Evidence Relating to Environmental Noise Exposure and Annoyance, Sleep Disturbance, Cardio-Vascular and Metabolic Health Outcomes in the Context of IGCB (N): A Scoping Review of New Evidence

Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project) - study protocol

INTRODUCTION

The European Environment Agency estimates that 75% of the European population lives in cities. Despite the many advantages of city life, the risks and challenges to health arising from urbanisation need to be addressed in order to tackle the growing burden of disease and health inequalities in cities. This study, Urban environment and health: a cross-sectional multiregional project based on population health surveys in Spain (DAS-EP project), aims to investigate the complex association between the urban environmental exposures (UrbEEs) and health.

METHODS AND ANALYSIS

DAS-EP is a Spanish multiregional cross-sectional project that combines population health surveys (PHS) and geographical information systems (GIS) allowing to collect rich individual-level data from 17 000 adult citizens participating in the PHS conducted in the autonomous regions of the Basque Country, Andalusia, and the Valencian Community, and the city of Barcelona in the years 2021-2023. This study focuses on the population living in cities or metropolitan areas with more than 100 000 inhabitants. UrbEEs are described by objective estimates at participants' home addresses by GIS, and subjective indicators present in PHS. The health outcomes included in the PHS and selected for this study are self-perceived health (general and mental), prevalence of chronic mental disorders, health-related quality of life, consumption of medication for common mental disorders and sleep quality. We aim to further understand the direct and indirect effects between UrbEEs and health, as well as to estimate the impact at the population level, taking respondents' sociodemographic and socioeconomic characteristics, and lifestyle into consideration.

ETHICS AND DISSEMINATION

The study was approved by the regional Research Ethics Committee of the Basque Country (Ethics Committee for Research Involving Medicinal Products in the Basque Country; PI2022138), Andalusia (Biomedical Research Ethics Committee of the Province of Granada; 2078-N-22), Barcelona (CEIC-PSMar; 2022/10667) and the Valencian Community (Ethics Committee for Clinical Research of the Directorate General of Public Health and Center for Advanced Research in Public Health; 20221125/04). The results will be communicated to the general population, health professionals, and institutions through conferences, reports and scientific articles.

Association between Noise and Cardiovascular Disease in a Nationwide U.S. Prospective Cohort Study of Women Followed from 1988 to 2018

BACKGROUND

Long-term noise exposure is associated with cardiovascular disease (CVD), including acute cardiovascular events such as myocardial infarction and stroke. However, longitudinal cohort studies in the U.S. of long-term noise and CVD are almost exclusively from Europe and few modeled nighttime noise, when an individual is likely at home or asleep, separately from daytime noise. We aimed to examine the prospective association of outdoor long-term nighttime and daytime noise from anthropogenic sources with incident CVD using a U.S.-based, nationwide cohort of women.

METHODS

We linked L 50 nighttime and L 50 daytime anthropogenic modeled noise estimates from a U.S. National Parks Service model (L 50 : sound pressure levels exceeded 50 percent of the time) to geocoded residential addresses of 114,116 participants in the Nurses' Health Study. We used time-varying Cox proportional hazards models to estimate risk of incident CVD, coronary heart disease (CHD), and stroke associated with long-term average (14-y measurement period) noise exposure, adjusted for potential individual- and area-level confounders and CVD risk factors (1988-2018; biennial residential address updates; monthly CVD updates). We assessed effect modification by population density, region, air pollution, vegetation cover, and neighborhood socioeconomic status, and explored mediation by self-reported average nightly sleep duration.

RESULTS

Over 2,548,927 person-years, there were 10,331 incident CVD events. In fully adjusted models, the hazard ratios for each interquartile range increase in L 50 nighttime noise (3.67 dBA) and L 50 daytime noise (4.35 dBA), respectively, were 1.04 (95% CI: 1.02, 1.06) and 1.04 (95% CI: 1.02, 1.07). Associations for total energy-equivalent noise level (L eq ) measures were stronger than for the anthropogenic statistical L 50 noise measures. Similar associations were observed for CHD and stroke. Interaction analyses suggested that associations of L 50 nighttime and L 50 daytime noise with CVD did not differ by prespecified effect modifiers. We found no evidence that inadequate sleep (< 5 h/night) mediated associations of L 50 nighttime noise and CVD.

DISCUSSION

Outdoor L 50 anthropogenic nighttime and daytime noise at the residential address was associated with a small increase in CVD risk in a cohort of adult female nurses. https://doi.org/10.1289/EHP12906.

The effects of occupational noise on sleep: A systematic review

Noise exposure in the workplace is one of the most common occupational hazards, which can affect sleep in the human. The effects of occupational noise can be different than that of environmental or social noise. This study aimed to conduct a systematic review on the effects of occupational noise on various characteristics of sleep. In this study, three electronic bibliographic databases (Scopus, PubMed, and Web of Science) were systematically searched up to 14 December 2022. The search algorithm included two sets of keywords and possible combinations. The first group was keywords related to occupational noise, and the second group was keywords related to sleep. A total of 2082 articles were identified in the initial search, and 2034 articles were excluded based on exclusion criteria or lacking inclusion criteria. Finally, 48 articles met the inclusion criteria and were selected for final review. Among 13 articles identified as high quality, all studies (100%) showed that noise had a significant effect on sleep among workers in various occupations. Among 17 articles with moderate quality, thirteen studies (76.47%) indicated that noise had a significant effect on sleep among workers in different occupations. Among 18 low-quality articles, fifteen studies (83.33%) showed that noise had a significant effect on sleep. 41 out of 48 studies (85.42%) found that occupational noise can negatively impact sleep among employees in various occupations. There are at least four potential pathways for this effect, including the physiological effect of daytime noise exposure, the psychological effect of daytime noise exposure, the effect of nighttime noise exposure, and the effect of hearing problems due to noise.

