ARTICLE IN PRESS

Sleep Medicine Reviews (2007) 11, 135–142

www.elsevier.com/locate/smrv

CLINICAL REVIEW

Environmental noise, sleep and health

Alain Muzet

FORENAP, BP 27, Rouffach, France

KEYWORDS Summary Unlike other physical ambient factors (i.e. electromagnetic fields or air
Noise; pollutants), noise is perceived by a specific system (auditory system) in humans. It is
Sleep disturbance; therefore a phenomenon that is sensed and evaluated by everybody, and this is why
Subjective exposure to noise is one of the most, if not the most, frequent complaints of
evaluation; populations living in large cities. In these areas and their surroundings, the sources of
Health effects; noise most frequently cited are traffic, followed by neighbourhood noises and
Habituation; aircraft noises. Sleep is a physiological state that needs its integrity to allow the
Age living organism to recuperate normally. It seems to be sensitive to environmental
factors that can interrupt it or reduce its amount. Ambient noise, for example, is
external stimuli that are still processed by the sleeper sensory functions, despite a
non-conscious perception of their presence. Over the past 30 years, research into
environmental noise and sleep has focused on different situations and environments,
and therefore the findings are variable. However, it still seems necessary for some
fundamental questions to be answered on whether environmental noise has long-
term detrimental effects on health and quality of life and, if so, what these effects
are for night-time, noise-exposed populations.
& 2007 Elsevier Ltd. All rights reserved.

Sound and noise Sound evokes physiological signals in the auditory

system constituted by the ear and the auditory
Sound is produced by any mechanical movement pathways. However, some sounds do not evoke
and is propagated as a motion wave through the air those signals as they are out of the auditory
or any other material. Therefore, sound is defined perception range in humans, which theoretically
by its mechanical energy and is measured in ranges from 20 to 20,000 Hz.
energy-related units. Sound pressure proportional Noise is generally defined as an unwanted sound
to the square of sound intensity (W/m2) is or set of sounds. This definition means that it is not
expressed in Pascal units (Pa), whereas sound possible to classify sounds as noise on the unique
pressure level is expressed in decibel units (dB) basis of their physical characteristics. The general
on a logarithmic scale, owing to the wide range agreement is that noise is an audible acoustic
covered. phenomenon that adversely affects, or may affect,
people. The effects of noise can be appreciated
Tel.: +33 3 89787370; fax: +33 3 89787371. physiologically but also psychologically (annoyance
E-mail address: alain.muzet@forenap.com. and disturbed well-being).

1087-0792/$ - see front matter & 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.smrv.2006.09.001
 ARTICLE IN PRESS
136 A. Muzet

