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<p>Simulator sickness (SS) is an obstacle to extensive adoption of virtual reality (VR) systems. While the simulator sickness questionnaire (SSQ) is the standard for assessing SS symptoms, it lacks temporal resolution to monitor symptom progression during exposures. In the present study, we examined heart rate variability (HRV) and eye-tracking (ET) metrics as physiological markers of SS, using a visual analogue scale (VAS) to gauge symptoms concurrently. Thirty subjects completed up to five virtual roller-coaster rides while electrocardiography (ECG) and ET data were continuously recorded. VAS ratings were collected at baseline and after each ride and showed a strong positive correlation with post-exposure SSQ total scores (<i>p</i> = .78, <i>p</i> &lt; .001). Among our metrics, from HRV, low-frequency/high-frequency (LF/HF) ratio was significantly associated with VAS ratings (β = 0.19, b = 0.26, χ<sup>2</sup> = 4.98, <i>p</i> = .03), suggesting a shift toward sympathetic dominance as symptoms intensified. From ET, pupil coherence emerged as a significant predictor of VAS (β = 0.14, b = 4.31, χ<sup>2</sup> = 4.10, <i>p</i> = .04), while other time-domain HRV (e.g., RMSSD, SDNN) and ET (e.g., blink rate, mean pupil size) metrics were not significantly related to ratings (all <i>p</i>-values &gt; 0.05). In a combined linear mixed-effects model, both LF/HF ratio (β = 0.20, b = 0.26, <i>p</i> = .02) and pupil coherence (β = 0.19, b = 5.53, <i>p</i> = .02) remained significant predictors of VAS ratings. These findings suggest the potential utility of VAS and multimodal physiological metrics, including LF/HF and pupil coherence, as indicators of SS symptom levels, and may inform future monitoring and adaptive approaches in immersive environments.</p>

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Using heart rate variability and eye-tracking to differentiate simulator sickness severity rated by visual analogue scale

  • 期刊论文

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  • 发表日期：

    2026年5月13日

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  • Guilherme H. Elcadi,
  • Marcus Lindskog,
  • Robin Dahlkvist,
  • Christian K. K. Lindberg,
  • Tina Karlsson,
  • Jouni Lindqvist

摘要

Simulator sickness (SS) is an obstacle to extensive adoption of virtual reality (VR) systems. While the simulator sickness questionnaire (SSQ) is the standard for assessing SS symptoms, it lacks temporal resolution to monitor symptom progression during exposures. In the present study, we examined heart rate variability (HRV) and eye-tracking (ET) metrics as physiological markers of SS, using a visual analogue scale (VAS) to gauge symptoms concurrently. Thirty subjects completed up to five virtual roller-coaster rides while electrocardiography (ECG) and ET data were continuously recorded. VAS ratings were collected at baseline and after each ride and showed a strong positive correlation with post-exposure SSQ total scores (p = .78, p < .001). Among our metrics, from HRV, low-frequency/high-frequency (LF/HF) ratio was significantly associated with VAS ratings (β = 0.19, b = 0.26, χ2 = 4.98, p = .03), suggesting a shift toward sympathetic dominance as symptoms intensified. From ET, pupil coherence emerged as a significant predictor of VAS (β = 0.14, b = 4.31, χ2 = 4.10, p = .04), while other time-domain HRV (e.g., RMSSD, SDNN) and ET (e.g., blink rate, mean pupil size) metrics were not significantly related to ratings (all p-values > 0.05). In a combined linear mixed-effects model, both LF/HF ratio (β = 0.20, b = 0.26, p = .02) and pupil coherence (β = 0.19, b = 5.53, p = .02) remained significant predictors of VAS ratings. These findings suggest the potential utility of VAS and multimodal physiological metrics, including LF/HF and pupil coherence, as indicators of SS symptom levels, and may inform future monitoring and adaptive approaches in immersive environments.