The Effects of Semi-Autonomous Driving on Heart Rate Variability and Anxiety

Hakan Göçer1, Ahmet Barış Durukan2,3, İbrahim Duvarcı4

1Department of Cardiology, Private Edremit Korfez Hospital, Balikesir, Türkiye
2Department of Cardiovascular Surgery, Liv Ankara Hospital, Ankara, Türkiye
3Department of Cardiovascular Surgery, İstinye University Faculty of Medicine, İstanbul, Türkiye
4Department of Psychiatry, Private Farabi Hospital, Konya, Türkiye

Keywords: Anxiety; autonomic nervous system; driving; heart rate variability; surveys and questionnaires.

Abstract

Objective: Traditional driving imposes substantial cognitive and physical demands on drivers, often contributing to stress, fatigue, and increased cardiovascular risk. Semi-autonomous driving technologies may alleviate these burdens. We aimed to evaluate the effects of semi-autonomous driving on autonomic nervous system activity and anxiety by comparing heart rate variability (HRV) and validated anxiety measures with manual driving.

Methods: Forty-five healthy adults underwent HRV analysis using Holter monitoring while driving the same route under manual and semi-autonomous conditions. Frequency-domain (Low-frequency [LF]/high-frequency [HF] ratio), time-domain (standard deviation of NN intervals [SDNN], root mean square of successive differences [RMSSD], percentage of successive RR intervals that differ by more than 50ms [pNN50]), and non-linear indices (sample entropy, detrended fluctuation analysis [DFA] α1) were assessed. Mean heart rate, maximum heart rate, and minimum heart rate were also analyzed. Anxiety was evaluated with the State-Trait Anxiety Inventory (STAI; range 20–80) and a 10-point Visual Analog Scale (VAS).

Results: There were 22 male and 23 female participants. The mean age was 34.7±6.9 years. Semi-autonomous driving was associated with significantly lower LF/HF ratio compared with manual driving (1.7±0.5 vs. 2.9±0.7, p<0.001). Time-domain HRV indices improved, with higher SDNN (61.5±10.1 vs. 43.6±8.9 ms), RMSSD (47.8±8.3 vs. 29.1±6.8 ms), and pNN50 (23.5±6.2% vs. 12.9±4.6%; all p<0.001). Non-linear measures showed increased sample entropy (1.41±0.27 vs. 1.14±0.22, p<0.01) and reduced DFA α1 (1.04±0.13 vs. 1.18±0.15, p<0.01). Mean heart rate decreased from 82.4±9.1 to 75.8±8.3 bpm (p<0.001). Anxiety outcomes paralleled these findings: VAS scores were lower (3.7±0.8 vs. 6.1±1.0, p<0.001) and STAI-State decreased (38.4±6.1 vs. 47.1±6.5, p<0.001), while STAI-Trait remained unchanged (43.5±6.8 vs. 45.0±7.3, p=0.12).

Conclusion: Semi-autonomous driving reduced sympathetic dominance and anxiety while enhancing parasympathetic activity and HRV complexity. These findings suggest potential psychophysiological benefits of semi-autonomous driving, warranting confirmation in larger and more diverse populations.

Cite This Article: Göçer H, Durukan AB, Duvarcı İ. The Effects of Semi-Autonomous Driving on Heart Rate Variability and Anxiety. Koşuyolu Heart J 2026;29(2):101–106