Noise in the environment annoyance and the most difficult to characterize

and quantify.2 This is mainly due to the general
Noise is a phenomenon that affects everybody. We attitude of the exposed people towards the source
are constantly exposed to noise during our every- of noise and who is responsible for it. Neighbour-
day life. Within our environment, there are hood noises (e.g. voices, music or footsteps) have
different sources of noise, but they generally high information content, which may catch the
depend on our activity, location, and the time of attention of the listener, independent of their
day. intensity. Thus, independent of the noise exposure
Transportation noise represents a large majority characteristics, the psychological dimension of the
of external noise affecting people in large cities expressed annoyance is highly related to the
and their surroundings. Road traffic noise is mostly specific relationship that exists between the noise
noise generated by the engine of the vehicle, but producer and the noise receiver (‘‘the bark of your
noise produced by frictional contact between the neighbour’s dog is much louder than the bark of
vehicle and the air, as between tyres and the road your dog’’). Therefore, in the domestic setting, the
surface, exceeds engine noise at speeds higher than physical characteristics of the noise are often less
50 km/h for passenger cars and at speeds higher important than the resultant attitude towards the
than 80 km/h for lorries. Railway noise mainly source of the noise.3
depends on the speed of the train and the quality Noise from leisure activities is clearly increasing
of the track. High-speed trains, for instance, might with the invasion of more powered machines on the
produce high-frequency noise, which is fairly ground as well as in air and water (e.g. off-road
similar to those generated by jet aircrafts. The vehicles, motorboats, and sporting airplanes). They
expected development of this high-speed freight are often limited to more or less specific areas, but
transport system in the next few years should be they tend to increase at the periphery of large
regarded as potentially disturbing for people living cities. Outdoor shooting activities, as well as
alongside the rail tracks, especially at night. Air outdoor concerts, have to be avoided in residential
traffic noise has been given much research atten- areas, but less noisy activities are often pro-
tion during the past 30 years. Noise from a single grammed almost everywhere and are, in addition,
aircraft, however, has considerably diminished often accompanied by increased motor traffic.
during this period, as the concept of engines and
flying machines has changed. However, increasing
volume of traffic, and specifically night-time The exposure to noise
traffic, has often created conflict between popula-
tions living around large airports and the airport As discussed previously, complaints about global
authorities. noise exposure are one of the most, if not the most,
Industrial plants can also be a source of excessive frequent complaints among populations living in
noise for the surroundings. This type of noice can large cities.4 Surveys show that frequency of
be complex in nature, owing to the wide variety of complaints from noise increases with the size of
sources. It can be spontaneous or more or less cities, and that exposure to noise is inversely
continuous, with large variations in intensity. Low- related to family income, with those on lower
frequency noises are not so well attenuated by levels of income being the most exposed to
surrounding structures, and they can be trans- ambient noise.2 The most frequently cited sources
mitted across large distances. Building construction are traffic noises, followed by noises from the
and ground work (e.g. hammering, crane, or heavy neighbourhood and then aircraft noises.
trucks) can generate high noise emissions. Military Ten years ago in France, the number of people
activities, although generally limited to specific living in a ‘‘noisy environment’’ was estimated to
areas, may also cause large noise disturbances for be 10% of the total population or 6 million
the surrounding populations. individuals, comprising 2 million (including
Inside buildings, several different types of noises 450,000 children) exposed to high levels of noise
can be found: mechanical devices (e.g. lift, above 70 dB Leq 8h–20h (Leq or equivalent noise
ventilation, pumps, water pipes) or domestic noises level: constant noise level having an equivalent
(e.g. neighbour’s voices, Hi Fi, TV set, pets, and energy to the total energy of the actual noises
musical instruments). Ventilation noise can be occurring between 08:00 and 20:00).5 Unfortu-
quite disturbing in residential areas because of its nately, there is no reason to believe that this
low-frequency characteristics, even at low A- picture has much improved, and these days the
weighted sound pressure levels.1 Domestic noises numbers are certainly higher. However, the extent
are among the most frequently reported causes of of the noise problem is large, and the case given
 ARTICLE IN PRESS
Environmental noise, sleep and health 137

above can be applied to many more industrialized The effects of noise on sleep can be immediate or
countries. Thus, annoyance to community noise is secondary to the noise exposure. The first category
widespread among citizens in the European Union, corresponds to responses occurring simultaneously
and the number of people exposed to moderately or immediately after the noise emission, whereas
high levels (55–65 dB Leq) still increases in those the latter corresponds to effects visible the next
countries. This is mainly due to the increasing day or after a few days.
sources of noise and their wider dispersion, along
with greater individual mobility and growing leisure Immediate effects: objective measures of
activities. sleep disturbance

