Key result
Exam week stress is linked to a ~1.5-point increase in anxiety scores without altering short-term HRV.
Why the study?
Examination stress in college students may be accompanied by anxiety, sleep disturbances, and altered autonomic regulation, and short-term heart rate variability may provide complementary insight into cardiac autonomic regulation during stress.
Does examination stress increase self-reported anxiety and sleep insufficiency and alter short-term heart rate variability in fourth-year medical students?
Observational (n=50)
No
Does examination stress increase self-reported anxiety and sleep insufficiency and alter short-term heart rate variability in fourth-year medical students?
Examination stress in medical students significantly increases self- and peer-reported anxiety and sleep insufficiency without producing overall significant changes in short-term 5-minute HRV parameters, although the LF/HF ratio was negatively associated with anxiety severity in multivariable-adjusted cross-sectional analysis.
Answers are grounded in this paper and cite their sources.
Short-term HRV may not reliably capture acute psychological stress in healthy adults; leaves open whether longer-term autonomic monitoring better reflects anxiety-related cardiovascular strain.
BACKGROUNDExamination stress is common among college students and may be accompanied by anxiety, sleep disturbances, and changes in autonomic regulation.Short-term heart rate variability (HRV) is a noninvasive physiological measure that may provide complementary insight into cardiac autonomic regulation during stress. AIMTo explore changes in anxiety, sleep insufficiency, and short-term HRV during examination stress and their associations in medical students.(unadjusted P = 0.028), whereas the unadjusted correlation between low/high frequency (LF/HF) and self-reported GAD-7 scores did not reach statistical significance (P = 0.053).After FDR correction for multiple correlations, only the association between sleep insufficiency and self-reported GAD-7 scores remained significant (FDR-adjusted P < 0.001).In the multivariable regression model, greater sleep insufficiency was independently associated with higher self-reported GAD-7 scores (P < 0.001), and LF/HF was negatively associated with the GAD-7 self-report score (P = 0.015). CONCLUSIONEW was associated with higher levels of self-reported anxiety and more severe sleep insufficiency, but no overall significant changes were observed in the measured shortterm HRV parameters.Exploratory EW analyses suggest that LF/HF may be associated with individual differences in anxiety severity after adjustment for other variables, although this association was not significant in the unadjusted correlation analysis; however, further validation is needed.
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Fang et al. (2026) conducted an observational in Examination stress and anxiety (n=50). Examination week stress vs. Regular academic days was evaluated on Change in self-reported Generalized Anxiety Disorder-7 (GAD-7) score between regular days and examination weeks (MD 1.48, 95% CI 0.47-2.49, p=0.005). Examination week stress significantly increased self-reported GAD-7 anxiety scores by 1.48 points compared to regular academic days (5.46 vs 3.98; P = 0.005), without altering short-term HRV.
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