WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep
Abstract
:1. Introduction
2. Methods
2.1. Mapping of Identified Reviews
2.2. Search for Individual Studies
2.3. Inclusion and Exclusion Criteria
2.4. Risk of Bias and Quality Assessment
3. Polysomnography Measured Cortical Awakenings for Road, Rail, and Aircraft Noise
3.1. Event-Related Analysis
3.2. Statistical Analysis
3.3. Conclusions
4. Self-Reported Sleep Outcomes for Road, Rail, and Aircraft Noise
- Awakenings from sleep, which refers to the period after sleep onset and before the final awakening. They are defined as events where a subject wakes up from sleep, regains consciousness, and recalls the awakening in the next morning.
- The process of falling asleep, which is defined as the transition from wakefulness into sleep.
- Sleep disturbance refers to internal/external interference with sleep onset or sleep continuity (sleep maintenance).
4.1. Statistical Analysis
4.2. Additional Studies
4.3. Conclusions
5. Wind Turbine Noise and Self-Reported and Actigraphy Measured Sleep Outcomes
5.1. Literature Review
5.2. Conclusions
6. Hospital Noise
6.1. Literature Review
6.2. Conclusions
7. Additional Sleep Outcome Measures
7.1. Cardiac and Blood Pressure Outcome Measures during Sleep in Adults
7.2. Motility Measured Sleep Outcomes in Adults
7.3. Sleep Disturbance in Children
8. Summary of Available Evidence
9. Conclusions
Supplementary Materials
Acknowledgments
Author Contributions
Conflicts of Interest
References
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Odds Ratio per 10 dBA (LAS,max) | Road (STRAIN and DEUFRAKO) | Aircraft (STRAIN) | Rail (DEUFRAKO) | Combined Estimate (Based on Road, Rail, and Aircraft) |
---|---|---|---|---|
Unadjusted | 1.36 (1.19–1.55) | 1.35 (1.22–1.50) | 1.35 (1.21–1.52) | 1.35 (1.25–1.45) |
Adjusted for Age and Gender | 1.36 (1.19–1.55) | 1.35 (1.21–1.50) | 1.34 (1.19–1.50) | 1.28 (1.21–1.36) |
Adjusted for Age, Gender, Day of the Week, and Time From Sleep Onset | 1.32 (1.15–1.50) | 1.32 (1.19–1.47) | 1.34 (1.19–1.51) | 1.29 (1.21–1.36) |
Study | N | Country | Sleep Disturbance Questions | Noise Metric (Range for Obtained Data) |
---|---|---|---|---|
Falling Asleep (Total N = 6368) | ||||
+ Nguyen et al. (2015) [69] | 1095 | Hanoi, Vietnam | In daily life, when an airplane passes by, at what degree are you disturbed in the following cases: When it makes it difficult for you to fall asleep? Not at all, Slightly, Moderately, Very, Extremely | Lnight, 22:00–6:00, measured (1 week) (37.5–57.5) |
+ Yano et al. (2015) [70] | 780 | Hanoi, Vietnam | Lnight, 22:00–6:00, measured (1 week) (37.5–57.5) | |
+ Nguyen et al. (2012) [71] | 512 | Da Nang City, Vietnam | Lnight, 22:00–6:00, measured (1 week) (37.5–52.5) | |
+ Nguyen et al. (2010) [72] Nguyen et al. (2011) [73] | 805 | Hanoi, Vietnam | Lnight, 22:00–6:00, measured (1 week) (37.5–52.5) | |
+ Nguyen et al. (2009) [74] | 868 | Ho Chi Minh City, Vietnam | Lnight, 22:00–6:00, measured (1 week) (42.5–62.5) | |
+ Schreckenberg et al. (2009) [75] | 2308 | Germany | How much has aircraft noise in the last 12 months disturbed falling asleep? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00 (37.5–57.5) |
Awakenings (Total N = 4054) | ||||
+ Nguyen et al. (2015) [69] | 1093 | Hanoi, Vietnam | In daily life, when an airplane passes by, to what degree are you disturbed in the following cases: When you are awakened in your sleep? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00, measured (1 week) (37.5–57.5) |
+ Yano et al. (2015) [70] | 776 | Hanoi, Vietnam | Lnight, 22:00–6:00, measured (1 week) (37.5–57.5) | |