Perceiving noise in daily life: How real-time sound characteristics affect personal momentary noise annoyance in various activity microenvironments and times of day

Annoyance is a major health burden induced by environmental noise. However, our understanding of the health impacts of noise is seriously undermined by the fixed contextual unit and limited sound characteristics (e.g., the sound level only) used in noise exposure assessments as well as the stationarity assumption made for exposure-response relationships. To address these limitations, we analyze the complex and dynamic relationships between personal momentary noise annoyance and real-time noise exposure in various activity microenvironments and times of day, taking into account individual mobility, multiple sound characteristics and nonstationary relationships. Using real-time mobile sensing, we collected individual data of momentary noise annoyance, real-time noise exposure as well as daily activities and travels in Hong Kong. A new sound characteristic, namely sound increment, is defined to capture the sudden increase in sound level over time and is used along with the sound level to achieve a multi-faceted assessment of personal real-time noise exposure at the moment of annoyance responses. Further, the complex noise exposure-annoyance relationships are learned using logistic regression and random forest models while controlling the effects of daily activity microenvironments, individual sociodemographic attributes and temporal contexts. The results indicate that the effects of the real-time sound level and sound increment on personal momentary noise annoyance are nonlinear, despite the overall significant and positive impacts, and different sound characteristics can produce a joint effect on annoyance. We also find that the daily activity microenvironments and individual sociodemographic attributes can affect noise annoyance and its relationship with different sound characteristics to varying degrees. Due to the temporal changes in daily activities and travels, the noise exposure-annoyance relationships can also vary over different times of the day. These findings can inform both local governments and residents with scientific evidence to promote the creation of acoustically comfortable living environments.

Exposure to Noise and Cardiovascular Disease in a Nationwide US Prospective Cohort Study of Women

Background: Long-term noise exposure is associated with cardiovascular disease (CVD), including acute cardiovascular events such as myocardial infarction and stroke. However, longitudinal cohort studies of long-term noise and CVD are almost exclusively from Europe, and few modelled nighttime and daytime noise separately. We aimed to examine the prospective association of outdoor long-term nighttime and daytime noise from anthropogenic sources with incident CVD using a US-based, nationwide cohort of women. Methods: We linked L50 (median) nighttime and L50 daytime modelled anthropogenic noise estimates from a US National Park Service model to geocoded residential addresses of 114,116 participants in the Nurses' Health Study. We used time-varying Cox proportional hazards models to estimate risk of incident CVD, coronary heart disease (CHD), and stroke associated with long-term average noise exposure, adjusted for potential individual- and area-level confounders and CVD risk factors (1988-2018). We assessed effect modification by population density, region, air pollution, vegetation cover, and neighborhood socioeconomic status, and explored mediation by self-reported average nightly sleep duration. Results: Over 2,544,035 person-years, there were 10,331 incident CVD events. In fully-adjusted models, the hazard ratios for each interquartile range increase in L50 nighttime noise (3.67 dBA) and L50 daytime noise (4.35 dBA), respectively, were 1.04 (95% CI 1.02, 1.06) and 1.04 (95% CI 1.02, 1.07). Similar associations were observed for CHD and stroke. Stratified analyses suggested that associations of nighttime and daytime noise with CVD did not differ by prespecified effect modifiers. We found no evidence that inadequate sleep (< 5 hours per night) mediated associations of noise and CVD. Discussion: Outdoor median nighttime and daytime noise at the residential address was associated with a small increase in CVD risk in a cohort of adult female nurses.

Joint associations and pathways from greenspace, traffic-related air pollution, and noise to poor self-rated general health: A population-based study in Sofia, Bulgaria

BACKGROUND

Little is still known of how multiple urban exposures interact as health determinants. This study investigated various ways in which greenspace, traffic-related air pollution, and noise could operate together, influencing general health status.

METHODS

In 2022, a cross-sectional population-based survey was conducted in Sofia, Bulgaria. Included were 917 long-term adult residents who completed questionnaires on poor self-rated health (PSRH), total time spent in physical activity (PA), home garden presence, time spent in urban greenspace and nature, and sociodemographics. Residential greenspace was operationalized using the normalized difference vegetation index (NDVI), tree cover density, number of trees, and access to local greenspace and parks. Nitrogen dioxide (NO₂) was modeled for the study area. Road traffic, railway, and aircraft day-evening-night sound levels (L_den) were extracted from EU noise maps. Area-level income and urbanicity were considered. Analyses included multivariate ordinal regressions, interactions, and structural equation modeling (SEM).

RESULTS

Associations with PSRH were per 0.10 NDVI _300 m: OR = 0.65 (0.42-1.01), home garden: OR = 0.72 (0.49-1.07), per 5 μg/m³ NO₂: OR = 1.57 (1.00-2.48), per 5 dB(A) L_den road traffic: OR = 1.06 (0.91-1.23), railway: OR = 1.11 (1.03-1.20), and aircraft: OR = 1.22 (1.11-1.34). Spending >30 min/week in nature related to better health. In multi-exposure models, only associations with aircraft and railway L_den persisted. People with lower education and financial difficulties or living in poorer districts experienced some exposures stronger. In SEM, time spent in nature and PA mediated the effect of greenspace.

CONCLUSIONS

Greenspace was associated with better general health, with time spent in nature and PA emerging as intermediate pathways. NO₂, railway, and aircraft noise were associated with poorer general health. These results could inform decision-makers, urban planners, and civil society organizations facing urban development problems. Mitigation and abatement policies and measures should target socioeconomically disadvantaged citizens.

