Effects of cigarette smoking on cardiac autonomic responses: A cross-sectional study

Nadeen Makhoul, Ishay Avivi, Sapir Barak Lanciano, Ella Haber Kaptsenel, Hana Bishara, Hagar Palacci, Chen Chaiat, Giris Jacob, Udi Nussinovitch

Research output: Contribution to journalArticlepeer-review


It has been suggested that some of the adverse, long-term cardiovascular outcomes of smoking are mediated by impaired autonomic nervous system (ANS) activity. Yet, this association is currently inconclusive. Heart rate variability (HRV) and the deep breathing test (DBT) represent common quantitative markers of ANS activity due to their simplicity and reliability. This large cross-sectional study was designed to assess the effect of active smoking on ANS function as manifested by HRV or DBT abnormalities. Electrocardiograms were recorded at rest for 5 min and during forced metronomic breathing. HRV and DBT were calculated according to accepted standards. Participants were divided into two groups based on current smoking status. The study included 242 healthy volunteers (196 nonsmokers and 46 smokers). There were no significant differences in age, sex, and BMI between groups. Cumulative smoking exposure burden (CSEB) for the study group was 5.3 ± 1.3 pack-years. Comparative analysis of HRV and DBT parameters according to smoking status revealed no significant differences between groups. Significant (p < 0.05), yet weak or moderate correlations (r < 0.7) were found between CSEB and abnormal change in HRV parameters consistent with sympathetic overactivity and decreased parasympathetic tone. In conclusion, smoking for a relatively short period in healthy adults does not seem to lead to significant impairment in ANS function. Yet, the consequences of smoking seem to be amplified when cumulative exposure burden increases.

Original languageEnglish
Article number8571
Pages (from-to)1-9
Number of pages9
JournalInternational Journal of Environmental Research and Public Health
Issue number22
StatePublished - 2 Nov 2020


  • Autonomic nervous system
  • Cigarette smoking
  • Deep breathing test
  • Heart rate variability
  • Nicotine


Dive into the research topics of 'Effects of cigarette smoking on cardiac autonomic responses: A cross-sectional study'. Together they form a unique fingerprint.

Cite this