{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T19:10:31Z","timestamp":1792782631663,"version":"4.5.0"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Tel Aviv University","id":[{"id":"https:\/\/ror.org\/04mhzgx49","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur Arch Otorhinolaryngol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To examine the association between heart-rate variability (HRV) and physician performance during airway management simulations in two physician cohorts studied under different HRV measurement conditions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This exploratory pilot study included otolaryngologists and anesthesiologists participating in two high-fidelity airway simulation courses. HRV was measured via finger-mounted optical sensor and expressed as RMSSD. In one cohort, HRV was recorded immediately before simulation (pre-task); in the second, several days prior (baseline). Blinded supervisors rated performance on standardized 10-point Likert scales. Pearson and exploratory partial correlations adjusting for age, years in practice, and self-reported stress were calculated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-five physicians participated (17 males, 8 females; mean age 35.9 \u00b1 4.7 years). The cohorts differed significantly in age, clinical experience, and performance scores. In the pre-task cohort (n = 11), lower HRV was associated with higher performance (Log RMSSD unadjusted r = \u22120.73, 95% CI [\u22120.927, \u22120.244]; adjusted r = \u22120.85, 95% CI [\u22120.97, \u22120.46]). In the baseline cohort (n = 14), higher HRV was associated with higher performance (Log RMSSD unadjusted r = 0.53, 95% CI [0.055, 0.845]; adjusted r = 0.73, 95% CI [0.198, 0.933]). Wide confidence intervals reflect the small samples and these estimates should be interpreted cautiously. No associations were observed between self-reported stress and either HRV or performance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>HRV was associated with physician performance during airway management simulations, with differing directions of association observed in two physician cohorts studied under different measurement conditions. These findings are exploratory and hypothesis-generating and require confirmation in larger standardized within-subject studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00405-026-10603-3","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:28:47Z","timestamp":1789604927000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Heart rate variability and physician performance during airway management simulations: an exploratory pilot study"],"prefix":"10.1007","author":[{"given":"Narin N","family":"Carmel-Neiderman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yosef","family":"Kula","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Lebovits","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yori","family":"Gidron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nogah","family":"Nativ-Zeltzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yitzhak Brzezinski","family":"Sinai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E","family":"Kozuch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Bilaus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Toukan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barak","family":"Cohen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidal","family":"Muhanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6202-4647","authenticated-orcid":false,"given":"Yuval","family":"Nachalon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"10603_CR1","doi-asserted-by":"publisher","first-page":"223","DOI":"10.1016\/j.jcrc.2020.09.020","volume":"63","author":"A Vincent","year":"2021","unstructured":"Vincent A, Semmer NK, Becker C, Beck K, Tschan F, Bobst C et al (2021) Does stress influence the performance of cardiopulmonary resuscitation? A narrative review of the literature. J Crit Care 63:223\u2013230","journal-title":"J Crit Care"},{"issue":"3","key":"10603_CR2","doi-asserted-by":"publisher","first-page":"318","DOI":"10.1016\/j.surg.2009.10.007","volume":"147","author":"S Arora","year":"2010","unstructured":"Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R (2010) The impact of stress on surgical performance: a systematic review of the literature. Surgery 147(3):318\u2013330 330.e1","journal-title":"Surgery"},{"key":"10603_CR3","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1471-227X-13-8","volume":"13","author":"S Hunziker","year":"2013","unstructured":"Hunziker S, Pagani S, Fasler K, Tschan F, Semmer NK, Marsch S (2013) Impact of a stress coping strategy on perceived stress levels and performance during a simulated cardiopulmonary resuscitation: a randomized controlled trial. BMC Emerg Med 13:8","journal-title":"BMC Emerg Med"},{"issue":"1","key":"10603_CR4","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1177\/0194599818758993","volume":"159","author":"MM Lind","year":"2018","unstructured":"Lind MM, Corridore M, Sheehan C, Moore-Clingenpeel M, Maa T (2018) A multidisciplinary approach to a pediatric difficult airway simulation course. Otolaryngol Head Neck Surg 159(1):127\u2013135","journal-title":"Otolaryngol Head Neck Surg"},{"key":"10603_CR5","doi-asserted-by":"publisher","first-page":"213","DOI":"10.3389\/fpsyg.2017.00213","volume":"8","author":"S Laborde","year":"2017","unstructured":"Laborde S, Mosley E, Thayer JF (2017) Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research - Recommendations for Experiment Planning, Data Analysis, and Data Reporting. Front Psychol 8:213","journal-title":"Front Psychol"},{"issue":"2","key":"10603_CR6","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1007\/s00421-009-1341-x","volume":"109","author":"CS Weber","year":"2010","unstructured":"Weber CS, Thayer JF, Rudat M, Wirtz PH, Zimmermann-Viehoff F, Thomas A et al (2010) Low vagal tone is associated with impaired post stress recovery of cardiovascular, endocrine, and immune markers. Eur J Appl Physiol 109(2):201\u2013211","journal-title":"Eur J Appl Physiol"},{"issue":"1","key":"10603_CR7","first-page":"e34345","volume":"15","author":"JE Peabody","year":"2023","unstructured":"Peabody JE, Ryznar R, Ziesmann MT, Gillman L (2023) A systematic review of heart rate variability as a measure of stress in medical professionals. Cureus 15(1):e34345","journal-title":"Cureus"},{"issue":"2","key":"10603_CR8","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1007\/s12160-009-9101-z","volume":"37","author":"JF Thayer","year":"2009","unstructured":"Thayer JF, Hansen AL, Saus-Rose E, Johnsen BH (2009) Heart rate variability, prefrontal neural function, and cognitive performance: the neurovisceral integration perspective on self-regulation, adaptation, and health. Ann Behav Med 37(2):141\u2013153","journal-title":"Ann Behav Med"},{"issue":"2","key":"10603_CR9","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1016\/j.neubiorev.2011.11.009","volume":"36","author":"JF Thayer","year":"2012","unstructured":"Thayer JF, Ahs F, Fredrikson M, Sollers JJ, Wager TD (2012) A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health. Neurosci Biobehav Rev 36(2):747\u2013756","journal-title":"Neurosci Biobehav Rev"},{"key":"10603_CR10","doi-asserted-by":"publisher","first-page":"710","DOI":"10.3389\/fnins.2019.00710","volume":"13","author":"G Forte","year":"2019","unstructured":"Forte G, Favieri F, Casagrande M (2019) Heart rate variability and cognitive function: A systematic review. Front Neurosci 13:710","journal-title":"Front Neurosci"},{"issue":"3","key":"10603_CR11","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1002\/aet2.10335","volume":"3","author":"JM Mefford","year":"2019","unstructured":"Mefford JM, Kahle S, Gupta S, Tancredi D, Danielson AR, Clarke SO (2019) Heart rate variability and acute stress among novice airway managers. AEM Educ Train 3(3):291\u2013294","journal-title":"AEM Educ Train"},{"issue":"8","key":"10603_CR12","doi-asserted-by":"publisher","first-page":"e0327406","DOI":"10.1371\/journal.pone.0327406","volume":"20","author":"Y Kula","year":"2025","unstructured":"Kula Y, Horosov R, Gidron Y, Ekshtein A, Gordon B, Iversen Z et al (2025) Pre-training heart rate variability as a predictor of Air Force Academy completion. PLoS ONE 20(8):e0327406","journal-title":"PLoS ONE"},{"issue":"3","key":"10603_CR13","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1007\/s10484-025-09702-4","volume":"50","author":"Y Kula","year":"2025","unstructured":"Kula Y, Iversen Z, Cohen A, Levine AD, Gidron Y (2025) Does vagal nerve activity predict performance in