Sleep disturbance may be quantified by number

and duration of nocturnal awakenings, number of
Sleep disturbance due to noise sleep stage changes, and modifications in their
amount. Proper rhythms of particular sleep
Sleep disturbance is part of the extra-auditory stages (i.e. slow wave sleep [SWS] or stages 3 and
effects of noise (Fig. 1). The input to the auditory 4, and rapid eye movement [REM] sleep [Fig. 2]),
area of the brain through the auditory pathways is also characterize sleep disturbance, together
prolonged by inputs reaching both the brain with modifications in the autonomic functions
cortical area and the descending pathways of the (heart rate, blood pressure, vasoconstriction and
autonomic functions. Thus, the sleeping body still respiratory rate).
responds to stimuli coming from the environment,
although the noise sensitivity of the sleeper Shortening of the sleep period
depends on several factors. Some of these factors
are noise dependent, such as the type of noise (e.g. Total sleep time can be reduced by both longer time
continuous, intermittent, impulsive), noise inten- to fall asleep and premature final awakening. It has
sity, noise frequency, noise spectrum, noise interval been reported that intermittent noises with peak
(e.g. duration, regularity, expected), noise signifi- noise levels of 45 dB(A) and above, can increase the
cation and the difference between the background time to fall asleep by a few minutes to 20 min.6 On
noise level and the maximum amplitude of the the other hand, sleep pressure is significantly
occurring noise stimulus. Other factors are related reduced after the first 5 h. Therefore, in the morning
to the sleeper, such as age, sex, personality hours, noise events can more easily awake and
characteristics and self-estimated sensitivity to prevent the sleeper of going back to sleep. The
noise. main problem, however, is to determine whether

Auditory effects

Auditory fatigue,
temporary and
permanent deafness

Extra-auditory effects
Subjective effects

Annoyance, fatigue, lack

Biological effects of concentration Behavioral effects

Sleep disturbances
Autonomic functions Medication intake
(cardiovascular, endocrine and Psychiatric symptoms
digestive systems) Masking effects and
Growth and immune learning
system

Figure 1 Auditory and extra-auditory effects of noise.

 ARTICLE IN PRESS
138 A. Muzet

W
REM
1
2
3
4

0 1 2 3 4 5 6 7 8 hours

W
REM
1
2
3
4

0 1 2 3 4 5 6 7 8 hours

Figure 2 Hypnograms of a young adult. Top: during non-disturbed sleep. Sleep onset occurs within 10 min after light out
time (0). Sleep begins by NREM sleep stages and the first REM episode occurs some 90 min after sleep onset. SWS (stages
3 and 4) occurs mainly during the first 3 h of the night. REM sleep episodes appear at very regular intervals. No
awakening is seen during the entire night. Bottom: during a noise-disturbed night. Sleep onset is slightly delayed. The
first episode of stage 4 is partly interrupted. A significant amount of SWS does occur during the fifth hour (possibly as a
compensatory mechanism of the disturbed first episode). REM sleep still shows clear rhythmic occurrence but some of
the episodes are fragmented. Significant awakenings occur throughout the sleep process. Sleep efficiency is reduced.

a significant part of sleep can be chronically reduced Sleep stage modifications

with no detrimental effect in the long term.
If nocturnal awakenings can be provoked for peak
noise level of 55 dB(A) and above, disturbance of
normal sleep sequence can be observed for peak
Sleep awakenings noise levels between 45 and 55 dB(A). In order to
protect noise-sensitive people, The World Health
It seems obvious that noise occurring during sleep Organization recommended a maximal level (LA-
may cause awakenings. The awakening threshold max) inside the bedroom at night of 45 dB,
observed with noise (the sleeper is asked to push a whereas, for the same period, the mean recom-
button when awake) depends on several factors. In mended level (integrated noise level over the 8
the sleeper’s current stage of sleep, the threshold nocturnal hours: Lnight) was of 30 dB.9
is particularly high in deep slow wave sleep (stages SWS and REM sleep are both considered to be
3 and 4), whereas it is much lower in shallower important stages of sleep, which should be well
sleep stages (stages 1 and 2).7 The awakening protected. SWS seems to be an energy restoration
threshold also depends on physical characteristics state of the sleeping body, whereas REM sleep
of the noisy environment (intermittent or sharp seems to be more related to mental and memory
rising noise occurring above a low background noise processes. Carter10 reported that SWS could be
will be particularly disturbing), as well as noise reduced in young sleepers exposed to intermittent
signification. Thus, whispering the sleeper’s name noises. We previously reported that REM sleep
can awake the person more easily than a much rhythmicity could also be affected by environmen-
louder but neutral acoustic stimulus.8 Similarly, and tal noise exposure.11 It is a common observation in
with a similar intensity, the noise of an alarm will all noise-disturbed sleep studies to see an increase
awaken the sleeper more easily than a noise in sleep stage changes resulting in a reduced
without any particular signification. amount of SWS and REM sleep to the benefit of
 ARTICLE IN PRESS
Environmental noise, sleep and health 139

