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154 APPENDIX 4. NOISE AND SLEEP IN CHILDREN FACTORS THAT MODIFY AUDITORY AROUSAL THRESHOLDS IN CHILDREN By the time that most studies were conducted in infants, it had become progressively evident that arousal and awakening thresholds are influenced by a variety of factors. These significantly modify the response to ambient noise of sleeping infants. Some factors inhibit the arousal response, while others enhance the response. PRENATAL AND PERINATAL FACTORS Age of gestation In 97 healthy infants, auditory awakening thresholds decreased significantly from the 44th to the 60th week after conception (Kahn, Picard and Blum, 1986). Awakening thresholds were defined as the infant opening their eyes and/or crying. Mean awakening thresholds dropped from 98.5+/-11 at the 44th week after conception to 83 dB(A) by the 60th week after conception. Cigarette smoke To evaluate the effects of cigarette smoke on polygraphic arousal thresholds, 26 newborns were studied with polygraphic recordings for one night: 13 were born to mothers who did not smoke, and 13 were born to mothers who smoked (over 9 cigarettes per day) (Franco et al., 1999). Another group of infants with a median postnatal age of 12 weeks were also studied: 21 born to non-smoking mothers and 21 born to smoking mothers. The auditory arousal thresholds of the infants of both age groups were measured with the use of auditory challenges of increasing intensity, administered during REM sleep. More intense auditory stimuli were needed to induce arousals in newborns (p=.002) and infants (p=.044) of smokers than in infants of non-smokers (mean value of 84+/-11 dB(A) for smokers and 81.6+/-20 for non-smokers). Behavioural awakening (infants opening their eyes and/or crying) occurred significantly less frequently in the newborns of smokers (p=.002) than of non-smokers. It was concluded that newborn and infants born to smoking mothers had higher arousal thresholds to auditory challenges than those born to non-smoking mothers. From the present findings, it appeared that the impact of exposure to cigarette smoke occurred mainly before birth. POSTNATAL FACTORS The following postnatal factors modify arousal from sleep. Sleep stage In infants, auditory stimuli have generally indicated increased responses during active as compared with quiet sleep (Busby, Mercier and Pivik, 1994). NIGHT NOISE GUIDELINES FOR EUROPE
APPENDICES 155 Time of the night In 31 infants, the arousal thresholds decreased across the night (mean value of 67+/- 12.5 dB(A) in the first part of the night, for 51+/-3.5 in the third part of the night; p=.017) (Franco et al., 2001). Similar findings had been reported in adult subjects (Rechtschaffen, Hauri and Zeitlin, 1966). Body position during sleep To investigate whether prone or supine sleeping was associated with a different response threshold to environmental stimuli, 25 3-month-old healthy infants with a median age of 9 months were exposed to an auditory challenge while sleeping successively prone or supine (Franco et al., 1998). Three infants were excluded from the study because they awoke while their position was being changed. For the 22 infants included in the analysis, more intense auditory stimuli were needed to arouse the infants in the prone position (median of 70 db(A), range values 50 to more than 100 db(A)) than in the supine position (median of 60 db(A), range values 50–90 db(A)) (p=.011). Arousal thresholds were higher in the prone than in the supine position in 15 infants, unchanged in 4 infants and lower in the prone position in 3 infants (p=.007). It was concluded that infants show higher arousal thresholds to auditory challenges when sleeping in the prone position than when sleeping in the supine position. The findings could not readily be explained. The difference in arousal thresholds could be related to difference in chest wall mechanoreceptor responses, or differences in BP and/or central baroreceptors responses. Ambient room temperature Two groups of healthy infants with a median age of 11 weeks were recorded polygraphically during one night: 31 infants were studied at 24°C and 31 infants at 28°C. To determine their arousal thresholds, the infants were exposed to white noises of increasing intensities during REM and non-REM sleep (Franco et al., 2001). The arousal thresholds decreased across the night in the infants sleeping at 24°C (p= .017). The finding was not found for the infants sleeping at 28°C. When analysing the arousal responses according to time of the night, it was found that the auditory thresholds were significantly higher at 28°C (75+/-19 dB(A)) than at 24°C (51+/-3.5 dB(A)) between 03.00 and 06.00 (p=.003). These findings were only seen in REM sleep. Sleeping with the head covered by bedclothes To evaluate the influence of covering the face of sleeping infants with a bed sheet, 18 healthy infants with a median of 10.5 weeks (range 8–15 weeks) were recorded polygraphically for one night (Franco et al., 2002). They slept in their usual supine position. During sleep, a bed sheet was gently placed on their face for 60 minutes. With the face free or covered by the sheet, the infants were exposed to white noises of increasing intensities during REM and non-REM sleep. Compared to with their face free, during the periods when their faces were covered, the infants had increases in pericephalic ambient temperature (p
