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The aim of this letter is to emphasize some of the most important factors that may affect the reliability of heart rate variability (HRV) analysis and to share the initial findings of our recent study on the effects of spontaneous saliva swallowing on HRV and the reliability of HRV analysis. The reliability of HRV analysis is controversial (1). Despite this, more than 28,000 papers related to HRV have been published in SCI. Some of these have been written on the methodology and usage fields of HRV analyses, while some have been examined possible clinical applications. Comprehensive studies have shown that diminished HRV causes mortality and morbidity, and these studies have increased the clinical importance of HRV analysis. However, a significant number of studies have not considered the factors that could affect the reliability of their studies. It has been shown that short-term HRV changes with many factors such as respiratory parameters, speech, prandial state, surrounding sounds, postural stress or physical activities, and emotional state. The reliability of HRV analysis can be increased by various measures. Signal recording should be performed in a quiet and calm environment in the resting position, and the subjects should not be speaking. Records should be taken 3–4 h after the last meal of the subjects. It will be useful to ensure that subjects do not breathe quickly or slowly during recording; if possible, paced breathing can be used. During our previous studies, we have observed that HRV mostly follows respiratory movements with a small phase difference (2, 3). However, in some signal regions on the tacoAnatol J Cardiol 2017; 17: 493-6 Letters to the Editor

Issues related to reliability of HRV analysis and effect of spontaneous saliva swallowing on HRV