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78 EFFECTS ON HEALTH No particular risk groups could be identified on the basis of epidemiological research on cardiovascular effects of community noise. The assessment of dose-effect relationships sometimes suggested a cut-off level, above which the risk tends to increase. From a biological point of view, one would expect a continuous increase in risk with increasing noise level. However, adaptation, habituation and coping may be reasons for an empirical threshold of effect. Decisions with respect to guideline values usually refer to a quantitative risk assessment of populations (for example population attributable risk percentage). However, prevention strategies – for ethical reasons – should not ignore the individual risks of highly exposed subjects, even if their number may be small. With respect to night noise exposure, nearly no information is available from epidemiological studies on the cardiovascular effects of long-term noise exposure of the bedroom during the night. Only one study distinguished between the exposures of the bedroom and the living room in the statistical analyses (Maschke, Wolf and Leitmann, 2003). The results suggested slightly higher effect estimates for the prevalence of hypertension with respect to the noise exposure of the bedroom (during the night) compared with the exposure of the living room (during the day). However, the difference was small (odds ration 1.9 vs. 1.5), which means that it still remains an open question whether the night exposure or the overall exposure throughout the whole day is the driving force. The study has some methodological limitations that were addressed in the summary of the major technical report and in a recent advisory report of the Health Council of the Netherlands (2004). They are mainly concerned with the fact that the study population consisted of a selected, predominantly older and health conscious group of persons that might have already suffered from regular health problems (risk group). A few studies that looked at the association between subjective responses to community noise and cardiovascular outcomes suggest a closer relationship with sleep-related annoyance/disturbance reaction rather than with non-sleep-related annoyance/disturbance (Bellach et al., 1995; Babisch et al., 1999, 2005; Maschke, Wolf and Leitmann, 2003; Niemann and Maschke, 2004). Closing the bedroom window or, vice versa, sleeping with the bedroom window open, was associated with a lower or higher risk, respectively (Lercher, 1996). The same was found with respect to changing the bedroom to the living room because of noise. These findings may indicate that night-time noise may be more a determinant of noise-induced cardiovascular effects than daytime exposure. However, daytime activity patterns and expectations of the individuals are much more inhomogeneous than during the night, which tends to dilute the statistical association of true effects with the day noise exposure. Given the situation that only a few data are available from epidemiological studies with respect to effects on sleep (exposure of the bedroom during the night), there does not seem to be any other way of reasoning than inferring night noise recommendations or guidelines from the results of studies that refer to noise exposure during the daytime period (L day ) or the whole day (L dn , L 24h ). L den , in this context, appears to be a useful noise indicator for decision-making and regulatory purposes. Penalties of 5 dB(A) and 10 dB(A) are usually given to the evening period and the night period, respectively. It can be used for noise mapping and refers normally to the most exposed facade, which incorporates a certain degree of exposure misclassification regarding cause–effect relationships. This weighted indicator was introduced to assess the relationship between sound level and noise annoyance (European Commission, 2002a). However, it may not be adequate for research into (somatic) health-related noise effects. Non-weighted separate exposure indicators, such as L day , L evening or L night , may be more appropriate when assessing physiological responses to the noise. In urban settings, night-time average noise levels (22.00–06.00) for road traffic tend to be approximately 7–10 dB(A) lower than daytime average noise levels – relatively independent (no freeways) of the traffic volume of the street (Utley, 1985; Ullrich, 1998; Evans et al., 2001). In such cases, L den is approximate- NIGHT NOISE GUIDELINES FOR EUROPE
