Abstract
The negative impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health, including that of movement restrictions that unintentionally contributed to its deterioration, has been widely reported. However, the effects of isolation and related factors remain unclear. To explore the physiological, psychological, and lifestyle factors that affected stress levels in individuals with confirmed COVID-19 undergoing isolation, we used a modified version of a commercially available wearable device for the purpose of real-time monitoring. The study included 60 infection patients affected by infectious diseases (30 with confirmed COVID-19 undergoing isolation at home, and 30 inpatients at our institution with other infectious diseases). Based on the data distribution, we conducted correlation analyses within each group and evaluated the relationship between variables using conservative methods, general linear regression, and linear mixed models. The groups comparison was evaluated using an independent-samples t-test. Stress scores in the study population showed significant associations with psychological and lifestyle factors, but not with psychiatric scale scores. According to the linear model, caffeine consumption affected the root mean square of successive differences (RMSSD) (p = 0.031). In participants with confirmed COVID-19 undergoing isolation at home, alcohol consumption and anxiety levels showed strong correlations with RMSSD (p< 0.005), although this was not evident in linear models. Stress scores were significantly higher in participants with COVID-19, whereas RMSSD deviation from the mean of an age-matched Korean cohort was significantly lower than that in patients with other infectious diseases. This study suggests that while perceived stress may influence parasympathetic function in all patients with infectious diseases, this effect may be particularly pronounced in those with COVID-19 undergoing isolation. These individuals are more likely to experience stress and anxiety, and their parasympathetic function may be compromised (reflected in a reduction of heart rate variability). Our results suggests that lifestyle factors and perceived stress influences parasympathetic function in under stressful conditions associated with confinement, and that these factors should be considered in the management of individuals with COVID-19 in isolation.