shallower sleep stages. This instability of the sleep daytime period with increased tiredness, daytime
process might be detrimental if it becomes chronic. sleepiness and need for compensatory resting
Its picture is close to that observed in chronic periods.2
insomniacs, and exploring the long-term evolution However, the actual value of subjective
of such sleep disturbance could be important. complaints might be quite different from assess-
ments based on instrumental measures. In fact,
Autonomic responses many factors influence people’s subjective
evaluations of their own sleep quality. Several
Awakenings and sleep-stage modifications are not studies show that subjective self-reports on
the only possible acute effects of noise on the sleep sleep quality or on nocturnal awakenings do not
process itself. The limit values given above do not correlate well with more objective measures of
mean that for lower noise levels there are no more sleep disturbance.14 When the number of noise
effects on the sleeper. Autonomic responses, such events increases, the number of sleep modifica-
as heart rate changes and vasoconstrictions, can be tions or awakenings also increases, although not
obtained for much lower peak noise intensities, proportionally. As indicated by Porter et al.15
indicating that the sleeping body still perceives the noise heard at night will be more intrusive
external stimuli even if there is no consciousness or and noticeable than during the day. This is
memory about these events the next day.7 Although caused by reduced outside and inside background
these effects are considered to be minimal, they noises at night and to the circadian fluctuation of
have been found not to habituate over long biological rhythms. The night-time period may also
exposure times compared with clear subjective be a time of higher noise sensitivity, especially if
habituation over successive noise-exposed awakenings related to aircrafts flying over occur.
nights.12,13 These autonomic responses represent Therefore, use of self-reports of movement, awa-
reflex responses of the sleeping body to the kenings, or other sleep-related effects, needs
external stimuli, which can already be observed serious reconsideration because of their question-
at quite a low intensity. The health effects of long- able validity.
term repetition of such responses should be However, if the number of noise events is
discussed, especially in the case of multi-exposure important and the noise level is high, nocturnal
(e.g. air and surface traffic). In this situation, there awakening can be excessively prolonged and
could be a cumulative effect of these cardio- even constitute a premature final awakening of
vascular responses over a few thousands stimuli the night. Sleep disturbance occurring during the
per night. early part of the night and during the time just
preceding usual awakening seems to be most
annoying.6,16 In this case, sleep disturbances will
lead to excessive daytime fatigue, often accom-
Secondary effects of the sleep panied by daytime sleepiness, with its specific
disturbance due to noise effects being low work capacity and increased
accident rate.
The secondary effects of night-time noise exposure Fear of living under aircraft routes is often a
can be separated into subjective reports of sleep major reason of protesting against aircraft
disturbances and objective effects on daytime noise even if the measured noise levels are
functioning. relatively low. This largely accounts for the
difficulty in trying to find a clear relationship
Subjective evaluation of sleep disturbance between subjective complaints and actual noise
exposure.
Objective recordings of sleep disturbance data
are too costly and too difficult to use with large
samples of the population or when funding is Other secondary effects
limited. Next-day subjective evaluation of sleep
quality is a much easier and less costly way of In addition to subjective evaluations of sleep
collecting data, especially in the field. Sleep quality, after-effects of nocturnal noise exposure
disturbance per se can be assessed from complaints can be measured the following morning by objec-
about bad sleep quality, delayed sleep onset, tive biochemical data (i.e. increase in levels of
nocturnal awakenings, and early morning stress hormones, including noradrenalin, adrenalin
waking up. These sleep disturbances are often and cortisol),10,17,18 or by cognitive performance
accompanied by impaired quality of the subsequent deterioration during the next day.19,20
 ARTICLE IN PRESS
140 A. Muzet

