Relationships among heart rate variability, sleep disturbances, and fatigue in patients undergoing interventional therapy for hepatocellular carcinoma

Background Fatigue and sleep disturbances are commonly experienced by patients with hepatocellular carcinoma (HCC). However, the potential association between these conditions and autonomic nervous system reflected by heart rate variability (HRV) is unclear. We aimed to evaluate the differences in HRV parameters among HCC patients with different degrees of fatigue and sleep disturbances, as well as the relationship between HRV parameters and fatigue and sleep disturbances. Methods In this cross-sectional study, a total of 66 patients with HCC hospitalized for interventional therapy were enrolled. Patients completed questionnaires during hospitalization, including the Pittsburgh Sleep Quality Index (PSQI) and the Fatigue Scale-14 (FS-14), and underwent a 5-minute resting electrocardiogram (ECG) for HRV analysis. Group comparisons and logistic regression models adjusted for age were used to examine the associations between HRV parameters and symptom severity, with Benjamini-Hochberg false discovery rate (FDR) correction for multiple comparisons. Results Acceleration capacity (AC) was significantly higher and low frequency (LF) was significantly lower in the high PSQI group compared to the low PSQI group (AC: p = 0.036; LF: p = 0.041); Compared to the low FS-14 group, the high FS-14 group had significantly higher mean heart rate (MeanHR) and AC, while most other HRV indices were significantly lower (MeanHR: p = 0.029; AC: p = 0.009). The results of the adjusted logistic regression model indicated that increased AC showed a marginal trend toward an association with poor sleep quality (p = 0.071), while MeanHR remained significantly associated with severe fatigue (OR = 1.098, p = 0.004). After FDR correction, the differences in eight HRV parameters between fatigue groups remained significant (all q < 0.05), whereas the differences between sleep-quality groups did not survive correction. Conclusions Our findings suggest that alterations in HRV parameters, particularly mean heart rate (MeanHR) and acceleration capacity (AC), are associated with the severity of fatigue and sleep disturbances in HCC patients. Given the exploratory cross-sectional design, these metrics should be regarded as candidate non-invasive physiological correlates of autonomic dysfunction and symptom burden. Their clinical relevance requires confirmation in larger prospective studies.