Effect of sleep disturbance on biomarkers related to the development of adverse health outcomes: A systematic review of the human literature.

Literature suggests that unrestricted and undisturbed sleep is vital for basic human function and performance; however, it is unclear as to what amount of sleep disturbance leads to dysregulation in biomarkers, which may underscore the development of adverse health effects. This systematic review aims to identify the amount of sleep disturbance that contributes to biomarker changes as a potential precursor to the development of adverse health effects. English-language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from 1 January 1980 to 31 July 2021 were searched. Where possible, random-effects meta-analyses were used to examine the effect of sleep disturbances on adverse health effects. The risk of bias of individual studies was assessed using the Cochrane Risk of Bias Tool and the Risk of Bias of Nonrandomised Studies - of Exposures instruments and the certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. The search identified 92 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, cardiac output, waist circumference, cortisol, adrenaline, noradrenaline, immune system markers, glucose, insulin, cholesterol, and triglyceride levels. Although some meta-analyses suggested there may be an association between sleep disturbances and certain outcomes, the certainty in the evidence was very low due to concerns with risk of bias, inconsistency across exposures, populations, and imprecision in the estimates of effects. Further research is needed to explore the point at which types, levels and duration of sleep disturbances may begin to increase the risk of developing adverse health outcomes to inform and tailor health interventions.

Impact of Noise Exposure on Risk of Developing Stress-Related Metabolic Effects: A Systematic Review and Meta-Analysis.

Background: Exposure to noise can increase biological stress reactions, which may increase adverse health effects, including metabolic disorders; however, the certainty in the association between exposure to noise and metabolic outcomes has not been widely explored. The objective of this review is to evaluate the evidence between noise exposures and metabolic effects. Materials and Methods: A systematic review of English and comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases between January 1, 1980 and December 29, 2021 was performed. Risk of Bias of Nonrandomized Studies of Exposures was used to assess risk of bias of individual studies and certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: Fifty-six primary studies reporting on cortisol, cholesterol levels, waist circumference, glucose levels, and adrenaline and/or noradrenaline were identified. Although meta-analyses suggested that there may be an increase in waist circumference and adrenaline with increased noise exposure, the certainty in the evidence is very low. Overall, the certainty in the evidence of an effect of increased noise on all the outcomes were low to very low due to concerns with risk of bias, inconsistency across exposure sources, populations, and studies, and imprecision in the estimates of effects. Conclusions: The certainty of the evidence of increased noise on metabolic effects was low to very low, which likely reflects the inability to compare across the totality of the evidence for each outcome. The findings from this review may be used to inform policies involving noise reduction and mitigation strategies, and to direct further research in areas that currently have limited evidence available.

Implications of the COVID-19 pandemic on self-reported health status and noise annoyance in rural and non-rural Canada.

The Canadian Perspectives on Environmental Noise Survey (CPENS), conducted between April 12th, 2021 and May 25th, 2021 coincided with the third wave of the COVID-19 pandemic. Canadians 18 years of age and older (n = 6647) reported the degree to which the pandemic affected their physical health, mental health, stress, annoyance toward environmental and indoor noise, and overall well-being. Depending on the outcome evaluated, between 18 and 67% of respondents reported the measure as "somewhat" or "much worse" due to the pandemic. Stress was most affected, followed by mental health, overall well-being, physical health, annoyance toward environmental noise and annoyance toward indoor noise. Logistic regression models indicated that province, geographic region (rural/remote, suburban, urban), age, gender, poor physical/mental health, heart disease, a history of high sleep disturbance (in general) or diagnosed sleep disorders, anxiety/depression, working/schooling from home, and being retired significantly impacted the odds of reporting a worsening by the pandemic to varying degrees and directions, depending on the outcome. Indigenous status was unrelated to any of the modelled outcomes. Future research could address some of the noted study limitations and provide the data to determine if the observations on the reported measures of health are temporary, or long-lasting.

Impact of Noise Exposure on Risk of Developing Stress-Related Health Effects Related to the Cardiovascular System: A Systematic Review and Meta-Analysis.