EFFECTS ON HEALTH 79 ly 2–3 dB(A) higher than L day (Bite and Bite, 2004). Therefore, in epidemiological studies in which the relative effects of road traffic noise are studied, the sound emission during the daytime can as well be viewed as an approximate relative measure of the overall sound emission including the night. This seems to be further justified because existing noise regulations usually consider a 10 dB(A) difference between the day and the night. The NOAEL of 60 dB(A) for L day corresponds, in this respect, with 50 dB(A) for L night . This approximation can only be made with respect to road traffic noise. Aircraft noise has been less intensively studied in noise epidemiology. The studies focused on high BP. Dose–response curves were hardly considered. A large European study on the association between aircraft noise and road traffic noise on BP is currently being conducted (Jarup et al., 2003). Regarding aircraft noise – and particularly the ongoing debate on night flight restrictions in the vicinity of busy airports – no other alternative exists at present than to take the myocardial infarction risk curves derived from road traffic noise studies as an approximate for aircraft noise. Since aircraft noise acts on all sides of a building, that is, different to road traffic noise, the suspicion exists that the effects induced by aircraft noise could be greater than those induced by road traffic (Ortscheid and Wende, 2000; Babisch, 2004a). This may be due to the lack of evasive possibilities within the home and the greater annoyance reactions to aircraft noise, which are usually expressed in social surveys (Miedema and Vos, 1998). More research is needed regarding the association between aircraft noise and cardiovascular end points. This section is clearly focused on ill health as an outcome of the adverse effect of noise. A common dose-effect curve for the relationship between road traffic noise (outdoors) and the risk of myocardial infarction was developed. This curve can be used for a quantitative risk assessment and the calculation of attributable cases in a community. However, decisions regarding limit values have to be made within the spectrum between discomfort (annoyance) and ill health (disease) (Lindström, 1992; Babisch, 2002). Whereas quality targets at the lower end of the effects scale may be more flexible, quality targets at the upper end may be more obligatory. For example, for ethical reasons (equality principle) it does not seem to be justified if (ill) health-based limit values are varied according to the type of living area as expressed in land development plans (for example residential, mixed or commercial). 4.6 INSOMNIA A group of Japanese researchers carried out a questionnaire-based survey of 3600 adult Japanese women (aged between 20 and 80) to gather information about the factors that contribute to insomnia (Kageyama et al., 1997). Some 11% of subjects were found to be affected by insomnia (as defined on the basis of WHO’s International Statistical Classification and Related Health Problems, 10th revision – ICD10). Analysis of the survey data took account of various distorting variables, such as age, number of (small) children in the family, social status, receipt of medical treatment, regularity of bedtimes, apnoea-like problems and serious unpleasant experiences in the six months prior to completing the questionnaire. When the percentage of insomniacs in each of the three areas with the highest exposures was compared with the percentage in the low-exposure areas, the ratios worked out at, respectively, 1.4 (2100 vehicles per hour, L night of around 65 dB(A)), 2.1 (2400 vehicles per hour, L night of around 67 dB(A)) and 2.8 (6000 vehicles per hour, L night of around 70 dB(A)). The most frequently reported problem was difficulty getting to sleep. NIGHT NOISE GUIDELINES FOR EUROPE
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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
Page 48 and 49: 28 SLEEP AND HEALTH Early reports d
Page 50 and 51: 30 SLEEP AND HEALTH ents’ reports
Page 52 and 53: 32 SLEEP AND HEALTH Although cortic
Page 54 and 55: 34 SLEEP AND HEALTH causal relation
Page 56 and 57: 36 SLEEP AND HEALTH cardiovascular
Page 58 and 59: 38 SLEEP AND HEALTH So do fatigue-r
Page 60 and 61: 40 SLEEP AND HEALTH ers that the ag
Page 62 and 63: 42 SLEEP AND HEALTH 2.5 ANIMAL STUD
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Page 66 and 67: 46 EFFECTS ON SLEEP ing sleep stage
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Page 78 and 79: 58 EFFECTS ON HEALTH for aircraft:
Page 80 and 81: 60 EFFECTS ON HEALTH acoustic and n
Page 82 and 83: 62 EFFECTS ON HEALTH Noise Exposure
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Page 100 and 101: 80 EFFECTS ON HEALTH Research into
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Page 106 and 107: 86 EFFECTS ON HEALTH lage newly exp
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Page 110 and 111: 90 EFFECTS ON HEALTH In a United Ki
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Page 116 and 117: 96 EFFECTS ON HEALTH have had exper
Page 118 and 119: 98 EFFECTS ON HEALTH • number of
Page 120 and 121: 100 EFFECTS ON HEALTH Furthermore,
Page 122 and 123: 102 GUIDELINES AND RECOMMENDATIONS
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
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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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