+ Nguyen et al. (2012) [71] | 511 | Da Nang City, Vietnam | Lnight, 22:00–6:00, measured (1 week) (37.5–52.5) | |
+ Nguyen et al. (2010) [72] Nguyen et al. (2011) [73] | 804 | Hanoi, Vietnam | Lnight, 22:00–6:00, measured (1 week) (37.5–52.5) | |
+ Nguyen et al. (2009) [74] | 870 | Ho Chi Minh City, Vietnam | Lnight, 22:00–6:00, measured (1 week) (42.5–62.5) | |
Sleep Disturbance (Total N = 2309) | ||||
+ Schreckenberg et al. (2009) [75] | 2309 | Germany | How much has aircraft noise in the last 12 months disturbed sleeping during the night? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00 (37.5–57.5) |
Falling Asleep-Noise source not specified in sleep questions (Total N = 2978) | ||||
+ Brink et al. (2005) [76] 2001 Study | 1528 | Switzerland | How often do you have the following symptoms: Problems falling asleep? Never, Rarely, Sometimes, Often, Very Often, Always | Lnight, 22:00–6:00 (27.5–62.5) |
+ Brink et al. (2005) [76] 2003 Study | 1450 | Lnight, 22:00–6:00 (27.5–62.5) | ||
Awakenings-Noise source not specified in sleep questions (Total N = 2978) | ||||
+ Brink et al. (2005) [76] 2001 Study | 1528 | Switzerland | How often do you have the following symptoms: Problems with sleeping through? Never, Rarely, Sometimes, Often, Very Often, Always | Lnight, 22:00–6:00 (27.5–62.5) |
+ Brink et al. (2005) [76] 2003 Study | 1450 | Lnight, 22:00–6:00 (27.5–62.5) | ||
Sleep Disturbance-Noise source not specified in sleep questions (Total N = 195) | ||||
* Brink (2011) [77] | 195 | Switzerland | During the last 4 weeks, have you suffered from any of the following disorders or health problems? Difficulty in sleeping or insomnia? Not at all, Somewhat, Very Much. | Lnight, 22:00–6:00 (32.5–52.5) |
Lnight, 22:00–6:00 (32.5–52.5) |
Study | N | Country | Sleep Disturbance Questions | Noise Metric (Range for Obtained Data) |
---|---|---|---|---|
Falling Asleep (Total N = 10,212) | ||||
+ Bodin et al. (2015) [66] | 2444 | Sweden | Do you experience any of the following because of road traffic noise? Difficulties falling asleep. Never, Sometimes, Often. | LAeq, 24 h (37.5–62.5) |
+ Sato et al. (2002) [78] | 1302 | Gothenburg, Sweden | Does the road traffic noise cause the following conditions? Difficulty to fall asleep? No, Little Disturbed, Rather Disturbed, Very Disturbed. | Lnight, 22:00–7:00, measured (1 night) (42.5–72.5) |
814 | Kumamoto, Japan | Lnight, 22:00–7:00, measured (1 night) (47.5–77.5) | ||
779 | Sapporo, Japan | Lnight, 22:00–7:00, measured (1 night) (52.5–67.5) | ||
+ Phan et al. (2010) [79] Shimoyama et al. (2014) [80] | 1471 | Hanoi, Vietnam | How much are you disturbed in falling asleep by road traffic? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00, measured (1 night) (62.5–77.5) |
1458 | Ho Chi Minh City, Vietnam | Lnight, 22:00–6:00, measured (1 night) (67.5–77.5) | ||
481 | Da Nang, Vietnam | Lnight, 22:00–6:00, measured (1 night) (57.5–67.5) | ||
682 | Hue, Vietnam | Lnight, 22:00–6:00, measured (1 night) (52.5–72.5) | ||
781 | Thai Nguyen, Vietnam | Lnight, 22:00–6:00, measured (1 night) (52.5–67.5) | ||
Awakenings (Total N = 10177) | ||||
+ Bodin et al. (2015) [66] | 2438 | Sweden | Do you experience any of the following because of road traffic noise? You wake up? Never, Sometimes, Often. | LAeq, 24 h (37.5–62.5) |
+ Sato et al. (2002) [78] | 1291 | Gothenburg, Sweden | Does the road traffic noise cause the following conditions? Awakening? No, Little Disturbed, Rather Disturbed, Very Disturbed. | Lnight, 22:00–7:00, measured (1 night) (42.5–72.5) |
819 | Kumamoto, Japan | Lnight, 22:00–7:00, measured (1 night) (47.5–77.5) | ||
779 | Sapporo, Japan | Lnight, 22:00–7:00, measured (1 night) (52.5–67.5) | ||
