Heart rate variability as a predictor of autonomic dysfunction and cardiovascular risk in periodontitis

Vineetha Saminathan; Saravanan Ayyavoo; Jeyabanu Murugiah; Kalyanipraba Premsundar; Rohini Pushparaj; Thamarai Selvi Kanagaraj

Vineetha Saminathan Department of Physiology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chengalpattu District, Tamil Nadu, India https://orcid.org/0000-0002-7234-5978
Saravanan Ayyavoo Department of Physiology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chengalpattu District, Tamil Nadu, India https://orcid.org/0000-0001-8869-602X
Jeyabanu Murugiah Department of Physiology, Nandha Medical College and Hospital, Erode, Tamil Nadu, India https://orcid.org/0009-0009-9776-7913
Kalyanipraba Premsundar Department of Physiology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chengalpattu District, Tamil Nadu, India https://orcid.org/0009-0003-3028-821X
Rohini Pushparaj Department of Physiology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chengalpattu District, Tamil Nadu, India https://orcid.org/0009-0004-2808-3028
Thamarai Selvi Kanagaraj Department of Physiology, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology (SRMIST), Kattankulathur, Chengalpattu District, Tamil Nadu, India https://orcid.org/0000-0001-7791-7923

Keywords: periodontitis, heart rate variability, autonomic dysfunction, sympathetic dominance, parasympathetic activity, cardiovascular risk

Abstract

Periodontitis is a chronic inflammatory disease damaging the supportive structure of teeth. It has many systemic impacts including cardiac autonomic dysfunction. Heart Rate Variability (HRV) measures an objective analysis of the extent of autonomic regulation and where decreased parasympathetic activity coupled with increased sympathetic predominance was determined to correlate well with risk in cardiovascular function. This research ascertains periodontitis and its correlation to autonomic dysfunction by HRV analysis. In total, 54 periodontitis patients were involved in the study, categorized under four groups, namely Gingivitis (n=14), Mild Periodontitis (n=13), Moderate Periodontitis (n=13), and Severe Periodontitis (n=14). Kubios HRV software version 3.5 was used for the analysis of time-domain and frequency-domain parameters of lead II ECG for HRV analysis. The indices of SNS and PNS were calculated for the assessment of autonomic balance. The correlation between the HRV parameters with the severity of periodontal disease was performed statistically. The SNS index was increased with periodontitis severity (Gingivitis: 1.09±0.60, Mild Periodontitis: 4.25±2.4, Moderate Periodontitis: 3.82±2.2, Severe Periodontitis: 4.45±1.5; p<0.001), which reflected enhanced sympathetic activation. On the other hand, the PNS index was significantly reduced (0.55±0.91 in Gingivitis to -0.98±0.59 in Severe Periodontitis; p<0.001), indicating parasympathetic withdrawal. SDNN, a marker of overall autonomic tone, decreased significantly (p=0.025), while high-frequency (HF) power, indicative of vagal activity, showed a strong negative correlation with periodontitis severity (Rho=-0.58, p<0.001). These findings suggest progressive autonomic dysfunction with increasing periodontal inflammation. Significant autonomic dysfunction, including elevated sympathetic hyperactivity and diminished parasympathetic regulation, is associated with periodontitis and lowers heart rate variability. Higher cardiovascular risk is correlated with the advancement of periodontal disease, underscoring the necessity of HRV evaluation as a possible biomarker. Future studies should examine if treating periodontal disease can enhance systemic health and restore autonomic balance.