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The full report is titled “Sleep Disruption due to Hospital Noises. A Prospective Evaluation.” It is in the 7 August 2012 issue of Annals of Internal Medicine (volume 157, pages 170-179). The authors are O.M. Buxton, J.M. Ellenbogen, W. Wang, A. Carballeira, S. O'Connor, D. Cooper, A.J. Gordhandas, S.M. McKinney, and J.M. Solet.
Sleep Disruption due to Hospital Noises. Ann Intern Med. 2012;157:I-32. doi: 10.7326/0003-4819-157-2-201208070-00456
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Published: Ann Intern Med. 2012;157(3):I-32.
Noise that prevents or interrupts sleep is a nearly universal complaint of patients who are hospitalized. Studies have shown that hospital noise has increased over the past few decades, in large part from an increased number of machines, such as monitors and pagers, and the urban location of many hospitals.
To understand what types and volume of sounds caused the most sleep disruption and to investigate the effects of sound according to the stage of sleep.
Twelve healthy, young adult volunteers, both men and women.
The volunteers spent 3 nights in a sleep laboratory. The first night was intended to get them used to sleeping in the laboratory, and no studies were done. On the next 2 nights, prerecorded noises from an actual hospital, including human voices, IV alarms, telephones, ice machines, outside traffic, and helicopters, were transmitted into the volunteers' rooms, and the effect of the specific type and volume of noise on their sleep was studied by using an electroencephalogram (EEG). Patient heart rates were monitored with an electrocardiogram (EKG).
As the overall level of noise increased, sleep was more likely to be disrupted. Of importance, they found that electronic sounds from medical equipment were more disruptive than the sounds of human voices or environmental sounds, such as traffic noise. When patients' sleep was disrupted, even for a few seconds, their heart rates increased. This occurred most often during rapid eye movement (REM) sleep, the lightest sleep stage.
Most patients in hospitals are much older than the patients studied and have clinically significant illness, both of which are factors already known to interfere with sleep. Thus, patients in hospitals may be more negatively affected by sound than the volunteers in this study.
Hospital noise may not only be unpleasant but disrupts sleep in ways that are considered significant, such as increasing heart rate. Efforts to reduce hospital noise may need to focus especially on the type and use of hospital machines, as well as on hospital architecture and design and policies that could reduce disruptive sounds near patients.
This article was published at www.annals.org on 12 June 2012.
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Tanu Pramanik BSc.MA(Sociology).DSc(Clin.Psychology)
Lecturer & Research supervisor,Allianze University College of Medical Sciences, 13200-Penang,Malaysia
August 12, 2012
The effects of noise on sleep and their potential harmful repercussions on cardiac patients in hospitals
The authors of the current paper (1) deserve applause for timely evaluation of the effects of sound pollution on hospitalized patients.The World Health Organization guidelines say that for a good sleep, sound level should not exceed 30 dB(A) for continuous background noise, and 45 dB(A) for individual noise events.(2) The effect of noise on sleep, however, not only depends on the acoustical parameters of noise but also on the individual as there is large variance in the experience of a person with a particular noise. Personal characteristics such as personality traits, diurnal type, age and self-estimated sensitivity to noise are important individual factors.(3)These autonomic responses to noise during sleep can be obtained for much lower peak noise intensities as during wake states. These effects, mainly involving increased heart rate and vasoconstriction, have been found to habituate over successive noise-exposed nights as opposed to long exposure times. This could indicate an effect on cardiovascular response over the long term exposure. (4)During sleep, heart rate is related to changes in the parasympathetic-sympathetic balance with an increase in sympathetic tone associated with activation and with electroencephalogram (EEG) arousal. Catecholamine levels and sympathetic activity decrease during sleep. So, as one might assume that decreased sleep is associated with increased sympathetic activity and as a result increased blood pressure and heart rate. This association has been observed not only with sleep deprivation but also with regard to sleep disruption. Brief awakenings from sleep for only a few seconds are associated with temporary elevation in blood pressure and heart rate that results from an autonomic reflex.(5)Noise that prevents or interrupts sleep is a nearly universal complaint of patients who are hospitalized (1) However, no previous record of systematic research or published report from developing countries like ours is available till date. The causal relationships between noise exposure, effects on sleep, and contribution to health disturbances, both behavioral and physical, are not firmly established yet. Therefore, we designed current research proposal with a well-defined objective to study noise induced repercussions on cardiac patients in a hospital setting. During our study, we will use EEG, EKG, polysomnogram and other monitoring systems for the patients selected under stringent criteria set by the clinical research committee and University ethical committee. Our research may reveal adequate experimental data to substantiate noise induced repercussions on cardiac patients which may enlighten hospital authorities to be more cautious to protect vulnerable patients from sound pollution.
1.Sleep Disruption due to Hospital Noises: Ann Intern Med. 7 August 2012;157(3):1-32
2. Berglund B, Lindvall T, Schwela DH. Guidelines for Community Noise. World Health Organization 1999. Available from: http://www.who.int/docstore/peh/noise/guidelines2.html . [Accessed on 2010 March 28].
3.Muzet A, Weber LD, Di Nisi J, Ehrhart J. Comparison of cardiovascular reactivity to noise during waking and sleep. National Center for Scientific Research Center for Bioclimatic studies. Convention No 82243, 1985.
4.Muzet A, Ehrhart J, Eschenlauer R, Lienhard JP. Habituation and age differences of cardiovascular responses to noise during sleep. In Sleep 1980;212-5.
5.Sforza E, Chapotot F, Lavoie S, Roche F, Pigeau R, Buguet A. Heart rate activation during spontaneous arousals from sleep: Effect of sleep deprivation. Clin Neurophysiol 2004;115:2442-51.
Hospital Medicine, Pulmonary/Critical Care, Sleep Disorders.
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