+ Phan et al. (2010) [79] Shimoyama et al. (2014) [80] | 1454 | Hanoi, Vietnam | How much are you disturbed by awakening during nighttime by road traffic? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00, measured (1 night) (62.5–77.5) |
1460 | Ho Chi Minh City, Vietnam | Lnight, 22:00–6:00, measured (1 night) (67.5–77.5) | ||
479 | Da Nang, Vietnam | Lnight, 22:00–6:00, measured (1 night) (57.5–67.5) | ||
680 | Hue, Vietnam | Lnight, 22:00–6:00, measured (1 night) (52.5–72.5) | ||
777 | Thai Nguyen, Vietnam | Lnight, 22:00–6:00, measured (1 night) (52.5–67.5) | ||
Sleep Disturbance (Total N = 9901) | ||||
+ Brown et al. (2015) [81] | 8841 | Hong Kong | How much is your sleep disturbed by road traffic noise? 11 point scale used from 0 (not disturbed at all) to 10 (extremely disturbed) (8, 9, 10 HSD) | Lnight (42.5–67.5) |
+ Hong et al. (2010) [82] | 550 | Korea | How much have you been disturbed in your sleep by road traffic noise at night when you are sleeping in your house over the last 12 months? 11 point scale used from 0 (not disturbed at all) to 10 (extremely disturbed) (8, 9, 10 HSD) | Lnight, 22:00–7:00 (50.0–73.0) |
+ Ristovska et al. (2009) [83] | 510 | Macedonia | Do you think that your sleep was disturbed due to night-time noise or noise events during the night in the last twelve months and more? Not at all, Very little, Moderate, High, Very High. | Lnight, 23:00–7:00, measured (2 nights) (42.5–62.5) |
Falling Asleep–Noise source not specified in sleep questions (N = 10,545) | ||||
+ Bodin et al. (2015) [66] | 2520 | Sweden | Do you have problems falling asleep? Rarely/never, A few times per month, A few times a week, Almost every day | LAeq, 24 h (37.5–62.5) |
* Halonen et al. (2012) [67] | 6793 | Finland | How many times during the past 4 weeks have you had the following symptoms? Difficulty falling asleep? Never, 1 per month, 1 per week, 2–4 per week, 5–6 per week, Nearly every night. | Lnight, 22:00–7:00 (42.5–57.5) |
* Frei et al. (2014) [84] | 1232 | Switzerland | How often does it happen, that you cannot fall asleep well? Never, Rarely, Sometimes, Often. | Lnight, 22:00–6:00 (27.5–62.5) |
Awakenings–Noise source not specified in sleep questions (N = 10,603) | ||||
+ Bodin et al. (2015) [66] | 2519 | Sweden | Do you wake up at night? Rarely/never, A few times per month, A few times a week, Almost every day | LAeq, 24 h (37.5–62.5) |
* Halonen et al. (2012) [67] | 6853 | Finland | How many times during the past 4 weeks have you had the following symptoms? Frequently waking up during the night. Never, 1 per month, 1 per week, 2–4 per week, 5–6 per week, nearly every night. | Lnight, 22:00–7:00 (42.5–57.5) |
* Frei et al. (2014) [84] | 1231 | Switzerland | How often does it happen, that you wake up at night multiple times? Never, Rarely, Sometimes, Often. | Lnight, 22:00–6:00 (27.5–62.5) |
Sleep Disturbance-Noise Source not specified in sleep questions (N = 9474) | ||||
* Brink (2011) [77] | 8245 | Switzerland | During the last 4 weeks, have you suffered from any of the following disorders or health problems? Difficulty in sleeping, or insomnia? Not at all, Somewhat, Very Much | Lnight, 22:00–6:00 (32.5–77.5) |
* Frei et al. (2014) [84] | 1229 | Switzerland | How often does it happen that your sleep is restless? Never, Rarely, Sometimes, Often | Lnight, 22:00–6:00 (27.5–62.5) |
Study | N | Country | Sleep Disturbance Questions | Noise Metric (Range for Obtained Data) |
---|---|---|---|---|
Falling Asleep (Total N = 6520) | ||||
+ Bodin et al. (2015) [66] | 2342 | Sweden | Do you experience any of the following because of railway noise? Difficulties falling asleep? Never, Sometimes, Often | LAeq, 24h (37.5–62.5) |
