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

##plugins.themes.academic_pro.article.sidebar##

Published Nov 9, 2025
https://doi.org/10.62438/tunismed.v103i9.6214
Download
pdf
Vol. 103 No. 9 (2025): Tunis Med sept 2025

##plugins.themes.academic_pro.article.main##

Hela Cherif
Pulmonology Department; Health and environment in Security Forces research laboratory LR211NT01, Security Forces Hospital,Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis,Tunisia
Soumaya Debiche
Pulmonology Department; Health and environment in Security Forces research laboratory LR211NT01, Security Forces Hospital,Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis,Tunisia
https://orcid.org/0009-0003-9211-3095
Sabrine Louhaichi
Thoracic Surgery Department, Abderrahmane Mami Hospital, Ariana, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis; Tunisia
Salma Mokaddem
Pulmonology Department; Health and environment in Security Forces research laboratory LR211NT01, Security Forces Hospital,Tunis, Faculty of Medicine of Tunis, Tunis El Manar University, Tunis,Tunisia
https://orcid.org/0000-0002-7775-3073

Abstract

Introduction: 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.


Methods: 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. 


Results: 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.


Conclusion: 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  ..(abstract truncated at 250 words).


 

Keywords:

Adolescent, Autonomic Nervous System, Internet Addiction Disorder, Respiratory Muscles, young adults

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Internet gaming disorder. 5th ed. 2013;913–7.
  2. Clinical descriptions and diagnostic requirements for ICD-11 mental, behavioural and neurodevelopmental disorders [Internet]. Geneva: World Health Organization; 2024. Available from: https://iris.who.int/bitstream/handle/10665/375767/9789240077263-eng.pdf
  3. Rehbein F, Kliem S, Baier D, Mößle T, Petry NM. Prevalence of Internet gaming disorder in German adolescents: diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample. Addiction. 2015 May;110(5):842–51.
  4. Liao Z, Huang Q, Huang S, Tan L, Shao T, Fang T, et al. Prevalence of Internet Gaming Disorder and Its Association With Personality Traits and Gaming Characteristics Among Chinese Adolescent Gamers. Front Psychiatry. 2020 Nov;11:598585.
  5. Oka T, Hamamura T, Miyake Y, Kobayashi N, Honjo M, Kawato M, et al. Prevalence and risk factors of internet gaming disorder and problematic internet use before and during the COVID-19 pandemic: A large online survey of Japanese adults. J Psychiatr Res. 2021 Oct;142:218–25.
  6. Wartberg L, Kriston L, Zieglmeier M, Lincoln T, Kammerl R. A longitudinal study on psychosocial causes and consequences of Internet gaming disorder in adolescence. Psychol Med. 2019 Jan;49(2):287–94.
  7. Zou Z, Wang H, d’Oleire Uquillas F, Wang X, Ding J, Chen H. Definition of Substance and Non-substance Addiction. In: Zhang X, Shi J, Tao R, editors. Substance and Non-substance Addiction. Singapore: Springer; 2017. p. 21–41. (Advances in Experimental Medicine and Biology; vol. 1010).
  8. Kuss DJ, Griffiths MD. Online gaming addiction in children and adolescents: A review of empirical research. J Behav Addict. 2012;1(1):3–22.
  9. Yao YW, Liu L, Ma SS, Shi XH, Zhou N, Zhang JT, et al. Functional and structural neural alterations in Internet gaming disorder: A systematic review and meta-analysis. Neurosci Biobehav Rev. 2017;83:313–24.
  10. Ding W na, Sun J hua, Sun YW, Chen X, Zhou Y, Zhuang Z guo, et al. Trait impulsivity and impaired prefrontal impulse inhibition function in adolescents with internet gaming addiction revealed by a Go/No-Go fMRI study. Behav Brain Funct. 2014;10:20.
  11. Jung W, Jang KI, Lee SH. Heart and Brain Interaction of Psychiatric Illness: A Review Focused on Heart Rate Variability, Cognitive Function, and Quantitative Electroencephalography. Clin Psychopharmacol Neurosci. 2019 Nov 20;17(4):459–74.
  12. Lee D, Park J, Namkoong K, Hong SJ, Kim IY, Jung YC. Diminished cognitive control in Internet gaming disorder: A multimodal approach with magnetic resonance imaging and real-time heart rate variability. Progress in Neuro-Psychopharmacol Biol Psychiatry. 2021;111:110127.
  13. Hong SJ, Lee D, Park J, Namkoong K, Lee J, Jang DP, et al. Altered Heart Rate Variability During Gameplay in Internet Gaming Disorder: The Impact of Situations During the Game. Front Psychiatry. 2018;9:429.
  14. Ji HM, Hsiao TC. Instantaneous Respiratory Response of Gamer with High-Risk Internet Gaming Disorder during Game-Film Stimuli by Using Complementary Ensemble Empirical Mode Decomposition. Annu Int Conf IEEE Eng Med Biol Soc. 2020;2020:980–3.
  15. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
  16. Cherif, Louhaichi,DebicheMokaddem. protocol IGD. La Tunisie Médicale.
  17. Wilson DB. Practical Meta Analysis Effect Size Calculator [Internet]. George Mason University; 2023. (Campbell Collaboration). Available from: https://www.campbellcollaboration.org/calculator/d-means-sds
  18. Sterne JAC, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.
  19. Park JH, Yoo SY, Park HY, Choi JS. Resting-state heart rate variability, level of stress and resilience in internet gaming disorder and alcohol use disorder. Front Pharmacol. 2023;14:1152819.
  20. Mutlu C, Birinci T, Senel A, Mustafaoglu R, Bulanık Koc E, Karacetin G, et al. A multi-dimensional assessment of internet gaming disorder in children and adolescents: A case-control study. Work. 2024;77(4):1089–99.
  21. Meerkerk GJ, Den Eijnden RJ, Vermulst AA, Garretsen HF. The Compulsive Internet Use Scale (CIUS): some psychometric properties. Cyberpsychol Behav. 2009;12(1):1-6.
  22. Critchley HD. Neural mechanisms of autonomic, affective, and cognitive integration. J Comp Neurol. 2005;5;493(1):154-66.
  23. Mazzola L, Mauguière F, Chouchou F. Central control of cardiac activity as assessed by intra-cerebral recordings and stimulations. Neurophysiol Clin. 2023;53(2):102849.
  24. Alonazi A, Almutairi W, Bains G, Daher N, Alismail A. Effects of smartphone addiction on children’s lung function. Pediatr Int. 2021;63(3):323–30.
  25. Skok K, Waszkiewicz N. Biomarkers of Internet Gaming Disorder-A Narrative Review. J Clin Med. 2024 Aug 1;13(17):5110.