Background: : Exposure to acute noise can cause an increase in biological stress reactions, which provides biological plausibility for a potential association between sustained noise exposure and stress-related health effects. However, the certainty in the evidence for an association between exposures to noise on short- and long-term biomarkers of stress has not been widely explored. The objective of this review was to evaluate the strength of evidence between noise exposure and changes in the biological parameters known to contribute to the development of stress-related adverse cardiovascular responses. Materials and Methods: This systematic review comprises English language comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases from January 1, 1980 to December 29, 2021. Where possible, random-effects meta-analyses were used to examine the effect of noise exposure from various sources on stress-related cardiovascular biomarkers. The risk of bias of individual studies was assessed using the risk of bias of nonrandomized studies of exposures instrument. The certainty of the body of evidence for each outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: : The search identified 133 primary studies reporting on blood pressure, hypertension, heart rate, cardiac arrhythmia, vascular resistance, and cardiac output. Meta-analyses of blood pressure, hypertension, and heart rate suggested there may be signals of increased risk in response to a higher noise threshold or incrementally higher levels of noise. Across all outcomes, the certainty of the evidence was very low due to concerns with the risk of bias, inconsistency across exposure sources, populations, and studies and imprecision in the estimates of effects. Conclusions: : This review identifies that exposure to higher levels of noise may increase the risk of some short- and long-term cardiovascular events; however, the certainty of the evidence was very low. This likely represents the inability to compare across the totality of the evidence for each outcome, underscoring the value of continued research in this area. Findings from this review may be used to inform policies of noise reduction or mitigation interventions.

Impact of Noise Exposure on Risk of Developing Stress-Related Obstetric Health Effects: A Systematic Review and Meta-Analysis.

Background: Exposure to noise can increase biological stress reactions and that could increase the risk of stress-related prenatal effects, including adverse obstetric outcomes; however, the association between exposure to noise and adverse obstetric outcomes has not been extensively explored. The objective of this review was to evaluate the evidence between noise exposures and adverse obstetric outcomes, specifically preeclampsia, gestational diabetes, and gestational hypertension. Materials and Methods: A systematic review of English language, comparative studies available in PubMed, Cochrane Central, EMBASE, and CINAHL databases between January 1, 1980 and December 29, 2021 was performed. Risk of bias for individual studies was assessed using the Risk of Bias Instrument for Nonrandomized Studies of Exposures, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the certainty of the body of evidence for each outcome. Results: Six studies reporting on preeclampsia, gestational diabetes, and gestational hypertension were identified. Although some studies suggested there may be signals of increased responses to increased noise exposure for preeclampsia and gestational hypertension, the certainty in the evidence of an effect of increased noise on all the outcomes was very low due to concerns with risk of bias, inconsistency across studies, and imprecision in the effect estimates. Conclusions: While the certainty of the evidence for noise exposure and adverse obstetric outcomes was very low, the findings from this review may be useful for directing further research in this area, as there is currently limited evidence available. These findings may also be useful for informing guidelines and policies involving noise exposure situations or environments.

A comparison of self-reported health status and perceptual responses toward environmental noise in rural, suburban, and urban regions in Canada.

Health Canada, in collaboration with Advanis, conducted the Canadian Perspectives on Environmental Noise Survey (CPENS) to investigate expectations and attitudes toward environmental noise in rural and non-rural Canada. The CPENS, a 26-item questionnaire, was completed online by 6647 randomly selected Canadians, age 18 y and older between April and May 2021. The prevalence of reporting their area as often or always calm, quiet, and relaxing was 76.8%, 64%, and 48.4% in rural/remote, suburban, and urban, respectively. A high expectation of quiet was less prevalent yet followed the same pattern: rural/remote (58.2%), suburban (37.4%), and urban (21.8%). Self-reported health status and noise sensitivity were unrelated to geographic region. A high magnitude of non-specific sleep disturbance over the previous 12 months was reported by 7.8% overall; highest among urban dwellers (9.8%), followed by suburban (7.2%) and rural/remote (5.5%) dwellers (p < 0.01). High annoyance toward road traffic noise was 8.5% overall, and significantly higher in urban (10.5%), relative to suburban (7.9%) and rural/remote (6.6%) areas (p < 0.0001). Annoyance toward noise from rail, aircraft, mining, industry, marine activity, construction, wind turbines, and landscaping equipment is reported. The analysis also explores potential differences between Indigenous Peoples of Canada and non-Indigenous Canadians in their attitudes and expectations toward environmental noise.

Annoyance toward landscaping equipment noise in Canada.

Noise annoyance toward landscaping equipment was one of nine sources evaluated in the Canadian Perspectives on Environmental Noise Survey, completed online by 6647 Canadian adults. At 6.3% (95% confidence interval = 5.8-6.9), landscaping equipment ranked third after road traffic and construction noise. Stepwise multivariate logistic regression modelled factors associated with annoyance. The perceived impact of the COVID-19 pandemic on outdoor noise annoyance, education level, working/attending school from home, geographic region, province, noise sensitivity, sleep disturbance, duration of residency, and perceived changes in outdoor daytime noise influenced the odds of reporting high annoyance toward landscaping equipment noise over the previous year.

Sleep actigraphy time-synchronized with wind turbine output.