Physiological sensitivity to noise exposure with long-term health effects. Of course,

these effects depend on the magnitude and the
The noise physiological sensitivity depends also on repetition of sleep disturbance. To be awakened
the age of the sleeper. Although electroencephalo- when engaged in a quiet and comfortable universe
gram (EEG) modifications and awakening thresholds full of sweet dreams is, per se, a real aggression
are, on average, 10 dB(A) higher in children than in that only few sleepers may appreciate. However, it
adults, their cardiovascular sensitivity to noise is is much more through the reduction of daytime
similar to, if not higher than, older people.21 quality of life that sleep disturbance can be
Elderly people complain much more than younger evaluated. Chronic partial sleep deprivation in-
adults about environmental noise. However, their duces marked tiredness, increases a low vigilance
spontaneous awakenings during sleep are also much state, and reduces both daytime performance and
more numerous. Therefore, it is difficult to the overall quality of life.26 Excessive daytime
conclude if elderly people are more sensitive to fatigue accompanied by sleepiness, deterioration
noise or if they hear noise because they are often of normal behaviour, expression of anger, lack of
awake during the night. This natural fragmentation concentration and reduced work ability are often
of their night sleep tends also to lengthen their associated with chronic sleep deprivation. In this
return to the sleeping state, and this accounts for a case, the need for additional resting period during
significant part in their subjective complaints. The the daytime is not always satisfied. In fact, the
main question about possible sensitive groups subtle equilibrium between waking and sleeping
remains almost entirely unanswered. Most of the states is deteriorated to the detriment of the
studies (in laboratories as well as in the home) have quality of both states.
been carried out on groups of ‘‘normal’’ people or, More generally, some health effects, such as
at least, populations where some pathologies have increased prescription of drugs around major air-
been systematically excluded. ports27 or increased rate of psychiatric hospital
admission28 could also be related to night-time
noise exposure. However, many confounding fac-
The particular case of shift workers
tors cannot be eliminated in these epidemiological
studies and, therefore, it remains difficult to
The sleep of shift workers is often disturbed by
confirm such results. The perception by the
combined influences of ambient factors (noise is
exposed population of possible factors affecting
one of them) and chronobiological factors (sleeping
their health is often reported by the airport
at an unusual time of the day). Thus, noise was
services in charge of communication with the
considered as the first cause of sleep interruptions
public. Most of the complaints refer to sleep
in a group of female shift workers.22 It is also
disturbance, general fatigue and anxiety. Noise is
considered a major cause of sleep shortening during
then clearly identified as a factor of stress and
daytime.23 Some investigators comparing daytime
stress may be considered as the possible mechan-
to night-time sleep disturbance due to noise in shift
ism through which mental and physical health can
workers, have found that the percentage of noise-
be affected by noise.29
induced EEG effects was significantly higher during
Of particular interest is the possible relationship
the day than during the night-time REM sleep.24
between noise and the stress responses it produces,
These investigators also stated that the inversion of
as they have the potential to be linked to hyperten-
the sleep–wake cycle did not markedly influence
sion, cardiovascular disease and other severe med-
the average cardiovascular reactivity to noise, and
ical problems.30–37 As mentioned previously, there is
they concluded that daytime sleep disturbance by
also a need to protect sensitive groups and shift
noise was as important and harmful as night-time
workers who sleep during the day.25
disturbance. Carter et al.25 underlined the effects
of noise on the cardiovascular side and, particu-
larly, the modifications in blood pressure due to
suddenly occurring noises.
Conclusion
Sleep is a physiological state that needs its integrity
Possible health effects of noise-disturbed to allow for normal recuperation of the living
sleep organism. Its reduction or disruption is detrimental
in the long term, as chronic partial sleep depriva-
From a public health perspective, it is necessary tion induces marked tiredness, increases low
to be able to link sleep disturbance from noise vigilance state and reduces daytime performance
 ARTICLE IN PRESS
Environmental noise, sleep and health 141

