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XII EXECUTIVE SUMMARY An example of a health effect with limited evidence is myocardial infarction. Although evidence for increased risk of myocardial infarction related to L day is sufficient according to an updated meta-analysis, the evidence in relation to L night,outside was considered limited. This is because L night,outside is a relatively new exposure indicator, and few field studies have focused on night noise when considering cardiovascular outcomes. Nevertheless, there is evidence from animal and human studies supporting a hypothesis that night noise exposure might be more strongly associated with cardiovascular effects than daytime exposure, highlighting the need for future epidemiological studies on this topic. The review of available evidence leads to the following conclusions. • Sleep is a biological necessity and disturbed sleep is associated with a number of adverse impacts on health. • There is sufficient evidence for biological effects of noise during sleep: increase in heart rate, arousals, sleep stage changes and awakening. • There is sufficient evidence that night noise exposure causes self-reported sleep disturbance, increase in medicine use, increase in body movements and (environmental) insomnia. • While noise-induced sleep disturbance is viewed as a health problem in itself (environmental insomnia), it also leads to further consequences for health and wellbeing. • There is limited evidence that disturbed sleep causes fatigue, accidents and reduced performance. • There is limited evidence that noise at night causes hormone level changes and clinical conditions such as cardiovascular illness, depression and other mental illness. It should be stressed that a plausible biological model is available with sufficient evidence for the elements of the causal chain. VULNERABLE GROUPS Children have a higher awakening threshold than adults and therefore are often seen to be less sensitive to night noise. For other effects, however, children seem to be equally or more reactive than adults. As children also spend more time in bed they are exposed more to night noise levels. For these reasons children are considered a risk group. Since with age the sleep structure becomes more fragmented, elderly people are more vulnerable to disturbance. This also happens in pregnant women and people with ill health, so they too are a group at risk. Finally, shift workers are at risk because their sleep structure is under stress due to the adaptations of their circadian rhythm.
EXECUTIVE SUMMARY XIII THRESHOLDS FOR OBSERVED EFFECTS The no observed adverse effect level (NOAEL) is a concept from toxicology, and is defined as the greatest concentration which causes no detectable adverse alteration of morphology, functional capacity, growth, development or lifespan of the target organism. For the topic of night noise (where the adversity of effects is not always clear) this concept is less useful. Instead, the observed effect thresholds are provided: the level above which an effect starts to occur or shows itself to be dependent on the exposure level. It can also be a serious pathological effect, such as myocardial infarctions, or a changed physiological effect, such as increased body movement. Threshold levels of noise exposure are important milestones in the process of evaluating the health consequences of environmental exposure. The threshold levels also delimit the study area, which may lead to a better insight into overall consequences. In Tables 1 and 2, all effects are summarized for which sufficient and limited evidence exists. For these effects, the threshold levels are usually well known, and for some the dose-effect relations over a range of exposures could also be established. Effect Indicator Threshold, dB Biological effects Sleep quality Well-being Medical conditions Change in cardiovascular activity * * EEG awakening LAmax,inside 35 Motility, onset of motility LAmax,inside 32 Changes in duration of various stages of sleep, in sleep structure and fragmentation of sleep LAmax,inside 35 Waking up in the night and/or too early in the morning LAmax,inside 42 Prolongation of the sleep inception period, difficulty getting to sleep * * Sleep fragmentation, reduced sleeping time * * Increased average motility when sleeping Lnight,outside 42 Self-reported sleep disturbance Lnight,outside 42 Use of somnifacient drugs and sedatives Lnight,outside 40 Environmental insomnia** Lnight,outside 42 Table 1 Summary of effects and threshold levels for effects where sufficient evidence is available * Although the effect has been shown to occur or a plausible biological pathway could be constructed, indicators or threshold levels could not be determined. **Note that “environmental insomnia” is the result of diagnosis by a medical professional whilst “self-reported sleep disturbance” is essentially the same, but reported in the context of a social survey. Number of questions and exact wording may differ.
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46 EFFECTS ON SLEEP ing sleep stage
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48 EFFECTS ON SLEEP sleep time can
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50 EFFECTS ON SLEEP the instantaneo
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52 EFFECTS ON SLEEP Table 3.1. Coef
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54 EFFECTS ON SLEEP motility have b
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58 EFFECTS ON HEALTH for aircraft:
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60 EFFECTS ON HEALTH acoustic and n
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62 EFFECTS ON HEALTH Noise Exposure
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64 EFFECTS ON HEALTH commonly accep
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66 EFFECTS ON HEALTH Regarding mean
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68 EFFECTS ON HEALTH 1992). The rel
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76 EFFECTS ON HEALTH 4.5.14 RISK EV
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78 EFFECTS ON HEALTH No particular
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80 EFFECTS ON HEALTH Research into
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82 EFFECTS ON HEALTH tle direct res
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84 EFFECTS ON HEALTH level of expos
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86 EFFECTS ON HEALTH lage newly exp
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88 EFFECTS ON HEALTH ting the stres
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90 EFFECTS ON HEALTH In a United Ki
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92 EFFECTS ON HEALTH 4.8.14 ASSOCIA
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94 EFFECTS ON HEALTH noise-related
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96 EFFECTS ON HEALTH have had exper
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98 EFFECTS ON HEALTH • number of
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100 EFFECTS ON HEALTH Furthermore,
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102 GUIDELINES AND RECOMMENDATIONS
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112 Ancoli-Israel S, Roth T (1999).
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114 Bistrup ML (2003). Prevention o
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116 Cartwright J, Flindell I (2000)
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118 der Streßforschung (Bonner Ver
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120 Goto K, Kaneko T (2002). Distri
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122 Ishihara K (1999). The effect o
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124 Kogi K, Ohta T (1975). Incidenc
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126 Marth E et al. (1988). Fluglär
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128 Nieminen P et al. (2002). Growt
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130 Reyner et al. (1995). Patterns
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132 Suter AH (1992). Noise sources
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134 Weed DL (2000). Interpreting ep
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136 APPENDICES Term/acronym Definit
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138 APPENDICES APPENDIX 3. ANIMAL S
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140 APPENDICES cause a certain habi
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142 APPENDICES • Acute exposure t
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144 APPENDICES dence indicate that
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146 APPENDICES Fig.1 Effects of 12
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) 148 APPENDICES 50 40 Young rats O
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150 APPENDICES neuronal degeneratio
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152 Gesi M et al. (2002a). Morpholo
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154 APPENDIX 4. NOISE AND SLEEP IN
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156 APPENDICES during quiet sleep (
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158 APPENDICES (American Academy of
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160 APPENDICES cents, 12.2% of adol
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162 REFERENCES Abel SM (1990). The
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The WHO Regional Office for Europe
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