There was a moderate correlation between long- and short-term heart rate variability in sleep and wakefulness, and a strong correlation for awake high frequency (HF) in patients with Dravet syndrome, according to a new study.

The study also reported that HF was significantly associated with high seizure burden, including status epilepticus and frequent generalized tonic-clonic seizures both during sleep and wakefulness.

These findings are important as they highlight the heart rate variability parameters that are most reproducible and clinically significant as prognostic biomarkers.

In order to identify such parameters, a team of researchers led by Domenica Battaglia, MD, PhD, from Fondazione Policlinico Universitario A and Università Cattolica del Sacro Cuore in Rome, Italy, analyzed patients with Dravet syndrome for whom 24 hour-electrocardiogram Holter-derived heart rate variability data was available. 

Read more about the prognosis of Dravet syndrome 

The researchers analyzed 31 awake and 22 sleep recordings. They found that HF was the parameter that had the highest correlation with heart rate variability in both awake and sleep recordings.

Moreover, they identified age as a significant factor in simple models for most of the parameters except the root mean square of successive differences between normal heartbeats (RMSSD). 

The researchers also reported that a recent history of status epilepticus was associated with a significant reduction in heart rate variability both in simple and multiple regressions for all parameters except for awake LF and for sleep RMSSD and PNN50. 

Finally, frequent generalized tonic-clonic seizures were associated with a significant decrease in sleep RMSSD, HF, and low frequency. This was the case even when the data was corrected for the effect of age and history of status epilepticus. 

When they conducted a pairwise comparison, the researchers saw a significant increase in sleep for HF.

The study is published in the journal Epilepsy and Behavior.


Perulli M, Scala I, Venditti R, et al. Short- vs long-term assessment of heart rate variability: clinical significance in Dravet syndrome. Epilepsy Behav. 2023;25(146):109357. doi:10.1016/j.yebeh.2023.109357