a naval commando selection test? Appl Psychophysiol Biofeedback 50(3):349\u2013357","journal-title":"Appl Psychophysiol Biofeedback"},{"issue":"1","key":"10603_CR14","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1111\/j.1469-8986.2006.00475.x","volume":"44","author":"CA Morgan","year":"2007","unstructured":"Morgan CA, Aikins DE, Steffian G, Coric V, Southwick S (2007) Relation between cardiac vagal tone and performance in male military personnel exposed to high stress: three prospective studies. Psychophysiology 44(1):120\u2013127","journal-title":"Psychophysiology"},{"key":"10603_CR15","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/j.cortex.2022.07.008","volume":"155","author":"V Magnon","year":"2022","unstructured":"Magnon V, Vallet GT, Benson A, Mermillod M, Chausse P, Lacroix A et al (2022) Does heart rate variability predict better executive functioning? A systematic review and meta-analysis. Cortex 155:218\u2013236","journal-title":"Cortex"},{"issue":"2","key":"10603_CR16","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1080\/1750984X.2022.2145573","volume":"17","author":"S Laborde","year":"2024","unstructured":"Laborde S, Zammit N, Iskra M, Mosley E, Borges U, Allen MS et al (2024) The influence of breathing techniques on physical sport performance: a systematic review and meta-analysis. Int Rev Sport Exerc Psychol 17(2):1222\u20131277","journal-title":"Int Rev Sport Exerc Psychol"},{"key":"10603_CR17","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.ijpsycho.2019.02.011","volume":"139","author":"M De Couck","year":"2019","unstructured":"De Couck M, Caers R, Musch L, Fliegauf J, Giangreco A, Gidron Y (2019) How breathing can help you make better decisions: Two studies on the effects of breathing patterns on heart rate variability and decision-making in business cases. Int J Psychophysiol 139:1\u20139","journal-title":"Int J Psychophysiol"},{"key":"10603_CR18","doi-asserted-by":"crossref","unstructured":"Shao R, Man ISC, Lee TMC (2024) The Effect of Slow-Paced Breathing on Cardiovascular and Emotion Functions: A Meta-Analysis and Systematic Review. Mindfulness (N Y)","DOI":"10.1007\/s12671-023-02294-2"},{"key":"10603_CR19","doi-asserted-by":"publisher","first-page":"110911","DOI":"10.1016\/j.jpsychores.2022.110911","volume":"158","author":"A Yerushalmy-Feler","year":"2022","unstructured":"Yerushalmy-Feler A, Cohen S, Lubetzky R, Moran-Lev H, Ricon-Becker I, Ben-Eliyahu S et al (2022) Heart rate variability as a predictor of disease exacerbation in pediatric inflammatory bowel disease. J Psychosom Res 158:110911","journal-title":"J Psychosom Res"},{"issue":"3","key":"10603_CR20","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/S0165-0327(00)00338-4","volume":"61","author":"JF Thayer","year":"2000","unstructured":"Thayer JF, Lane RD (2000) A model of neurovisceral integration in emotion regulation and dysregulation. J Affect Disord 61(3):201\u2013216","journal-title":"J Affect Disord"},{"issue":"2","key":"10603_CR21","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/j.1542-474X.2011.00417.x","volume":"16","author":"U Nussinovitch","year":"2011","unstructured":"Nussinovitch U, Elishkevitz KP, Katz K, Nussinovitch M, Segev S, Volovitz B et al (2011) Reliability of Ultra-Short ECG Indices for Heart Rate Variability. Ann Noninv Electrocard 16(2):117\u2013122","journal-title":"Ann Noninv Electrocard"}],"container-title":["European Archives of Oto-Rhino-Laryngology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10603-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00405-026-10603-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00405-026-10603-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:28:50Z","timestamp":1789604930000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00405-026-10603-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":21,"alternative-id":["10603"],"URL":"https:\/\/doi.org\/10.1007\/s00405-026-10603-3","relation":{},"ISSN":["0937-4477","1434-4726"],"issn-type":[{"value":"0937-4477","type":"print"},{"value":"1434-4726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"assertion":[{"value":"20 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 September 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no conflict of interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}]}}