it may contribute to cardiovascular risk and cognitive dysfunction, but its correlation with cognitive performance within an endophenotypic framework needed investigation.
Does heart rate variability differ between patients with schizophrenia and their first-degree relatives, and does it correlate with cognitive performance?
Observational (n=30)
No
Does heart rate variability differ between patients with schizophrenia and their first-degree relatives, and does it correlate with cognitive performance?
Effect estimate: p=0.041 for LF/HF ratio difference
Absolute Event Rate: 1.57% vs 0.79%
p-value: p=0.041
Schizophrenia is associated with an increased LF/HF ratio indicating sympathovagal imbalance, which correlates with cognitive performance, suggesting HRV as a potential physiological marker in schizophrenia.
Altered sympathovagal balance may mark schizophrenia-related autonomic changes; cross-sectional data leave open causal and prognostic roles.
Background Heart rate variability (HRV) represents beat-to-beat fluctuations in heart rate arising from the dynamic balance between sympathetic and parasympathetic nervous system activity. Altered HRV reflects autonomic dysregulation and has been reported across several psychiatric disorders, including schizophrenia, where it may contribute to cardiovascular risk and cognitive dysfunction. Aim The aim of this study was to compare the time-domain and frequency-domain heart rate variability parameters between patients with schizophrenia and their first-degree relatives and to analyze the correlation between heart rate variability indices and cognitive performance within an endophenotypic framework. Methods This healthcare-based cross-sectional observational study was performed at the Kalinga Institute of Medical Sciences in Bhubaneswar, India, from October 2023 to October 2024. Fifteen clinically stable subjects diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria and fifteen age- and gender-matched first-degree relatives without schizophrenia were included. 5-minute resting HRV was assessed once at a single time point using a standardized three-lead electrocardiogram (ECG) after a 10-minute adaptation period. Time-domain parameters measured overall variability, whereas frequency-domain parameters analyzed sympathetic and parasympathetic modulation. Cognitive functioning was assessed using the Wechsler Abbreviated Scale of Intelligence (WASI). To compare the groups, we used the Mann-Whitney U test, and to look for associations, we used Spearman’s rank correlation. Results Time-domain heart rate variability parameters were comparable between patients with schizophrenia and first-degree relatives (p > 0.05). In the frequency domain, the low frequency (LF) to high frequency (HF) ratio (LF/HF) was significantly higher in patients with schizophrenia than in their relatives (median 1.57 vs. 0.79; p = 0.041), indicating relative sympathetic predominance. Absolute LF, HF, and very-low-frequency (VLF) power values did not differ significantly between groups (p > 0.05). Within the schizophrenia group, the LF/HF ratio showed a significant positive correlation with WASI scores (r = 0.701, p = 0.004). Conclusion Schizophrenia is associated with altered autonomic regulation characterized by an increased LF/HF ratio, suggesting sympathovagal imbalance, while time-domain HRV measures remain comparable to those of first-degree relatives. The observed association between autonomic modulation and cognitive performance supports the relevance of HRV as a potential physiological marker linked to cognitive functioning in schizophrenia. Further longitudinal and genetic studies are required to clarify its role as a potential endophenotypic trait.
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Samanta et al. (2026) conducted an observational in schizophrenia and first-degree relatives without schizophrenia (n=30). patients with schizophrenia vs. first-degree relatives without schizophrenia was evaluated on Comparison of time-domain and frequency-domain heart rate variability (HRV) parameters (p=0.041 for LF/HF ratio difference, p=0.041). Patients with schizophrenia had a significantly higher LF/HF ratio (median 1.57) compared to first-degree relatives (median 0.79; p=0.041), indicating altered sympathovagal balance, while time-domain HRV measures did not differ significantly.
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