Orfeu M. Buxton, PhD; Jeffrey M. Ellenbogen, MD; Wei Wang, PhD; Andy Carballeira, BM; Shawn O'Connor, BS; Dan Cooper, BS; Ankit J. Gordhandas, SB; Scott M. McKinney, BA; Jo M. Solet, PhD
Acknowledgment: The authors thank Jenny Lai Olsen, Margaret Merlino, Karen Gannon, Leah Rondon, Vanessa Castro, Carolina Smales, Deirdre McLaren, and James Porter for technical assistance; Peg Toro, audiologist, for consultation on screening for normal hearing; and Drs. Dean M. Hashimoto, John W. Cronin, and Matt Travis Bianchi for helpful comments on the manuscript.
Grant Support: This study was funded by investigator-initiated grants (Dr. Solet) from the Academy of Architecture for Health, the Facilities Guidelines Institute, and The Center for Health Design. Sleep laboratory work was completed through the generosity of Massachusetts General Hospital and with acoustic consultation by Cavanaugh Tocci Associates.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1159.
Reproducible Research Statement:Study protocol, data set, and statistical code: Available from Dr. Buxton (e-mail, orfeu_buxton@hms.harvard.edu). Execution of a materials transfer agreement is required for the transfer of data.
Requests for Single Reprints: Orfeu M. Buxton, PhD, 221 Longwood Avenue, BLI438-K, Boston, MA 02115; e-mail, orfeu_buxton@hms.harvard.edu.
Current Author Addresses: Dr. Buxton: 221 Longwood Avenue, BLI438-K, Boston, MA 02115.
Dr. Ellenbogen: Wang ACC 720, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114.
Dr. Wang: 221 Longwood Avenue, BLI438-M, Boston, MA 02115.
Mr. Carballeira: 10 Upton Street, Cambridge, MA 02139.
Mr. O'Connor: 3535 Market Street, Room 1514, Philadelphia, PA 19104.
Mr. Cooper: 221 Longwood Avenue, BLI2-230, Boston, MA 02115.
Mr. Gordhandas: 15 Parkman Street, WACC 7, Boston, MA 02114.
Mr. McKinney: ICME, Suite 053B, Huang Engineering Center, 475 Via Ortega, Stanford, CA 94305.
Dr. Solet: 15 Berkeley Street, Cambridge, MA 02138.
Author Contributions: Conception and design: O.M. Buxton, A. Carballeira, J.M. Solet.
Analysis and interpretation of the data: O.M. Buxton, J.M. Ellenbogen, W. Wang, A. Carballeira, A. Gordhandas, S.M. McKinney, J.M. Solet.
Drafting of the article: O.M. Buxton, J.M. Ellenbogen, S. O'Connor, D. Cooper, S.M. McKinney, J.M. Solet.
Critical revision of the article for important intellectual content: O.M. Buxton, J.M. Ellenbogen, A. Carballeira, S. O'Connor, D. Cooper, J.M. Solet.
Final approval of the article: O.M. Buxton, A. Carballeira, S. O'Connor, D. Cooper, A. Gordhandas, J.M. Solet.
Provision of study materials or patients: O.M. Buxton, J.M. Ellenbogen, D. Cooper, J.M. Solet.
Statistical expertise: W. Wang.
Obtaining of funding: O.M. Buxton, J.M. Ellenbogen, J.M. Solet.
Administrative, technical, or logistical support: O.M. Buxton, J.M. Ellenbogen, A. Carballeira, S. O'Connor, J.M. Solet.
Collection and assembly of data: O.M. Buxton, J.M. Ellenbogen, A. Carballeira, S. O'Connor, D. Cooper, J.M. Solet.
Sleep plays a critical role in maintaining health and well-being; however, patients who are hospitalized are frequently exposed to noise that can disrupt sleep. Efforts to attenuate hospital noise have been limited by incomplete information on the interaction between sounds and sleep physiology.
To determine profiles of acoustic disruption of sleep by examining the cortical (encephalographic) arousal responses during sleep to typical hospital noises by sound level and type and sleep stage.
3-day polysomnographic study.
Sound-attenuated sleep laboratory.
Volunteer sample of 12 healthy participants.
Baseline (sham) night followed by 2 intervention nights with controlled presentation of 14 sounds that are common in hospitals (for example, voice, intravenous alarm, phone, ice machine, outside traffic, and helicopter). The sounds were administered at calibrated, increasing decibel levels (40 to 70 dBA [decibels, adjusted for the range of normal hearing]) during specific sleep stages.
Encephalographic arousals, by using established criteria, during rapid eye movement (REM) sleep and non-REM (NREM) sleep stages 2 and 3.
Sound presentations yielded arousal response curves that varied because of sound level and type and sleep stage. Electronic sounds were more arousing than other sounds, including human voices, and there were large differences in responses by sound type. As expected, sounds in NREM stage 3 were less likely to cause arousals than sounds in NREM stage 2; unexpectedly, the probability of arousal to sounds presented in REM sleep varied less by sound type than when presented in NREM sleep and caused a greater and more sustained elevation of instantaneous heart rate.
The study included only 12 participants. Results for these healthy persons may underestimate the effects of noise on sleep in patients who are hospitalized.
Sounds during sleep influence both cortical brain activity and cardiovascular function. This study systematically quantifies the disruptive capacity of a range of hospital sounds on sleep, providing evidence that is essential to improving the acoustic environments of new and existing health care facilities to enable the highest quality of care.
Academy of Architecture for Health, Facilities Guidelines Institute, and The Center for Health Design.
Buxton OM, Ellenbogen JM, Wang W, Carballeira A, O'Connor S, Cooper D, et al. Sleep Disruption due to Hospital Noises: A Prospective Evaluation. Ann Intern Med. ;157:170–179. doi: 10.7326/0003-4819-156-12-201208070-00472
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© 2018
Published: Ann Intern Med. 2012;157(3):170-179.
DOI: 10.7326/0003-4819-156-12-201208070-00472
Hospital Medicine, Pulmonary/Critical Care, Sleep Disorders.
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