Suicide and Transportation Noise: A Prospective Cohort Study from Switzerland

BACKGROUND

Although plausible from a pathophysiological point of view, robust evidence for effects of transportation noise on mental health remains scarce. Meanwhile, psychiatric diseases are among the most prevalent noncommunicable diseases worldwide, and suicide as a mortality outcome highly connected to mental disorders presents a pressing public health issue. The aim of this study was to investigate the association between source-specific transportation noise, particulate matter (PM) air pollution, residential greenness, and suicide by means of a nationwide cohort study.

METHODS

Road traffic, railway and aircraft noise exposure as well as exposure to air pollution [PM with aerodynamic diameter ≤2.5μm (PM2.5)] and greenness [normalized difference vegetation index (NDVI)] were linked to 5.1 million adults (age 15 y and older) in the Swiss National Cohort, accounting for their address history. Mean noise exposure in 5-y periods was calculated. Individuals were followed for up to 15 y (2001-2015). Time-varying Cox regression models were applied to deaths by suicide (excluding assisted suicide). Models included all three noise sources, PM2.5, and NDVI plus individual and spatial covariates, including socioeconomic status. Effect modification by sex, age, socioeconomic indicators, and degree of urbanization was explored.

RESULTS

During the follow-up, there were 11,265 suicide deaths (10.4% poisoning, 33.3% hanging, 28.7% firearms, 14.7% falls). Road traffic and railway noise were associated with total suicides [hazard ratios: 1.040; 95% confidence interval (CI): 1.015, 1.065; and 1.022 (95% CI: 1.004, 1.041) per 10 dB day-evening-night level (Lden)], whereas for aircraft noise, a risk increase starting from 50 dB was masked by an inverse association in the very low exposure range (30-40 dB). Associations were stronger for females than males. The results were robust to adjustment for residential greenness and air pollution.

CONCLUSION

In this longitudinal, nationwide cohort study, we report a robust association between exposure to road traffic and railway noise and risk of death by suicide after adjusting for exposure to air pollution and greenness. These findings add to the growing body of evidence that mental health disorders may be related to chronic transportation noise exposure. https://doi.org/10.1289/EHP11587.

The ethical dilemmas of risky decisions

Even in a pandemic there seem to be inherent conflicts of interest between the individual and societal consequences of remedial actions and strategies. Actions taken in the sole interests of patients, as required by the Hippocratic oath, can have broadly inconvenient economic implications for the State. ("Average" benefits for a population can impose individual inconveniences for the vulnerable.). Understandably these decisions are not normally made explicitly and transparently by governments. This leads to seemingly illogical and inhumane strategies which are not understood and hence mistrusted and often ignored by the public. Vaccination sentiments on social media are often an unwanted symptom of this dilemma. This article outlines and discusses a number of examples of such situations with a focus on ethical aspects. It concludes that each case must be considered individually as to the issues that need to be weighed in these difficult decisions; and that there are no clear and universally acceptable ethical solutions. What can be learned from the COVID-19 crisis is that short term utilitarianism has consequences that in the eyes of the population are unacceptable. This lesson seems equally valid for cost benefit evaluations regarding other risks, such as from hazardous industries, flood defenses, and air transport. Decisionmakers and politicians can learn that persuasion only goes so far. In the end the people appear to prioritize in terms of deontology.

Exposure to outdoor residential noise during pregnancy, embryonic size, fetal growth, and birth outcomes

INTRODUCTION

Previous literature suggested that noise exposure during pregnancy was not associated with adverse birth outcomes. However, no studies evaluated the association between noise exposure and embryonic and fetal growth, or mutually assessed other urban environmental exposures such as traffic-related air pollution or natural spaces.

METHODS

We included 7947 pregnant women from the Generation R Study, the Netherlands. We estimated total (road traffic, aircraft, railway, and industry), road traffic, and railway noise at the participants' home addresses during pregnancy using environmental noise maps. We estimated traffic-related air pollution using land-use regression models, greenness within a 300 m buffer using the normalized difference vegetation index, and distance to blue spaces using topographical maps at the home addresses. Embryonic size (crown-rump length) and fetal growth parameters (head circumference, femur length, and estimated fetal weight) were measured by ultrasound at several gestational ages. Information on neonatal anthropometrics at birth (head circumference, length, and weight) and adverse birth outcomes (preterm birth, low birth weight, and small for gestational age) were retrieved from medical records.

RESULTS

Higher total noise exposure during pregnancy was associated with larger crown-rump length (0.07 SDS [95%CI 0.00 to 0.14]). No association was found with fetal growth parameters, neonatal anthropometrics, and adverse birth outcomes. Similar results were observed for road traffic noise exposure, while railway noise exposure was not associated with any of the outcomes. Traffic-related air pollution was not associated with crown-rump length. Total noise exposure mediated 15% of the association between exposure to greenness and smaller crown-rump length. No association was observed between distance to blue spaces and total noise exposure.

CONCLUSION

Exposure to outdoor residential noise during pregnancy was associated with larger embryonic size. Moreover, a reduction of total noise exposure during pregnancy partially mediated the association between exposure to greenness and smaller embryonic size. Additional research is warranted to confirm and further understand these novel findings.

