WHO Environmental Noise Guidelines for the European Region: A Systematic Review on Environmental Noise and Effects on Sleep

Mathias Basner, Sarah McGuire, Mathias Basner, Sarah McGuire

Abstract

To evaluate the quality of available evidence on the effects of environmental noise exposure on sleep a systematic review was conducted. The databases PSYCINFO, PubMed, Science Direct, Scopus, Web of Science and the TNO Repository were searched for non-laboratory studies on the effects of environmental noise on sleep with measured or predicted noise levels and published in or after the year 2000. The quality of the evidence was assessed using GRADE criteria. Seventy four studies predominately conducted between 2000 and 2015 were included in the review. A meta-analysis of surveys linking road, rail, and aircraft noise exposure to self-reports of sleep disturbance was conducted. The odds ratio for the percent highly sleep disturbed for a 10 dB increase in Lnight was significant for aircraft (1.94; 95% CI 1.61-2.3), road (2.13; 95% CI 1.82-2.48), and rail (3.06; 95% CI 2.38-3.93) noise when the question referred to noise, but non-significant for aircraft (1.17; 95% CI 0.54-2.53), road (1.09; 95% CI 0.94-1.27), and rail (1.27; 95% CI 0.89-1.81) noise when the question did not refer to noise. A pooled analysis of polysomnographic studies on the acute effects of transportation noise on sleep was also conducted and the unadjusted odds ratio for the probability of awakening for a 10 dBA increase in the indoor Lmax was significant for aircraft (1.35; 95% CI 1.22-1.50), road (1.36; 95% CI 1.19-1.55), and rail (1.35; 95% CI 1.21-1.52) noise. Due to a limited number of studies and the use of different outcome measures, a narrative review only was conducted for motility, cardiac and blood pressure outcomes, and for children's sleep. The effect of wind turbine and hospital noise on sleep was also assessed. Based on the available evidence, transportation noise affects objectively measured sleep physiology and subjectively assessed sleep disturbance in adults. For other outcome measures and noise sources the examined evidence was conflicting or only emerging. According to GRADE criteria, the quality of the evidence was moderate for cortical awakenings and self-reported sleep disturbance (for questions that referred to noise) induced by traffic noise, low for motility measures of traffic noise induced sleep disturbance, and very low for all other noise sources and investigated sleep outcomes.

Keywords: hospital noise; sleep; transportation noise; wind turbine noise.

Conflict of interest statement

M.B. is the current president of the International Commission on Biological Effects of Noise (ICBEN).

Figures

Figure 1
Figure 1
Effects of noise on sleep. It is hypothesized that health consequences will develop if sleep is relevantly disturbed by noise over long time periods (dashed lines; figure reproduced from Basner et al. [25]).
Figure 2
Figure 2
Flow of study selection.
Figure 3
Figure 3
Probability of a sleep stage change to awake or S1 in a 90 second time window following noise event onset depending on the maximum indoor sound pressure level (LAS,max) for (a) STRAIN road traffic (N = 61 subjects); (b) DEUFRAKO road traffic (N = 33); (c) STRAIN aircraft (N = 61); and (d) DEUFRAKO rail noise events (N = 33). Undisturbed events only (black), all events including disturbed and undisturbed events (gray dotted line).
Figure 4
Figure 4
Probability of a sleep stage change to awake or S1 in a 90 s time window following noise event onset depending on the maximum indoor sound pressure level (LAS,max) for (a) road (STRAIN and DEUFRAKO, N = 94 subjects); (b) aircraft (STRAIN, N = 61); and (c) rail noise (DEUFRAKO, N = 33). 95% confidence intervals (dashed lines). Results are for the unadjusted model.
Figure 5
Figure 5
Distribution of indoor noise levels and the time of events relative to sleep onset for (a,d) road; (b,e) aircraft; and (c,f) rail events (all undisturbed noise events from the STRAIN and DEUFRAKO studies used for analysis).
Figure 6
Figure 6
Probability of additional sleep stage changes to awake or S1 in a 90 s time window following noise event onset depending on the maximum indoor sound pressure level (LAS,max) for (a) road (STRAIN and DEUFRAKO, N = 94 subjects); (b) aircraft (STRAIN, N = 61); and (c) rail noise (DEUFRAKO, N = 33). 95% confidence intervals (dashed lines). Results are for the three unadjusted models.
Figure 7
Figure 7
The percent highly sleep disturbed (HSD) based on responses to questions on awakenings or difficulty falling asleep for road, rail, and aircraft noise and for studies that asked about how noise affects sleep (black dashed lines: 95% confidence intervals). The number of studies and subjects contributing to the analyses can be found in Table 2, Table 3 and Table 4.
Figure 8
Figure 8
The percent highly sleep disturbed (HSD) based on responses to questions on awakenings, difficulty falling asleep, and sleep disturbance for road, rail, and aircraft noise (black dashed lines: 95% confidence intervals). The number of studies and subjects contributing to the analyses can be found in Table 2, Table 3 and Table 4. Red: Miedema and Vos (2007) [22] highly sleep disturbed exposure-response curves.
Figure 9
Figure 9
The percent highly sleep disturbed (HSD) based on responses to questions on awakenings, difficulty falling asleep, and sleep disturbance for aircraft noise (black dashed lines: 95% confidence intervals). The number of studies and subjects contributing to the analyses can be found in Table 2. Blue: Janssen and Vos (2009) [87] highly sleep disturbed exposure-response curve.
Figure 10
Figure 10
Meta-analysis on the effects of aircraft noise on self-reported sleep disturbance (combined estimate) based on Odds Ratios for a 10 dBA increase in Lnight level for aircraft noise. The number of studies and subjects contributing to the analyses can be found in Table 2.
Figure 11
Figure 11
Meta-analysis on the effects of road noise on self-reported sleep disturbance (combined estimate) based on Odds Ratios for a 10 dBA increase in Lnight level for road noise. The number of studies and subjects contributing to the analyses can be found in Table 3.
Figure 12
Figure 12
Meta-analysis on the effects of rail noise on self-reported sleep disturbance (combined estimate) based on Odds Ratios for a 10 dBA increase in Lnight level for rail noise. The number of studies and subjects contributing to the analyses can be found in Table 4.
Figure 13
Figure 13
Meta-analysis on the effects of wind turbine noise on self-reported sleep disturbance based on Odds Ratios for a 10 dBA increase in A-weighted SPL level for wind turbine noise. The number of subjects contributing to the analyses can be found in Table 7.

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