Mapping the Neurophysiological Link Between Voice and Autonomic Function: A Scoping Review

Vocal production requires the coordinated control of respiratory, laryngeal, and autonomic systems. In individuals with high vocal demand, this physiological load may influence autonomic regulation, even in the absence of voice disorders. This scoping review systematically mapped current evidence on the relationship between voice production and autonomic nervous system (ANS) activity in adults, focusing exclusively on studies that assessed both systems simultaneously. A systematic search was conducted in PubMed, Scopus, Web of Science, Embase, and CINAHL, following PRISMA-ScR guidelines. Eligible studies included adults performing structured vocal tasks with concurrent autonomic measurements. Data were extracted and synthesized descriptively. Fifteen studies met the inclusion criteria. Most involved healthy adults with high vocal demand, while some included participants with subclinical or functional voice traits. Vocal tasks ranged from singing and sustained phonation to speech under cognitive or emotional load. Autonomic measures included heart rate (HR), heart rate variability (HRV), and electrodermal activity (EDA), among others. Four thematic trends emerged: autonomic synchronization during group vocalization; modulation of autonomic tone by vocal rhythm and structure; voice-ANS interplay under stress; and physiological coupling in hyperfunctional vocal behaviours. This review's findings suggest that vocal activity can modulate autonomic function, supporting the potential integration of autonomic markers into experimental and clinical voice research.