Environmental noise and health in low-middle-income-countries: A systematic review of epidemiological evidence

Evidence of the health impacts from environmental noise has largely been drawn from studies in high-income countries, which has then been used to inform development of noise guidelines. It is unclear whether findings in high-income countries can be readily translated into policy contexts in low-middle-income-countries (LMICs). We conducted this systematic review to summarise noise epidemiological studies in LMICs. We conducted a literature search of studies in Medline and Web of Science published during 2009-2021, supplemented with specialist journal hand searches. Screening, data extraction, assessment of risk of bias as well as overall quality and strength of evidence were conducted following established guidelines (e.g. Navigation Guide). 58 studies were identified, 53% of which were from India, China and Bulgaria. Most (92%) were cross-sectional studies. 53% of studies assessed noise exposure based on fixed-site measurements using sound level meters and 17% from propagation-based noise models. Mean noise exposure among all studies ranged from 48 to 120 dB (L_eq), with over half of the studies (52%) reporting the mean between 60 and 80 dB. The most studied health outcome was noise annoyance (43% of studies), followed by cardiovascular (17%) and mental health outcomes (17%). Studies generally reported a positive (i.e. adverse) relationship between noise exposure and annoyance. Some limited evidence based on only two studies showing that long-term noise exposure may be associated with higher prevalence of cardiovascular outcomes in adults. Findings on mental health outcomes were inconsistent across the studies. Overall, 4 studies (6%) had "probably low", 18 (31%) had "probably high" and 36 (62%) had "high" risk of bias. Quality of evidence was rated as 'low' for mental health outcomes and 'very low' for all other outcomes. Strength of evidence for each outcome was assessed as 'inadequate', highlighting high-quality epidemiological studies are urgently needed in LMICs to strengthen the evidence base.

Environmental Noise Exposure and Sleep Habits among Children in a Cohort from Northern Spain

Environmental noise is considered the second most serious environmental risk factor in Europe. However, little evidence exists regarding its impact on health and sleep in children, and the results are inconclusive. In this study, we aim to analyse the effect of environmental noise exposure on 11-year-old children's sleep habits. Data were collected from 377 participants in the INMA-Gipuzkoa (INfancia y Medio Ambiente) cohort project using both parent-reported and actigraphic sleep measures. The results revealed that 60% of children have a day-evening-night environmental noise exposure (L_den) of above 55 dB, which is defined as a "high noise level". No differences in noise exposure were observed between different socioeconomic groups. However, no effect of environmental noise was found on sleep variables. The paper highlights the importance of studying how environmental noise may affect children's sleep.

Spatial modelling and inequalities of environmental noise in Accra, Ghana

Noise pollution is a growing environmental health concern in rapidly urbanizing sub-Saharan African (SSA) cities. However, limited city-wide data constitutes a major barrier to investigating health impacts as well as implementing environmental policy in this growing population. As such, in this first of its kind study in West Africa, we measured, modelled and predicted environmental noise across the Greater Accra Metropolitan Area (GAMA) in Ghana, and evaluated inequalities in exposures by socioeconomic factors. Specifically, we measured environmental noise at 146 locations with weekly (n = 136 locations) and yearlong monitoring (n = 10 locations). We combined these data with geospatial and meteorological predictor variables to develop high-resolution land use regression (LUR) models to predict annual average noise levels (LAeq24hr, Lden, Lday, Lnight). The final LUR models were selected with a forward stepwise procedure and performance was evaluated with cross-validation. We spatially joined model predictions with national census data to estimate population levels of, and potential socioeconomic inequalities in, noise levels at the census enumeration-area level. Variables representing road-traffic and vegetation explained the most variation in noise levels at each site. Predicted day-evening-night (Lden) noise levels were highest in the city-center (Accra Metropolis) (median: 64.0 dBA) and near major roads (median: 68.5 dBA). In the Accra Metropolis, almost the entire population lived in areas where predicted Lden and night-time noise (Lnight) surpassed World Health Organization guidelines for road-traffic noise (Lden <53; and Lnight <45). The poorest areas in Accra also had significantly higher median Lden and Lnight compared with the wealthiest ones, with a difference of ∼5 dBA. The models can support environmental epidemiological studies, burden of disease assessments, and policies and interventions that address underlying causes of noise exposure inequalities within Accra.

Wired for sound: The effect of sound on the epileptic brain

Sound waves are all around us resonating at audible and inaudible frequencies. Our ability to hear is crucial in providing information and enabling interaction with our environment. The human brain generates neural oscillations or brainwaves through synchronised electrical impulses. In epilepsy these brainwaves can change and form rhythmic bursts of abnormal activity outwardly appearing as seizures. When two waveforms meet, they can superimpose onto one another forming constructive, destructive or mixed interference. The effects of audible soundwaves on epileptic brainwaves has been largely explored with music. The Mozart Sonata for Two Pianos in D major, K. 448 has been examined in a number of studies where significant clinical and methodological heterogeneity exists. These studies report variable reductions in seizures and interictal epileptiform discharges. Treatment effects of Mozart Piano Sonata in C Major, K.545 and other composer interventions have been examined with some musical exposures, for example Hayden's Symphony No. 94 appearing pro-epileptic. The underlying anti-epileptic mechanism of Mozart music is currently unknown, but interesting research is moving away from dopamine reward system theories to computational analysis of specific auditory parameters. In the last decade several studies have examined inaudible low intensity focused ultrasound as a neuro-modulatory intervention in focal epilepsy. Whilst acute and chronic epilepsy rodent model studies have consistently demonstrated an anti-epileptic treatment effect this is yet to be reported within large scale human trials. Inaudible infrasound is of concern since at present there are no reported studies on the effects of exposure to infrasound on epilepsy. Understanding the impact of infrasound on epilepsy is critical in an era where sustainable energies are likely to increase exposure.

