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The Moderating Effect of Heart Rate Variability in a Relationship between Anxiety
and Sleep Quality

V. Amelia and M. Chung 1
1

1
School of Nursing, College of Nursing, Taipei Medical University, Chinese Taipei

Background: Anxiety and poor sleep quality are prevalent ailments that frequently interact, increasing
one other’s impacts. Individuals suffering from anxiety, typically report poor sleep quality. Furthermore,
investigating their interplay can reveal additional interacting elements, thereby improving understanding
of their relationship. Heart Rate Variability (HRV) is generally known as an indicator of emotional regulation,
and this study provides a novel method for examining its moderating function in the relationship between
anxiety and sleep quality.

Objective: To explore the relationship between anxiety and sleep quality and evaluate the moderating
effect of HRV on this relationship.

Methods: This cross-sectional study, conducted between February and April 2023, included 437
participants aged 18 to 26 years old from Central Java, Indonesia. Sociodemographic characteristics and
anxiety levels were measured using self-reported questionnaires, and sleep quality used the Pittsburgh
Sleep Quality Index (PSQI). The HRV was measured at rest and frequency domain characteristics
(Low Frequency (LF), High Frequency (HF), and LF/HF ratio) computed. The study used a model to investigate
which HRV domain moderated the relationship between anxiety and sleep quality.

Results: Participants who had lower HRV reported increased anxiety levels, which was associated with
poorer sleep quality. After controlling factors such as age, gender, body mass index, ethnicity, and
socioeconomic status, it was found that LF (F = 6.52; R2 = 0.36; p < 0.001) and LF/HF ratio (F = 7.05; R2 = 0.39;
Oral Presentation Abstracts
p < 0.001) significantly mediated the relationship between anxiety and sleep quality. However, HF (F = 5.1; R2
= 0.021; p = 0.12) did not.

Conclusion: Lower HRV, particularly in the LF and LF/HF ratio, may be a biomarker of elevated anxiety levels
and is associated with an increased risk of poor sleep quality. Understanding the link between anxiety, sleep
quality, and HRV moderation informs effective health promotion strategies for enhancing sleep quality,
especially among young adults.

Keywords: anxiety, low frequency (LF), high frequency (HF), LF/HF ratio, sleep quality

_____________________________________________________________________________________________________
Correspondence: Min-Huey Chung, School of Nursing, College of Nursing, Taipei Medical University,
Chinese Taipei
E-mail: minhuey300@tmu.edu.tw

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