+ Sato et al. (2004) [85] | 1418 | Hokkaido, Japan | How much are you disturbed in falling asleep by train passing? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–7:00, measured (27.5–62.5) |
1562 | Kyushu, Japan | Lnight, 22:00-7:00, measured (27.5-72.5) | ||
+ Schreckenberg (2013) [86] | 1198 | Germany | To what extent have the following outcomes of railway noise occurred in the past 12 months? Railway noise disturbs when falling asleep. Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00 (42.5-82.5) |
Awakenings (Total N = 5311) | ||||
+ Bodin et al. (2015) [66] | 2344 | Sweden | Do you experience any of the following because of railway noise? You wake up? Never, Sometimes, Often | LAeq, 24h (37.5–62.5) |
+ Sato et al. (2004) [85] | 1418 | Hokkaido, Japan | How much are you disturbed by awakening during nighttime by train passing? Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–7:00, measured (27.5–62.5) |
1549 | Kyushu, Japan | Lnight, 22:00–7:00, measured (27.5–72.5) | ||
Sleep Disturbance (Total N = 1809) | ||||
+ Hong et al. (2010) [82] | 610 | Korea | How much have you been disturbed in your sleep by railway noise at night when you are sleeping in your house over the last 12 months? 11 point scale used from 0 (not disturbed at all) to 10 (extremely disturbed) (HSD 8, 9, 10) | Lnight, 22:00–7:00 (47.1–70) |
+ Schreckenberg (2013) [86] | 1199 | Germany | To what extent have the following outcomes of railway noise occurred in the past 12 months? Railway disturbs when sleeping during the night. Not at all, Slightly, Moderately, Very, Extremely. | Lnight, 22:00–6:00 (42.5–82.5) |
Falling Asleep- Noise source not specified in sleep questions (Total N = 3808) | ||||
+ Bodin et al. (2015) [66] | 2576 | Sweden | Do you have problems falling asleep? Rarely/never, A few times per month, A few times a week, Almost every day | LAeq, 24 h (37.5–62.5) |
* Frei et al. (2014) [84] | 1232 | Switzerland | How often does it happen, that you cannot fall asleep well? Never, Rarely, Sometimes, Often. | Lnight, 22:00–6:00 (27.5–57.5) |
Awakening-Noise source not specified in sleep questions (Total N = 3806) | ||||
+ Bodin et al. (2015) [66] | 2575 | Sweden | Do you wake up at night? Rarely/never, A few times per month, A few times a week, Almost every day | LAeq, 24 h (37.5–62.5) |
* Frei et al. (2014) [84] | 1231 | Switzerland | How often does it happen, that you wake up at night multiple times? Never, Rarely, Sometimes, Often. | Lnight, 22:00–6:00 (27.5–57.5) |
Sleep Disturbance-Noise source not specified in sleep questions (N = 5914) | ||||
* Brink (2011) [77] | 4685 | Switzerland | During the last 4 weeks, have you suffered from any of the following disorders or health problems? Difficulty in sleeping, or insomnia? Not at all, Somewhat, Very Much | Lnight, 22:00–6:00 (32.5–77.5) |
* Frei et al. (2014) [84] | 1229 | Switzerland | How often does it happen that your sleep is restless? Never, Rarely, Sometimes, Often | Lnight, 22:00–6:00 (27.5–57.5) |
Number of Studies | Odds Ratio per 10 dBA | 95% Confidence Interval | |
---|---|---|---|
Aircraft Noise | |||
Falling Asleep | 6 | 2.00 | 1.68–2.41 |
Awakenings | 5 | 1.72 | 1.31–2.27 |
Sleep Disturbance | 1 | 2.05 | 1.64–2.56 |
Combined Estimate | 6 | 1.94 | 1.61–2.33 |
Road Noise | |||
Falling Asleep | 8 | 2.63 | 1.86–3.73 |
Awakening | 8 | 1.75 | 1.24–2.47 |
Sleep Disturbance | 3 | 2.21 | 1.52–3.20 |
Combined Estimate | 12 | 2.13 | 1.82–2.48 |
Rail Noise | |||
Falling Asleep | 4 | 2.57 | 1.87–3.53 |
Awakening | 3 | 2.54 | 1.49–4.33 |
Sleep Disturbance | 2 | 4.10 | 0.69–24.41 |
