Altered Autonomic Functions in Exam Stress: Cardiovascular-Pulmonary Interactions

Abstract

Background:Medical training involves a long and exhaustive curriculum in which students are frequently evaluated by examinations. Pre-examination stress is a common condition faced by students prior to exams and is one of the most widely experienced problems for medical students. The aim of the study was to assess the effects of exam stress on autonomic nervous system functions of students through cardiovascular parameters and respiratory tests. Materials and Methods:The study group consisted of 29 second-year medical students. This cross-sectional study was carried out from February to March 2020 at Harran University, Turkey. The parameters used were oxygen saturation, pulse rate (PR), systolic (SBP) and diastolic blood pressure (DBP), and pulmonary function tests. Data were collected four times during an exam period (10 days, 7 days, and 1 hour before the exam and 1 hour after the exam). Results: There was a statistically significant difference between the measurements of PR, SBP, and DBP at different times (p˂0.001; p=0.001; p=0.003, respectively). When the average values of the measurements of Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), peak expiratory flow (PEF), and vital capacity (VC) at different times were compared, it was found that there was a statistically significant difference between the groups (p˂0.001; p= 0.006; p˂0.001; p˂0.001, respectively). As a result of the sympathetic nervous system induction, hemodynamic and respiratory tests increased gradually until the examination. The results of correlation analysis showed a negative relationship between PR, and FVC, FEV1, VC. Conclusions: It is evident that medical students undergo stress during their pre-exam period. It is thought that constant exposure to stress can disrupt the homeostatic balance in the long term and may be risk factor for cardiovascular and respiratory diseases.

Effects of examination-induced stress on memory and blood pressure

“…For example, excess BP reactivity is associated with altered α- and β-adrenoreceptor sensitivity, endothelial dysfunction, increased vascular resistance, and vascular remodeling. [ 20 ]…”

Role of Meditation in Ameliorating Examination Stress Induced Changes in Cardiovascular and Autonomic Functions

“…Recent studies show that examination-related stress increases SBP and DBP and lowers BRS values during the exam period compared to the semester time in healthy college students. 10 – 12 An examination can lead to significant stress, which can put the cardiovascular system at risk even in young, healthy individuals. The stress levels are even higher for medical students during their pre-examination period.…”

“…The stress levels are even higher for medical students during their pre-examination period. Constant exposure to stress is harmful in the long run as it disrupts the homeostatic balance and may be a risk factor for derangements in the cardiovascular and respiratory systems, 12 leading to disease. In a study conducted on medical students using academic examinations as a model of mental stress, it was found that the mean arterial pressure increased and the mean RR interval, SDNN, and pNN50 were significantly reduced during examinations.…”

“…Changes in stress markers such as salivary cortisol, immunoglobulin A, and luteinizing hormone in students during examination stress [7][8][9] have been reported. Examination stress also induces changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure (MBP), heart rate variability (HRV), and baroreflex sensitivity (BRS) [10][11][12][13] most probably due to autonomic perturbations. Performing yoga leads to a reduction in sympathetic activity and an enhancement of cardiovagal function.…”