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NIGHT NOISE GUIDELINES FOR EUROPE
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Keywords NOISE - ADVERSE EFFECTS -
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IV CONTENTS CHAPTER 3 EFFECTS OF NI
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VI ABSTRACT The WHO Regional Office
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VIII LIST OF CONTRIBUTORS Torbjörn
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X EXECUTIVE SUMMARY PROCESS OF DEVE
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XII EXECUTIVE SUMMARY An example of
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XIV EXECUTIVE SUMMARY Effect Indica
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XVI EXECUTIVE SUMMARY 50 100 Fig. 4
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XVIII EXECUTIVE SUMMARY For the pri
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2 METHODS AND CRITERIA impact on th
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4 METHODS AND CRITERIA ITALY: NETHE
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6 METHODS AND CRITERIA There are im
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8 METHODS AND CRITERIA use and heal
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10 METHODS AND CRITERIA L night = L
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12 METHODS AND CRITERIA 1.3.6 BACKG
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14 METHODS AND CRITERIA Fig. 1.8 sh
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16 SLEEP AND HEALTH • Stage 2 req
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18 SLEEP AND HEALTH Table 2.3 Mean
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20 SLEEP AND HEALTH vegetative, mot
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22 SLEEP AND HEALTH mal range. The
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24 SLEEP AND HEALTH Type Behavioura
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26 SLEEP AND HEALTH sible beyond th
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28 SLEEP AND HEALTH Early reports d
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30 SLEEP AND HEALTH ents’ reports
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32 SLEEP AND HEALTH Although cortic
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34 SLEEP AND HEALTH causal relation
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36 SLEEP AND HEALTH cardiovascular
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38 SLEEP AND HEALTH So do fatigue-r
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40 SLEEP AND HEALTH ers that the ag
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42 SLEEP AND HEALTH 2.5 ANIMAL STUD
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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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70 EFFECTS ON HEALTH Regarding airc
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72 EFFECTS ON HEALTH 4.5.10 DOSE-RE
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74 EFFECTS ON HEALTH larger increas
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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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Page 132 and 133: 112 Ancoli-Israel S, Roth T (1999).
Page 134 and 135: 114 Bistrup ML (2003). Prevention o
Page 136 and 137: 116 Cartwright J, Flindell I (2000)
Page 138 and 139: 118 der Streßforschung (Bonner Ver
Page 140 and 141: 120 Goto K, Kaneko T (2002). Distri
Page 142 and 143: 122 Ishihara K (1999). The effect o
Page 144 and 145: 124 Kogi K, Ohta T (1975). Incidenc
Page 146 and 147: 126 Marth E et al. (1988). Fluglär
Page 148 and 149: 128 Nieminen P et al. (2002). Growt
Page 150 and 151: 130 Reyner et al. (1995). Patterns
Page 152 and 153: 132 Suter AH (1992). Noise sources
Page 154 and 155: 134 Weed DL (2000). Interpreting ep
Page 156 and 157: 136 APPENDICES Term/acronym Definit
Page 158 and 159: 138 APPENDICES APPENDIX 3. ANIMAL S
Page 160 and 161: 140 APPENDICES cause a certain habi
Page 162 and 163: 142 APPENDICES • Acute exposure t
Page 164 and 165: 144 APPENDICES dence indicate that
Page 166 and 167: 146 APPENDICES Fig.1 Effects of 12
Page 168 and 169: ) 148 APPENDICES 50 40 Young rats O
Page 170 and 171: 150 APPENDICES neuronal degeneratio
Page 172 and 173: 152 Gesi M et al. (2002a). Morpholo
Page 176 and 177: 156 APPENDICES during quiet sleep (
Page 178 and 179: 158 APPENDICES (American Academy of
Page 180 and 181: 160 APPENDICES cents, 12.2% of adol
Page 182 and 183: 162 REFERENCES Abel SM (1990). The
Page 184: The WHO Regional Office for Europe
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