Combined Estimate | 5 | 3.06 | 2.38–3.93 |
Number of Studies | Odds Ratio per 10 dBA | 95% Confidence Interval | |
---|---|---|---|
Aircraft Noise | |||
Falling Asleep | 2 | 1.10 | 0.73–1.57 |
Awakenings | 2 | 0.89 | 0.66–1.22 |
Sleep Disturbance | 1 | 4.70 | 0.41–53.62 |
Combined Estimate | 3 | 1.17 | 0.54–2.53 |
Road Noise | |||
Falling Asleep | 3 | 1.03 | 0.77–1.38 |
Awakenings | 3 | 1.01 | 0.81–1.25 |
Sleep Disturbance | 2 | 1.43 | 0.36–5.59 |
Combined Estimate | 4 | 1.09 | 0.94–1.27 |
Rail Noise | |||
Falling Asleep | 2 | 2.02 | 1.44–2.83 |
Awakenings | 2 | 1.12 | 0.90–1.39 |
Sleep Disturbance | 2 | 1.23 | 0.85–1.80 |
Combined Estimate | 3 | 1.27 | 0.89–1.81 |
Reference | Country | N | N (>40 dBA) | Noise Exposure | Confounding Variables Adjusted for in the Statistical Analysis | Odds Ratio per 10 dBA (95% CI) | Odds Ratio Relative to Reference (95% CI) |
---|---|---|---|---|---|---|---|
Pedersen and Persson Waye (2004) [92] | Sweden | 351 | 25 | Predicted A-weighted SPL | Age, gender | 3.11 (1.34–7.30) | Reference: <35 dBA >35 dBA: 4.72 (0.27–82.97) |
Pedersen and Persson Waye, (2007) [93] | Sweden | 754 | 20 | Predicted A-weighted SPL | Age, gender | 0.74 (0.35–1.63) | NA |
Pedersen et al. (2009) [101] Bakker et al. (2012) [94] | Netherlands | 725 | 159 | Predicted A-weighted SPL | Age, gender, economic benefits | 1.34 (1.00–1.80) | Reference <30 dBA >45 dBA: 2.98 (1.35–6.60) |
Kuwano et al. (2014) [96] | Japan | 747 (332 Controls) | 260 | Lnight (22:00-6:00) | Age, gender | 4.20 (2.40–7.34) | Reference: <35 dBA 41–45 dBA: 5.55 (1.12–27.47) >46 dBA: 4.79 (0.64–35.70) |
Michaud (2015) [97] | Canada | 1238 | 234 | Predicted A-weighted SPL | None | 0.89 (0.66–1.18) | NA |
Pawlaczyk-Luszcynsa et al. (2014) [95] | Poland | 156 | 90 | Lden | None | NA | Reference: 35–40 dBA 40–45 dBA: 2.74 (1.08–6.97) |
Reference | N | Age | Hospital Unit | Noise Measurement | Subjective Measure | Objective Measure | Outcome |
---|---|---|---|---|---|---|---|
Aaron et al. 1996 [102] | 6 | 66.8 ± 2.8 years | Intensive and Intermediate Respiratory Care Unit | SPL every minute | NA | Polysomnography | Correlation (r = 0.57, p = 0.0001) between number of arousals (between 22:00–6:00) and SPL peaks ≥ 80 dB |
Adachi et al. 2013 [106] | 118 | 65.0 ± 11.6 years | General Medicine | Hourly Lmin, Leq, Lmax | Karolinska Sleep Log | Actigraphy | Multivariate linear and logistic regressions: No significant association between Lmin tertiles and sleep duration, Karolinska Sleep Quality, or noise complaints |
Elliott et al. 2013 [103] | 53 | 60.1 ± 20.0 years | Intensive Care Unit | LAeq and LCpeak levels logged every second | Richards Campbell Sleep Questionnaire | Polysomnography | Weak correlation between arousal indices and number of sound peaks > 80 dB (day r = 0.13, night r = 0.19) |
Gabor et al. 2003 [105] | 13 Patients: 7 Control: 6 | Patients: 56. 7± 19.2 years Controls: 23–65 years | Intensive Care Unit | SPL | NA | Polysomnography | 17.5 ± 11.2% (Patients) and 68.4 ± 11.1% (Control Subjects) of arousals were associated with a sound event greater than 10 dB over background |
Freedman et al. 2001 [104] | 22 | 61 ± 16 years | Intensive Care Unit | SPL every minute | NA | Polysomnography | 11.5 ± 11.8% of arousals and 26.2 ± 24.8% of awakenings was due to environmental noise |
Hsu et al. 2010 [121] | 40 | 54. 5± 14.5 years | Cardiac Surgical Unit | SPL every second | Questions on insomnia | Heart rate and blood pressure every 5 min | Correlation between insomnia and noise level, Leq (r = 0.09), Lmax (r = 0.24), Lmin (r = −0.03). |