and quality of life. Sleep seems to be fairly

sensitive to environmental factors, and, specifi-
cally, to ambient noise, as external stimuli are still
Research agenda
processed by the sleeper sensory functions, despite
Future research should focus on:
a non-conscious perception of their presence.
The large amount of research developed in the
laboratory during the past 30 years has produced
 Long term effects of night-time noise
exposure of different populations.
variable results, and some of them seem quite
controversial. In fact, the effects of noise exposure
 The study of specific sub-groups that can be
considered to be ‘‘at risk’’ (e.g. children,
depend on several factors, and the absence of a
elderly people, self-estimated sensitive
clear dose–effect relationship is certainly due to
people, insomniacs, sleep disorder patients,
the complex interactions of these factors, including
night and shift workers).
the noise characteristics, the individual sensitivity
and the context of the explored living environment.
 Combined effects of noise exposure and
other physical agents or stressors during
However, the amplitude of the subjective com-
sleep.
plaints about sleep disturbance seems to have been
increasing during recent years. Unfortunately, only
a few epidemiological studies have considered the
possible effect of noise exposure (considered
globally), together with other environmental fac-
tors, on the health of exposed populations. To our References
knowledge, no large-scale epidemiological study
1. Öhrström E, Skanberg A. Sleep disturbances from road
focusing on the effect of night-time noise exposure traffic and ventilation noise – laboratory and field experi-
on health has yet been undertaken. Therefore, it is ments. J Sound Vib 2004;271:279–96.
necessary to answer some fundamental questions in 2. Gualezzi JP. Le bruit dans la ville, Rapport au Conseil
order to understand the detrimental effects on Economique et Social, Les Editions des Journaux Officiels,
health and quality of life in the long term, for night- 1998.
3. Moch A. La sourde oreille. Grandir dans le bruit, Collection
time, noise-exposed populations. Continuous high- Epoque, Privat, Toulouse, 1985.
level exposure can lead to aggression in a hostile, 4. INSEE. Mesurer la qualité de vie dans les grandes
angry, and helpless population. It is often the agglomérations, INSEE Première, no 868, 2002.
population with the least income that suffers the 5. Lambert J, Vallet M. Rapport préparatoire à la Commission
Européenne sur le bruit de l’environnement, INRETS-LEN
most from noise in general. Also, annoyance due to
1994.
ambient noise may be often seen as the visible part 6. Öhrström E, Research on noise since 1988: present state:
of a greater problem. Therefore, it should be an In: Vallet M, editor. Proceedings of Noise and Man, ICBEN,
everyday concern to protect these populations Nice: INRETS 1993, p. 331–8.
against this major environmental aggression. 7. Muzet A. Réactivité de l’Homme endormi. In: Benoit O,
Forêt J, editors. Le Sommeil humain. Bases expérimentales
physiologiques et physiopathologiques. Paris: Masson;
Practice points 1992. p. 77–83.
8. Oswald I, Taylor AM, Treisman M. Discriminative responses
to stimulation during human sleep. Brain 1960;83:440–53.
Immediate and secondary effects of sleep *9. Noise and Health, WHO, Local authorities. Health and
disturbance due to noise are as follows: Environment, number 36, 2000.
10. Carter NL. Transportation noise, sleep, and possible after-
Immediate effects:
effects. Environ Int 1996;22:105–16.
11. Naitoh P, Muzet A, Lienhard JP. Effects of noise and
 Delayed sleep onset, earlier final awakening
elevated temperature on sleep cycle. Sleep Res
or nocturnal awakenings. 1975;4:174.
 Sleep stage changes or sleep structure 12. Muzet A, Ehrhart J. Habituation of heart rate and finger
changes. pulse responses to noise during sleep. In: Tobias JV, editor.
 Arousals and body movements. Noise as a public health problem. Rockville, MD: ASHA
report number 10; 1980. p. 401–4.
 Vegetative or hormonal responses to noise.
13. Vallet M, Gagneux JM, Clairet JM, et al. Heart rate
reactivity to aircraft noise after a long term exposure. In:
Secondary effects: Rossi G, editor. Noise as a public health problem. Milano:
Centro Ricerche E Studi Amplifon; 1983. p. 965–71.
 Subjective estimation of sleep quality. 14. Passchier-Vermeer W. Night-time noise events and awaken-
ing. TNO report 2003-32, Delft, The Netherlands 2003.
 Performance decrement.
 Change in daytime behaviour. The most important references are denoted by an asterisk.
 ARTICLE IN PRESS
142 A. Muzet