Hair cortisol as a viable tool for the assessment of an association between environmental noise exposure and chronic stress

Entrenched in the well-established link between stress and health, noise exposure as a potential contributor to stress-related health effects receives tremendous attention. Indeed, exposure to noise can act as a stressor as evidenced through increased heart rate, blood pressure, adrenaline, epinephrine, and cortisol. Cortisol is secreted from the adrenal glands in response to stressor-induced activation of the hypothalamic-pituitary-adrenal axis. For assessment of environmental noise and stress, repeated sampling in blood, saliva, or urine is necessary to evaluate the association between environmental noise exposure and protracted changes in cortisol. Controlling for the many variables that influence the secretion of cortisol at discrete sampling intervals is challenging. Studies suggest that systemically produced cortisol integrates and remains in hair as it grows, providing a measure that integrates a cortisol response over a longer period, circumventing several limitations associated with multiple sampling. Robust evidence supports the integration of cortisol into hair, yet recent studies call into question the notion that cortisol is retained with growth. The current paper discusses the strengths and limitations of hair cortisol analysis with an emphasis on its utility as a measure of chronic stress in environmental noise studies.

Environmental Noise and Effects on Sleep: An Update to the WHO Systematic Review and Meta-Analysis

BACKGROUND

Nighttime noise carries a significant disease burden. The World Health Organization (WHO) recently published guidelines for the regulation of environmental noise based on a review of evidence published up to the year 2015 on the effects of environmental noise on sleep.

OBJECTIVES

This systematic review and meta-analysis will update the WHO evidence review on the effects of environmental noise on sleep disturbance to include more recent studies.

METHODS

Investigations of self-reported sleep among residents exposed to environmental traffic noise at home were identified using Scopus, PubMed, Embase, and PsycINFO. Awakenings, falling asleep, and sleep disturbance were the three outcomes included. Extracted data were used to derive exposure-response relationships for the probability of being highly sleep disturbed by nighttime noise [average outdoor A-weighted noise level (Lnight) 2300-0700 hours] for aircraft, road, and rail traffic noise, individually. The overall quality of evidence was assessed using Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria.

RESULTS

Eleven studies (n=109,070 responses) were included in addition to 25 studies (n=64,090 responses) from the original WHO analysis. When sleep disturbance questions specifically mentioned noise as the source of disturbance, there was moderate quality of evidence for the probability of being highly sleep disturbed per 10-dB increase in Lnight for aircraft [odds ratio (OR)=2.18; 95% confidence interval (CI): 2.01, 2.36], road (OR=2.52; 95% CI: 2.28, 2.79), and railway (OR=2.97; 95% CI: 2.57, 3.43) noise. When noise was not mentioned, there was low to very low quality of evidence for being sleep disturbed per 10-dB increase in Lnight for aircraft (OR=1.52; 95% CI: 1.20, 1.93), road (OR=1.14; 95% CI: 1.08, 1.21), and railway (OR=1.17; 95% CI: 0.91, 1.49) noise. Compared with the original WHO review, the exposure-response relationships closely agreed at low (40 dB Lnight) levels for all traffic types but indicated greater disturbance by aircraft traffic at high noise levels. Sleep disturbance was not significantly different between European and non-European studies.

DISCUSSION

Available evidence suggests that transportation noise is negatively associated with self-reported sleep. Sleep disturbance in this updated meta-analysis was comparable to the original WHO review at low nighttime noise levels. These low levels correspond to the recent WHO noise limit recommendations for nighttime noise, and so these findings do not suggest these WHO recommendations need revisiting. Deviations from the WHO review in this updated analysis suggest that populations exposed to high levels of aircraft noise may be at greater risk of sleep disturbance than determined previously. https://doi.org/10.1289/EHP10197.

A controlled chamber study of effects of exposure to diesel exhaust particles and noise on heart rate variability and endothelial function

BACKGROUND

Adverse cardiovascular effects are associated with both diesel exhaust and road traffic noise, but these exposures are hard to disentangle epidemiologically. We used an experimental setup to evaluate the impact of diesel exhaust particles and traffic noise, alone and combined, on intermediary outcomes related to the autonomic nervous system and increased cardiovascular risk.

METHODS

In a controlled chamber 18 healthy adults were exposed to four scenarios in a randomized cross-over fashion. Each exposure scenario consisted of either filtered (clean) air or diesel engine exhaust (particle mass concentrations around 300 µg/m³), and either low (46 dB(A)) or high (75 dB(A)) levels of traffic noise for 3 h at rest. ECG was recorded for 10-min periods before and during each exposure type, and frequency-domain heart rate variability (HRV) computed. Endothelial dysfunction and arterial stiffness were assessed after each exposure using EndoPAT 2000.

RESULTS

Compared to control exposure, HRV in the high frequency band decreased during exposure to diesel exhaust, both alone and combined with noise, but not during noise exposure only. These differences were more pronounced in women. We observed no synergistic effects of combined exposure, and no significant differences between exposure scenarios for other HRV indices, endothelial function or arterial stiffness.

CONCLUSION

Three-hour exposure to diesel exhaust, but not noise, was associated with decreased HRV in the high frequency band. This indicates activation of irritant receptor-mediated autonomic reflexes, a possible mechanism for the cardiovascular risks of diesel exposure. There was no effect on endothelial dysfunction or arterial stiffness after exposure.

Associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents

BACKGROUND

Epidemiologic evidence linking environmental noise to obesity and hypertension remains scarce, especially in children, and the results remain inconclusive. This study aims to examine the cross-sectional associations of self-reported residential noise exposure with obesity and hypertension in children and adolescents.

METHODS

As an ongoing study, a representative sample of the children aged 6-9 years in Chongqing were selected in 2014. In 2019, self-reported residential noise (answer categories: "very quiet," "moderately quiet," "slightly quiet," and "not at all quiet") data were collected, and 3,412 participants with completed data were included in the analyses.