Missildine et al. 2010 [107] | 48 | 79 years | Medical Unit | SPL levels (23:00–7:00) | Richards Campbell Sleep Questionnaire | Actigraphy | For those subjects with less than 300 minof sleep, 59% were exposed to nighttime noise levels ≥ 40 dBA. In a multiple regression for sleep efficiency, the coefficient for median noise level was not significant (β = −0.671, p = 0.836). |
Park et al. 2014 [120] | 103 | 60 ± 14.8 years | Internal Medicine | Leq | Pittsburgh Sleep Quality Index | NA | Sleep disturbance scores increased with mean daytime and nighttime levels (β = 0.2; 95% CI = 0.09–0.53 for daytime; β = 0.12; 95% CI = 0.07–0.36 for nighttime). Controlled for age, gender, severity of disease, medication, and room type. |
Yoder et al. 2012 [108] | 106 | 66.0 ± 12 years | General Medicine | Lmin, Leq, Lmax | Pittsburgh Sleep Quality Index | Actigraphy | Patients exposed to the loudest tertile of average nighttime noise levels slept significantly less (−76 min, 95% CI −134 to −18 min, p = 0.01) than patients exposed to the lowest tertile of noise. |
Study | N | Age | Hospital Unit | Measure of Noise | Subjective Measure | Objective Measure | Outcome |
---|---|---|---|---|---|---|---|
Corser 1996 [109] | 12 | 23.3 ± 6.1 months | Pediatric Intensive Care Unit | SPL every 5 min | Patient Sleep Behavior Observation Tool used to identify sleep state every 5 min 19:00–7:00 | NA | Correlation between observed sleep state and noise (r = −0.2043, p < 0.05). |
Cureton-Lane and Fontaine 1997 [110] | 9 | 4.7 ± 3.5 years | Pediatric Intensive Care Unit | SPL every 5 min | Patient Sleep Behavior Observation Tool used to identify sleep stage every 5 min from 20:00–6:00 | NA | Noise was a significant predictor of sleep state in probit analysis (p < 0.001). Light levels and contact with staff were also significant predictors. |
Kuhn et al. 2013 [112] Kuhn et al. 2012 [113] | 26 | 28 weeks (median) | Neonatal Intensive Care Unit | Classified sound peaks: those exceeding the previous level by more than 5 dBA | Prechtl’s observational rating system for defining arousal states. | Heart Rate, Respiratory Rate and SaO2 | Average percent awakened due to classified sound peaks was 33.8% (95% CI: 24–37%). For control periods without sound peaks average percent awakened was 11.7% (95% CI: 6.2–17.1%). For sound peaks 10–15 dBA above background a significant decrease in respiration rate (−10 ± 12.5 breath/min, p = 0.002) during quiet sleep was found. |
Study | N | Age | Hospital Unit | Invention | Measure of Noise | Subjective Measure | Objective Measure | Outcome |
---|---|---|---|---|---|---|---|---|
Dennis et al. 2010 [114] | 50 Day: 35 Night: 15 | Day: 55.5 ± 14.4 years Night: 52.9 ± 16.3 years | Neuro-Intensive Care Unit | Implemented 2 h quiet period during the day and night | SPL collected 6 times a day over a period of 5 s before, after and during the quiet time hours | Sleep Observation Tool: seven observations made per subject | NA | Odds Ratio (97.5% CI) observed asleep: Day: 4.04 (2.24–7.30) Night: 0.96 (0.41–2.24) |
Duran et al. 2012 [118] | 20 | 30.0 ± 2.2 weeks | Neonatal Intensive Care Unit | Infants wore earmuffs that decreased noise levels by 7–12 dBA for 2 days | Measurements made every 2 h during an 8 h period | Anderson Behavioral State Scoring System. Measurements made every 2 h during an 8 h period | Blood pressure, heart rate, respiration rate, body temperature, and oxygen saturation. Measurements made every 2 h during an 8 h period | For the two conditions (with and without earmuffs): No difference was observed in physiological measures. 87.5% of infants with earmuffs observed asleep, 29.4% of infants without earmuffs observed asleep |