15. Porter ND, Kershaw AD, Ollerhead JB. Adverse effects of Noise as a public health problem. Nice, INRETS; 1993.
night-time aircraft noise. Report number 9964, National Air p. 393–403.
Traffic Services, 2000. 27. Knipschild P, Oudshoorn N. Medical effects of aircraft noise:
16. Fields JM. The relative effect of noise at different times of drug survey. Int Arch Occup Environ Health 1977;40:
the day. Report number CR-3965, NASA Langley Research 197–200.
Center, 1986. 28. Tarnopolsky A, Watkins G, Hand DJ. Aircraft noise and
17. Maschke C. Noise-induced sleep disturbance, stress reac- mental health: I. Prevalence of individual symptoms.
tions and health effects: In: Prasher D, Luxon L, editors. Psychol Med 1980;10:683–98.
Protection against noise, volume I: Biological effects. *29. Kryter KD. The effects of noise on man. Orlando: Academic
London: Whurr Publishers for the Institute of Laryngology Press; 1985.
and Otology; 1998. *30. Carter NL, Ingham P, Tran K, et al. A field study of the
*18. Maschke C, Harder J, Ising H, et al. Stress hormone changes effects of traffic noise on heart rate and cardiac arrhythmia
in persons exposed to simulated night noise. Noise Health during sleep. J Sound Vib 1994;169:221–7.
2002;5:35–45. 31. Carter NL. Cardiovascular response to environmental noise
*19. Smith AP. Noise, performance efficiency and safety. Inter during sleep: In: Proceedings of seventh international
Arch Occupat Environ Health 1990;62:1–5. congress on noise as a public health problem. Sydney,
*20. Wilkinson RT, Campbel LKB. Effects of traffic noise on Australia. 1998. p. 439–44.
quality of sleep: assessment by EEG, subjective report, or *32. Di Nisi J, Muzet A, Ehrhart J, et al. Comparison of
performance next day. J Acoust Soc Am 1984;75:468–75. cardiovascular responses to noise during waking and
21. Muzet A, Ehrhart J, Eschenlauer R, et al. Habituation and sleeping in humans. Sleep 1990;13:108–20.
age differences of cardiovascular responses to noise during 33. Griefahn B. Noise-induced extra aural effects. J Acoust Soc
sleep. In: Koella WP, editor. Sleep 1980. Basel: Karger; Japan 2000;21:307–17.
1981. p. 212–5. 34. Griefahn B. Sleep disturbances related to environmental
22. Lee K. Self-reported sleep disturbances in employed noise. Noise Health 2002;4:57–60.
women. Sleep 1992;15:493–8. 35. Maschke C. Epidemiological research on stress caused by
23. Knauth P, Rutenfranz J. The effects of noise on the sleep of traffic noise and its effects on high blood pressure
nightworkers. In: Colquhoun WP, Folkart S, Knauth P, and psychic disturbances: In: de Jong R, editor. Proceedings
editors. Experimental studies of shiftwork. Oplanden: of ICBEN 2003: Eighth international congress on noise
Westdeutscher; 1975. p. 57–65. as a public health problem, Rotterdam, the Netherlands,
*24. Nicolas A, Bach V, Tassi P, et al. , Electroencephalogram 2003.
and cardiovascular responses to noise during daytime sleep 36. Stansfeld SA, Lercher P. Non-auditory physiological effects
in shiftworkers. Eur J Appl Physiol 1993;66:76–84. of noise: five year review and future directions: In: de Jong
25. Carter N, Henderson R, Lal S, et al. Cardiovascular and R, editor. Proceedings of ICBEN 2003: Eighth International
autonomic response to environmental noise during sleep in Congress on Noise as a Public Health Problem, Rotterdam,
night shift workers. Sleep 2002;25:457–64. the Netherlands, 2003.
26. Öhrström E, Griefahn B. Summary of team 5: Effects of *37. Passchier-Vermeer W. Effects of noise and health. Noise/
noise on sleep: In: Vallet M, editor. Noise and man 1993. News Int 1996:137–50.