RESULTS

Participants living in a quieter area had a significantly lower risk of obesity than those living in a noisy area (very quiet: OR = 0.50, 95%CI: 0.29-0.88, P = 0.015; moderately quiet: OR = 0.61, 95%CI: 0.36-1.02, P = 0.059). Similar associations were observed for abdominal obesity, although did not reach statistical significance. Consistently, residential noise exposure was significantly associated with body mass index (BMI) and waist-to-height ratio. Self-reported residential noise exposure was positively associated with systolic blood pressure (β = -1.808; 95%CI = -3.495, -0.110; P = 0.037). When sleep quality, study stress, BMI, and vegetable/fruits consumption were further adjusted, all effect estimates decreased, and no statistical association was observed between noise exposure and blood pressure. Furthermore, we found that the mediating effects of obesity on the associations of self-reported residential noise exposure with hypertension were 6.8% (% of total effect mediated = 0.068, 95%CI: -2.58, 3.99), although did not reach statistical significance.

CONCLUSIONS

Self-reported residential noise exposure was associated with a higher risk of obesity or abdominal obesity. Also, self-reported residential noise exposure was positively associated with hypertension, and obesity may partially mediate this association, but did not reach statistical significance.

Association between occupational or environmental noise exposure and renal function among middle-aged and older Korean adults: a cross-sectional study

Exposure to occupational and environmental noise is closely linked to various auditory system diseases. Few studies have focused on the effect of noise exposure on the extra auditory system, especially the urinary system. We analyzed 17,154 participants aged 40–79 years from the Korea National Health and Nutrition Examination Survey between 2013 and 2018. A self-reported questionnaire was used to assess occupational or environmental noise exposure. Logistic regression was used to determine the differences in the prevalence of chronic kidney disease (CKD) based on noise exposure characteristics. For participants with noise exposure, linear regression was performed to determine relationship of the noise exposure period and estimated glomerular filtration rate (eGFR). In the noise exposure group, a higher CKD prevalence was associated with females who experienced long-term occupational noise (≥ 240 months) (adjusted OR 2.72, 95% CI 1.11–6.66). An increase of one month of occupational noise exposure was associated with a 0.0106 mL/min/1.73 m² decrease in eGFR in females aged < 60 years. Overall, noise exposure may be a risk factor for reduced renal function, especially long-term occupational noise exposure. More precise studies should determine (1) the relationship between noise and renal function and (2) the underlying mechanisms.

Urban Noise Exposure and Cardiometabolic Diseases: An Exploratory Cross-Sectional Study in Lisbon

Introduction: Urban noise pollution has been associated with an increased risk of developing metabolic syndrome. Nevertheless, existing observational studies relating to noise exposure and metabolic syndrome are based on non-generalizable cohorts. Lisbon remains a noisy city where this association has not been evaluated, and for this reason, we studied the relationship between exposure to urban noise and the prevalence of type 2 diabetes mellitus, obesity, and hypertension. Methods: Diurnal, evening and nocturnal noise emission levels were obtained for each street in the city from the Lisbon noise map. After allocation of all roads to the respective parish of Lisbon, the noise emission for each parish was averaged for each day period. The number of adult patients with type 2 diabetes mellitus, obesity and hypertension in 2014, 2015 and 2016 in each parish of Lisbon was obtained from the Regional Health Administration of Lisbon and Tagus Valley. Prevalence as a percentage of the population was determined using the number of residents in each parish determined in the 2011 population census. Spearman’s non-parametric correlation coefficient was used due to the non-normal distribution of the variables, at the 5% significance level (α = 0.05). Results: No correlations were found between daytime, afternoon or night-time noise exposure and the prevalence of type 2 diabetes mellitus, obesity or hypertension, although correlations were found between the cardiometabolic variables. Nevertheless, noise levels in Lisbon were above the legally established limit and the World Health Organization guidelines for environmental noise exposure in the European region. Conclusion: Our results do not agree with previous studies and should be faced as preliminary due to a strong biological plausibility for an association between noise exposure and cardiometabolic diseases and to encourage further studies, with longitudinal cohorts.

Assessing community noise annoyance: A review of two decades of the international technical specification ISO/TS 15666:2003

The robust assessment of noise annoyance is of key importance given that it is the most prevalent community response in populations exposed to environmental noise. In 1993, the International Commission on Biological Effects of Noise Community Response to Noise team began formalizing a standardized methodology for assessing noise annoyance which resulted in reporting guidelines and recommendations later published as a Technical Specification (TS) in 2003 by the International Standards Organization (ISO) [(2003). ISO/TS 15666]. This TS, intended to inform the international community on the quantification of the exposure-response relationship between noise exposure and annoyance, has been in circulation for nearly two decades and was updated in 2021 by ISO [(2021). ISO/TS 15666] by an international working group (ISO TC43/SC1/WG62). This paper reviews use of the 2003 TS, identifies common adaptations in use, and summarizes the revisions. Methodological issues arising from the use of the 5-point verbal and the 11-point numeric scale questions and the scoring of "highly annoyed" are discussed. The revisions are designed to encourage further standardization in noise annoyance research. The paper highlights research needs that, if addressed, would strengthen the methodology underlying the assessment of noise annoyance including multidimensional assessments of annoyance.

Representative Exposure-Annoyance Relationships Due to Transportation Noises in Japan

This paper focuses on clarifying the relationship between noise exposure and the prevalence of highly annoyed people due to transportation noise in Japan. The authors accumulated 34 datasets, which were provided by Socio-Acoustic Survey Data Archive and derived from the other surveys conducted in Japan. All the datasets include the following micro-data: demographic factors, exposure, and annoyance data associated with specific noise sources. We performed secondary analyses using micro-data and established the relationships between noise exposure (L_den) and the percentage of highly annoyed people (%HA) for the following noise source: road traffic, conventional railway, Shinkansen railway, civil aircraft, and military aircraft noises. Among the five transportation noises, %HA for the military aircraft noise is the highest, followed by civil aircraft noise and Shinkansen railway noise. The %HA for conventional railway noise was higher than that for road traffic noise. To validate the representativeness of the exposure–response curves, we have discussed factors affecting the difference in annoyance. In addition, comparing the Japanese relationship with that shown in the “Environmental Noise Guidelines for the European Region,” we revealed that Japanese annoyance is higher than the WHO-reported annoyance.