Gardner et al. 2009 [115] | 293 Experimental: 137 Control Group: 156 | Experimental Group: 56.4 ± 19.1 years Control Group: 50.5 ± 19.4 years | Orthopedic Unit | Implemented quiet hours | Daily SPL | Observed Sleep State | NA | Correlation between mean SPL levels and patients found to be awake: Experimental: (r = 0.704, p < 0.01) Control group: r = 0.243, p < 0.05) |
Thomas et al. 2012 [117] | 95 Phase 1: 32 Phase 2: 33 Phase 3: 30 | Phase 1: 49 ± 1 years Phase 2: 43 ± 3 years Phase 3: 46 ± 3 years | Neurological Unit | Study had 3 phases with measured noise levels Phase 2: Sleep promoting rules | SPL between 20:00–8:00 | Questions on sleep quality, sleep quantity | NA | Intervention did not result in a reduction in noise level. The median noise levels were: Phase 1: 38.6 dB, Phase 2: 40.6 dB, Phase 3: 43.5 dB |
Walder et al. 2000 [116] | 17 Before Guidelines: 9 After Guidelines: 8 | Before Guidelines: 62.5 ±16.5 years After Guidelines: 57.8 ±15.9 years | Surgical Intensive Care Unit | Implemented behavioral rules | SPL, every 1 s between 23:00–5:00. | Nurses estimated the patient’s sleep duration and the number of awakenings. | NA | Sleep duration was shorter, and the number of awakenings higher when the behavioral rules were implemented. |
Reference | N | Noise Source | Noise Metric | Outcome |
---|---|---|---|---|
Hong et al. (2006) [125] | 12 | Rail | LAmax indoor | Exposure-response between probability of motility and indoor LAmax. A higher probability of motility than in previous aircraft noise studies was found. |
Frei et al. (2014) [84] | 119 | Road | Lnight, 22:00–6:00, outdoor, most exposed facade | Decrease in sleep efficiency (percent) with outdoor Lnight. Coefficients for random subject intercept linear regression: 30–40 dB: 0.20 (95% CI −1.21, 1.60), 40–55 dB: −0.85 (95% CI −2.42, 0.71), >55 dB: −4.06 (−6.78, −1.35) |
Griefahn et al. (2000) [130] | 377 | Road and Rail | Indoor and outdoor whole night and individual event noise levels | No significant effect of noise on sleep parameters found. |
Lercher et al. (2010) [126] | 8 | Rail | LAmax indoor | Coefficient for LAmax, in a linear regression for the probability of motility reaction was significant. (0.04, 95% CI 0.01–0.07, p < 0.01) |
Ohrstrӧm et al. (2006) [128] | 79 | Road | LAeq,24hr outdoor, most exposed facade | No significant effect of noise on sleep parameters was found. |
Passchier-Vermeer et al. (2002) [64] | 418 | Aircraft | LAmax indoor | Exposure-response relationship between motility and indoor LAmax. |
Passchier-Vermeer et al. (2007) [131] | 262 | Road and Rail | LAmax indoor | Significant noise metric coefficient when comparing probability of motility reaction to an estimated indoor LAmax level. Motility reaction was greater when there was higher levels of background noise. |
Pirrera et al. (2014) [129] | 45 | Road | LAeq indoor | No significant difference in indoor average noise levels was found despite differences in outdoor noise level. No significant difference in time in bed, total sleep time, sleep latency, wake after sleep onset, or sleep efficiency was found. |
Reference | Age | N | Confounding Variables Adjusted for in the Statistical Analysis | Noise Source | Noise Metric | Outcome |
---|---|---|---|---|---|---|
Ising and Ising (2002) [134] | 7–13 years | 56 | Age, gender, social status | Road | LCmax Indoors | Significant correlation between LCmax and awakenings during sleep and problems to fall asleep |
Lercher et al. (2013) [133] | 8–11 years | 1251 | Gender, health status, and mother’s education | Road and Rail | Lden Outdoor most exposed facade | Lden was a significant predictor of self-reported sleep, but not when adjusted for sound perception score |
