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Heart rate variability (HRV), the variation of time intervals between heartbeats, reflects the result of the interaction between the autonomic nervous system and the cardiovascular system. Hypoxia is a stressor that causes changes in HRV and a decrease in arterial oxygen saturation (SaO2). The aim of our study is to analyse if the time and frequency domains of HRV are affected after a hypoxia tolerance test in healthy participants as a function of gender. Material and methods: 23 healthy volunteers (11 women and 12 men) with a mean age of 23.08±2.99 performed a hypoxia tolerance test (11%, 5050 m) with the iAltitude simulator. Heart rate and SaO2 were monitored during the test and HRV frequency domain (FD) and time domain (TD) data were obtained. We analysed the five minutes before and after each session. Outcomes: Simulated altitude-induced hypoxia can cause changes in HRV in a group of healthy individuals. Statistically significant differences were also found between before and after the normobaric hypoxia test in the time-domain variables RRm, SDNN, HRm, HR STD, pNN50. In addition, in women statistically significant differences were found in RMSSD, and in the frequency-domain variables HF and LF/HF. While in males, statistically significant differences were found in SDNN. In both men and women, significant differences were observed in RRm, HRm and pNN50. Conclusion: The differences found in HRV after the hypoxia tolerance test indicate that females show a greater activation of the parasympathetic nervous system compared to males. While males showed greater sympathetic activation. Keywords: Heart rate variability, normobaric hypoxia, stress, autonomic nervous system.

Gender refers to the socially constructed roles, behaviours, expressions and identities of girls, women, boys, men and gender diverse people. Gender-related factors are seldom assessed as determinants of health outcomes, despite their powerful contribution. The Gender Outcomes INternational Group: to Further Well-being Development (GOING-FWD) project developed a standard five-step methodology applicable to retrospectively identify gender-related factors and assess their relationship to outcomes across selected cohorts of non-communicable chronic diseases from Austria, Canada, Spain, Sweden. Step 1 (identification of gender-related variables): Based on the gender framework of the Women Health Research Network (ie, identity, role, relations and institutionalised gender), and available literature for a certain disease, an optimal ‘wish-list’ of gender-related variables was created and discussed by experts. Step 2 (definition of outcomes): Data dictionaries were screened for clinical and patient-relevant outcomes, using the International Consortium for Health Outcome Measurement framework. Step 3 (building of feasible final list): a cross-validation between variables per database and the ‘wish-list’ was performed. Step 4 (retrospective data harmonisation): The harmonisation potential of variables was evaluated. Step 5 (definition of data structure and analysis): The following analytic strategies were identified: (1) local analysis of data not transferable followed by a meta-analysis combining study-level estimates; (2) centrally performed federated analysis of data, with the individual-level participant data remaining on local servers; (3) synthesising the data locally and performing a pooled analysis on the synthetic data and (4) central analysis of pooled transferable data. The application of the GOING-FWD multistep approach can help guide investigators to analyse gender and its impact on outcomes in previously collected data.

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