Sex/Gender-Differences in the Health Effects of Environmental Noise Exposure on Hypertension and Ischemic Heart Disease-A Systematic Review

Previous studies have demonstrated cardiovascular health effects of environmental noise exposure, partly showing different effect estimates for males and females. This cannot be explained by biological differences between males and females alone. It is assumed that health outcomes and exposure patterns also depend on gender, determined by social, economic, and cultural factors in society. This systematic review evaluated the current state of how sex/gender is integrated in studies on environmental noise associated with hypertension, blood pressure, and ischemic heart diseases. A systematic literature search was conducted in three different databases, identifying thirty studies published between 1 January 2000 and 2 February 2020. Effects varied, with no consistent findings for both males and females. All studies used a binary operationalization of sex/gender, assuming static differences between males and females. The differentiation between biological and social dimensions of sex/gender was not present in any of the studies and the terms “sex” and “gender” were used interchangeably. However, biological and social dimensions of sex/gender were unconsciously taken up in the discussion of the results. Integrating sex/gender-theoretical concepts into future studies offers great potential to increase the validity of research findings, thus making them more useful for prevention efforts, health promotion, and health care.

Transportation noise pollution and cardiovascular disease

Epidemiological studies have found that transportation noise increases the risk of cardiovascular morbidity and mortality, with high-quality evidence for ischaemic heart disease. According to the WHO, ≥1.6 million healthy life-years are lost annually from traffic-related noise in Western Europe. Traffic noise at night causes fragmentation and shortening of sleep, elevation of stress hormone levels, and increased oxidative stress in the vasculature and the brain. These factors can promote vascular dysfunction, inflammation and hypertension, thereby elevating the risk of cardiovascular disease. In this Review, we focus on the indirect, non-auditory cardiovascular health effects of transportation noise. We provide an updated overview of epidemiological research on the effects of transportation noise on cardiovascular risk factors and disease, discuss the mechanistic insights from the latest clinical and experimental studies, and propose new risk markers to address noise-induced cardiovascular effects in the general population. We also explain, in detail, the potential effects of noise on alterations of gene networks, epigenetic pathways, gut microbiota, circadian rhythm, signal transduction along the neuronal-cardiovascular axis, oxidative stress, inflammation and metabolism. Lastly, we describe current and future noise-mitigation strategies and evaluate the status of the existing evidence on noise as a cardiovascular risk factor.

Health Effects Related to Wind Turbine Sound: An Update

Commissioned by the Swiss Federal Office for the Environment, an update of an earlier narrative review was prepared for the literature published between 2017 and mid-2020 about the effects of wind turbine sound on the health of local residents. Specific attention was hereby given to the health effects of low-frequency sound and infrasound. The Netherlands Institute for Public Health and the Environment and Mundonovo sound research collected the scientific literature on the effect of wind turbines on annoyance, sleep disturbance, cardiovascular disease, and metabolic effects, as well as mental and cognitive impacts. It also investigated what is known about annoyance from visual aspects of wind turbines and other non-acoustic factors, such as the local decision-making process. From the literature study, annoyance again came forward as the most important consequence of sound: the louder the sound (in dB) of wind turbines, the stronger the annoyance response was. The literature did not show that "low-frequency sound" (sound with a low pitch) results in extra annoyance on top of normal sound. Results of scientific research for other health effects are either not available or inconsistent, and we can conclude that a clear association with wind turbine related sound levels cannot be confirmed. There is evidence that long-term effects are related to the annoyance people experience. These results confirm earlier conclusions. There is increasing evidence that annoyance is lower when people can participate in the siting process. Worries of residents should be addressed in an early stage, by involving them in the process of planning and decision making.

Selected Approaches to the Assessment of Environmental Noise from Railways in Urban Areas

Rail transport is the second most important way of transporting people and freights by land in the European Union. Rail noise affects around 12 million people in the European Union during the day and around 9 million at night. There are two possible ways to assess environmental noise: noise measurement in situ and prediction using mathematical models. The aim of the work is based on the performed measurements and selected noise predictions to evaluate the accuracy of the prediction models and assess their sensitivity to various aspects. Two measuring points in the Banská Bystrica Self-Governing Region, within Slovakia, were selected for measurement, which is characterized by increased mobility of the population. For prediction, the two methodologies were selected (Schall 03 and Methodical instructions for the calculation of sound pressure level from transport). The results show that the Schall 03 method is sensitive to the measurement location (the value reaches half of the significance level) and to the location–period interaction. The second prediction method is sensitive to systematic error (absolute term) and, such as Schall 03, to the location–period interaction. This method systematically overestimates the results. Results showed greater accuracy of both prediction models compared to the measured noise values than the results of the authors in other countries and conditions.

Associations of long-term exposure to environmental noise and outdoor light at night with age at natural menopause in a US women cohort

Previous studies have suggested noise, especially at night time, and light at night (LAN) could cause neuroendocrine disturbance and circadian disruption, which may lead to ovarian follicle atresia and earlier onset of menopause. However, no study to date has directly investigated the associations of exposure to these factors and menopausal age.

