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Background  Decreased heart rate variability (HRV) is a predictor of autonomic system dysfunction, and is considered as a potential mechanism of increased risk of cardiovascular disease (CVD) induced by exposure to particulate matter less than 2.5 μm in diameter (PM 2.5 ). Previous studies have suggested that exposure to PM 2.5  may lead to decreased HRV levels, but the results remain inconsistent.    Methods  An updated systematic review and meta-analysis of panel studies till November 1, 2019 was conducted to evaluate the acute effect of exposure to ambient PM 2.5  on HRV. We searched electronic databases (PubMed, Web of Science, and Embase) to identify panel studies reporting the associations between exposure to PM 2.5  and the four indicators of HRV (standard deviation of all normal-to-normal intervals (SDNN), root mean square of successive differences in adjacent normal-to-normal intervals (rMSSD), high frequency power (HF), and low frequency power (LF)). Random-effects model was used to calculate the pooled effect estimates.    Results  A total of 33 panel studies were included in our meta-analysis, with 16 studies conducted in North America, 12 studies in Asia, and 5 studies in Europe. The pooled results showed a 10 μg/m 3  increase in PM 2.5  exposure which was significantly associated with a − 0.92% change in SDNN (95% confidence intervals (95%CI) − 1.26%, − 0.59%), − 1.47% change in rMSSD (95%CI − 2.17%, − 0.77%), − 2.17% change in HF (95%CI − 3.24%, − 1.10%), and − 1.52% change in LF (95%CI − 2.50%, − 0.54%), respectively. Overall, subgroup analysis suggested that short-term exposure to PM 2.5  was associated with lower HRV levels in Asians, healthy population, and those aged ≥ 40 years.    Conclusion  Short-term exposure to PM 2.5  was associated with decreased HRV levels. Future studies are warranted to clarity the exact mechanism of exposure to PM 2.5  on the cardiovascular system through disturbance of autonomic nervous function.    Supplementary Information  The online version contains supplementary material available at 10.1186/s12199-020-00912-2.

Acute effect of ambient fine particulate matter on heart rate variability: an updated systematic review and meta-analysis of panel studies