Ohrstrӧm et al. (2006) [128] | Mean 10.9 years (range 9–12.9) | 160 (survey) 79 (actigraphy) | None | Road | LAeq,24h Outdoor most exposed facade | Decrease in self-reported mean sleep quality (0–10) < 55 dB: 8.6, 55–59 dB: 8.2, 60–64 dB: 8.2, >64 dB: 8.1. No association between actigraphy measured sleep parameters and noise level |
Tiesler et al. (2013) [135] | 10.1 ± 2.2 years | 287 | Gender, age, parental education level, mother’s age at birth, television/computer usage, single parent status, sleeping alone, and orientation of the window | Road | Lnight Outdoors, least exposed facade | Reporting any sleep problems: OR: 1.79 (95% CI 1.10–2.92) Reporting problems falling asleep: OR 1.96 (95% CI 1.16–3.32) |
Sleep Outcomes | Noise Source | Number of Participants (Studies) | Quality of Evidence | Noise Metric | Odds Ratio per 10 dBA Increase (95% CI) |
---|---|---|---|---|---|
Cortical Awakenings in Adults | Road | 94 (2) | ⊕⊕⊕Ο Moderate There was evidence of dose-response | Indoor LAS,max | 1.36 (1.19–1.55) |
Rail | 33 (1) | ⊕⊕⊕Ο Moderate There was evidence of dose-response | Indoor LAS,max | 1.35 (1.21–1.52) | |
Aircraft | 61 (1) | ⊕⊕⊕Ο Moderate There was evidence of dose-response | Indoor LAS,max | 1.35 (1.22–1.50) | |
Self-Reported Sleep Disturbance in Adults (Noise Source Specified) | Road | 20,120 (12) | ⊕⊕⊕Ο Moderate There was evidence of dose-response | Outdoor Lnight | 2.13 (1.82–2.48) |
Rail | 7133 (5) | ⊕⊕⊕Ο Moderate There was evidence of dose-response | Outdoor Lnight | 3.06 (2.38–3.93) | |
Aircraft | 6371 (6) | ⊕⊕⊕Ο Moderate There was evidence of dose-response | Outdoor Lnight | 1.94 (1.61–2.33) | |
Self-Reported Sleep Disturbance in Adults (Noise Source Not Specified) | Road | 18,850 (4) | ⊕ΟΟΟ Very Low Confounding factors not accounted for in analysis, Imprecision low number of studies | Outdoor Lnight | 1.09 (0.94–1.27) |
Rail | 8493 (3) | ⊕ΟΟΟ Very Low Confounding factors not accounted for in analysis, Imprecision low number of studies | Outdoor Lnight | 1.27 (0.89–1.81) | |
Aircraft | 3173 (3) | ⊕ΟΟΟ Very Low Confounding factors not accounted for in analysis, Imprecision low number of studies | Outdoor Lnight | 1.17 (0.54–2.53) | |
Motility Measures of Sleep in Adults | Road, Rail, Aircraft | 1320 (8) | ⊕⊕ΟΟ Low Single event analysis indicates dose-response | LAmax and LAeq | Not estimated |
Self-Report and Motility Measured Sleep Disturbance in Children | Road, Rail, Aircraft | 1754 (4) | ⊕ΟΟΟ Very Low Inconsistency in results, small number of studies | Varied across studies | Not estimated |
Self-Reported Sleep Disturbance in Adults | Wind Turbine Noise | 3971 (6) | ⊕ΟΟΟ Very Low Inconsistency in results and imprecision due to small sample sizes at highest noise levels | Outdoor A-weighted SPL | 1.60 (0.86–2.94) |
All Sleep Outcome Measures | Hospital Noise | 964 Adults/67 Children (13 Adults/4 Children) | ⊕ΟΟΟ Very Low Inconsistency in results and imprecision due to small sample sizes | Varied across studies | Not estimated |
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Basner, M.; McGuire, S. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep. Int. J. Environ. Res. Public Health 2018, 15, 519. https://doi.org/10.3390/ijerph15030519
Basner M, McGuire S. WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep. International Journal of Environmental Research and Public Health. 2018; 15(3):519. https://doi.org/10.3390/ijerph15030519
Chicago/Turabian StyleBasner, Mathias, and Sarah McGuire. 2018. "WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep" International Journal of Environmental Research and Public Health 15, no. 3: 519. https://doi.org/10.3390/ijerph15030519