Methods

Premenopausal women from the Nurses' Health Study II (NHS II) were followed from age 40 through 2015. Median daytime and nighttime anthropogenic noise and outdoor LAN exposure were measured from a geospatial prediction model and satellite images, respectively, at residential addresses throughout the follow-up. Time-varying Cox proportional hazard models were used to calculate the hazard ratios and 95% confidence intervals, adjusting for individual lifestyle, reproductive history, and neighborhood socioeconomic factors. Possible effect modification by region, smoking status, body mass index, race/ethnicity, history of rotating shift work, and census tract population density and median income was examined.

Results

A total of 63,380 of 105,326 women self-reported natural menopause during 1,043,298 person-years of follow-up. No associations were found for noise (both daytime and nighttime) and outdoor LAN exposure with age at natural menopause (hazard ratios = 0.99-1.00) in the fully adjusted models. Sensitivity analyses showed similar null associations. No meaningful effect modification was found for region, smoking status, body mass index, race/ethnicity, history of rotating shift work, and census tract socioeconomic measures in stratified analyses.

Conclusion

No associations were found between environmental noise and outdoor LAN exposure in mid-adulthood and menopausal age in this cohort of US women.

Are occupational and environmental noises associated with periodontitis? Evidence from a Korean representative cross-sectional study

BACKGROUND

Evidences have shown that noise could be a risk factor for cardiovascular and metabolic diseases. Since periodontitis and CVD are characterized by inflammation, it is reasonable to doubt that occupational/environmental noise is a risk factor for periodontitis. The aim of this study was to examine the relationship between occupational/environmental noise and periodontitis in a nationally representative sample of Korean adults.

METHODS

This cross-sectional study used data from the 7th Korean National Health and Nutrition Examination Survey. The study sample included 8327 adults aged 40 to 80 years old. Noise exposure and the duration of the exposure were assessed with self-report questionnaires. The dependent variable was periodontitis. Age, gender, place of residence, income, marital status, smoking, frequency of daily tooth brushing, recent dental checkup, and diabetes were included as covariates. Logistic regression analyses estimated the association between noise exposure and periodontitis.

RESULTS

Those who were exposed to environmental noise during their lifetime had an increased prevalence of severe periodontitis (odds ratio [OR] 1.88; 95% confidence interval [CI] 1.05 to 3.40), and this association was strengthened as the duration of the environmental noise exposure was longer (OR of > 120 months 2.35 and OR of ≤120 months 1.49). There was a combined relationship for severe periodontitis between occupational and environmental noise exposure (OR of both exposures 2.62, OR of occupational exposure only 1.12, and OR of environmental exposure only 1.57).

CONCLUSION

Our study shows that noise exposure is associated with periodontitis, and the association was higher in the synergism between occupational and environmental interaction.

Updated Review of the Acoustic Modulation of Sleep: Current Perspectives and Emerging Concepts

With growing interest in the use of acoustic stimuli in sleep research and acoustic interventions used therapeutically for sleep enhancement, there is a need for an overview of the current lines of research. This paper summarizes the various ways to use acoustic input before sleep or stimulation during sleep. It thereby focuses on the respective methodological requirements, advantages, disadvantages, potentials and difficulties of acoustic sleep modulation. It highlights differences in subjective and objective outcome measures, immediate and whole night effects and short versus long term effects. This recognizes the fact that not all outcome parameters are relevant in every research field. The same applies to conclusions drawn from other outcome dimensions, consideration of mediating factors, levels of stimulation processing and the impact of inter-individual differences. In addition to the deliberate influences of acoustic input on sleep, one paragraph describes adverse environmental acoustic influences. Finally, the possibilities for clinical and basic research-related applications are discussed, and emerging opportunities are presented. This overview is not a systematic review but aims to present the current perspective and hence summarizes the most up-to-date research results and reviews. This is the first review providing a summary of the broad spectrum of possibilities to acoustically influence sleep.

Parameters Affecting Noise Emitted by Ships Moving in Port Areas

Only recently has noise been considered in the assessment of the sustainability of port infrastructures, after decades of unawareness. INTERREG Maritime projects unveiled problems that have been neglected so far, such as the lack of proper regulation and noise exposure assessments for citizens. While it is true that a port area includes a huge variety of possible noise sources, very few of them have been characterized from an acoustical point of view. INTERREG projects have boosted research in the field, and previous studies have dealt with noise produced by moving ships in ports. The present work starts from a previous measurement campaign used to obtain broadband and 1/3-octave-band noise emissions of moving ships, and it aims to explain their uncertainties. More than a month’s worth of continuous acoustic measurements and video recordings were deeply analyzed in order to obtain an input database that is as precise as possible. A multiple regression analysis was performed in order to understand the influence that parameters such as minimum distance, speed, and draught have on ships’ noise emissions, which were calculated using pass-by measurements, with a special focus on ferries. The minimum distance of each ship’s passage from the microphone was measured using a video recording with an innovative methodology, providing results with 3 m of uncertainty. Knowing which parameter is more influential would help in planning proper measurements for monitoring or for drafting correct guidelines. Draught was determined to be uninfluential in ferries’ noise emissions, while the minimum distance and speed relations were estimated and accounted for in the calculation of a refined sound power level. From a spectrum point of view, the frequencies from 500 Hz to 2.5 kHz were determined to be those that contributed the most to the noise produced by the transit of a ship, and they vary with speed. With the studied corrections, different ferry models resulted in similar noise emissions. The standard deviation of noise emitted was reduced by 0.5 dB (A), and the average was also improved by positioning the ships’ flow at the correct average minimum distance. Furthermore, the right placement of a source is also important in the acoustic mapping phase for a correct evaluation of the propagation of noise at a distance. The use of more precise input data is important for improving the output of acoustic propagation models during the assessment of port noise in the surrounding areas.