Cardiovascular and pulmonary response in Internet gaming disorder: A systematic review

Internet Gaming Disorder (IGD) is a behavioral addiction characterized by impaired control over gaming. While its psychological aspects are well-documented, its physiological correlates, particularly those governed by the autonomic nervous system (ANS), are less well-synthesized. Heart rate variability (HRV) and pulmonary function are key indicators of cardiorespiratory health and ANS regulation. This systematic review aimed to evaluate the impact of IGD on chronotropic (as measured by HRV) and ventilatory responses, both at rest and during active gaming.

We searched PubMed, Embase, and Scopus from database inception to December 2024 seeking for observational studies published in English or French. We included studies that diagnosed IGD using formal criteria (DSM-5/ICD-11) and objectively measured HRV and/or pulmonary function in individuals with IGD compared to healthy controls. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the ROBINS-I tool.

The search yielded 249 records, from which four case-control studies met the inclusion criteria, comprising 162 participants (77 IGD, 85 controls). The overall risk of bias was judged to be low. At rest (k=3 studies), baseline HRV parameters including the natural logarithm of high-frequency power (lnHF), root mean square of successive differences (RMSSD), and standard deviation of normal-to-normal intervals (SDNN) did not differ significantly between the IGD and control groups. During active gaming (k=2 studies), a blunted parasympathetic reactivity was observed in the IGD group, characterized by a significant drop in lnHF not observed in controls. Regarding pulmonary function (k=1 study), while lung volumes were similar, individuals with IGD showed significantly lower respiratory muscle strength compared to controls.

This review suggested that IGD is associated with preserved tonic autonomic function at rest but impaired phasic parasympathetic reactivity during gaming engagement. Furthermore, IGD may be linked to reduced respiratory muscle strength, potentially indicating a physical deconditioning. These physiological alterations highlight the systemic impact of IGD and may serve as potential biomarkers for diagnosis and monitoring.