Studies have yielded inconsistent evidence for an association between long-term average wind turbine sound pressure level (SPL) and disturbed sleep. Transient changes in sleep may be more susceptible to short-term variations in wind turbine SPL throughout the sleep period time. We analyzed sleep actigraphy data (participant sleep nights = 2,094, males = 151, females = 192) in 10 min intervals time-synchronized to wind turbine supervisory control and data acquisition. Calculated indoor wind turbine SPL was considered after adjusting for turbine rotor speed and closed/open bedroom windows. Maximum calculated nightly average wind turbine SPL reached 44.7 dBA (mean = 32.9, SD = 6.4) outdoors and 31.4 dBA (mean = 12.5, SD = 8.3) indoors. Wind turbine SPL in 10 min intervals, and nightly averages, was not statistically associated with actigraphy outcomes. However, the variability in wind turbine SPL due to changes in wind turbine operation across the sleep period time, as measured by the difference between the 10 min SPL and the nightly average SPL (∆SPL), was statistically related to awakenings (p = 0.028) and motility (p = 0.015) rates. These diminutive differences translate to less than 1 min of additional awake and motility time for a 5 dBA increase over a 450 min sleep period time. Overall results showed that wind turbine SPL below 45 dBA was not associated with any consequential changes in actigraphy-measured sleep. Observations based on ∆SPL provided some indication that a more sensitive assessment of sleep may be one that considers variations in wind turbine SPL throughout the sleep period time.

Wind turbine audibility calculations inside dwellings.

The objective of the current paper was to characterize indoor wind turbine sound pressure levels (SPLs) to assess the audibility of wind turbine noise indoors, accounting for window opening, frequency spectra, and presbycusis. Loudspeaker generated noise was used to determine the outdoor to indoor SPL differences at 11 representative dwellings using ISO 140-5:1998. The procedure was extended to 16 Hz. With windows closed, indoor broadband A- and C-weighted SPLs were lower by 25.9 and 15.3 dB, respectively, for wind turbine noise spectra. With windows opened, the corresponding results were 13.8 and 9.9 dB, respectively. Standard deviations for these results were 3 dB so that indoor and outdoor SPL would tend to be highly correlated. For 35 dBA outdoor SPL, the indoor SPL was potentially audible at frequencies as low as 31.5 Hz. Specifically, at 35 dBA, 80% to 100% of adults below the age of 60 years, would potentially be able to hear wind turbine noise indoors with windows partially open. This would drop to 10% to 30% with closed windows. Uncertainties around these estimates are discussed.

Wind turbine sound power measurements.

This paper provides experimental validation of the sound power level data obtained from manufacturers for the ten wind turbine models examined in Health Canada's Community Noise and Health Study (CNHS). Within measurement uncertainty, the wind turbine sound power levels measured using IEC 61400-11 [(2002). (International Electrotechnical Commission, Geneva)] were consistent with the sound power level data provided by manufacturers. Based on measurements, the sound power level data were also extended to 16 Hz for calculation of C-weighted levels. The C-weighted levels were 11.5 dB higher than the A-weighted levels (standard deviation 1.7 dB). The simple relationship between A- and C- weighted levels suggests that there is unlikely to be any statistically significant difference between analysis based on either C- or A-weighted data.

Wind turbine sound pressure level calculations at dwellings.

This paper provides calculations of outdoor sound pressure levels (SPLs) at dwellings for 10 wind turbine models, to support Health Canada's Community Noise and Health Study. Manufacturer supplied and measured wind turbine sound power levels were used to calculate outdoor SPL at 1238 dwellings using ISO [(1996). ISO 9613-2-Acoustics] and a Swedish noise propagation method. Both methods yielded statistically equivalent results. The A- and C-weighted results were highly correlated over the 1238 dwellings (Pearson's linear correlation coefficient r > 0.8). Calculated wind turbine SPLs were compared to ambient SPLs from other sources, estimated using guidance documents from the United States and Alberta, Canada.

Exposure to wind turbine noise: Perceptual responses and reported health effects.

Health Canada, in collaboration with Statistics Canada, and other external experts, conducted the Community Noise and Health Study to better understand the impacts of wind turbine noise (WTN) on health and well-being. A cross-sectional epidemiological study was carried out between May and September 2013 in southwestern Ontario and Prince Edward Island on 1238 randomly selected participants (606 males, 632 females) aged 18-79 years, living between 0.25 and 11.22 km from operational wind turbines. Calculated outdoor WTN levels at the dwelling reached 46 dBA. Response rate was 78.9% and did not significantly differ across sample strata. Self-reported health effects (e.g., migraines, tinnitus, dizziness, etc.), sleep disturbance, sleep disorders, quality of life, and perceived stress were not related to WTN levels. Visual and auditory perception of wind turbines as reported by respondents increased significantly with increasing WTN levels as did high annoyance toward several wind turbine features, including the following: noise, blinking lights, shadow flicker, visual impacts, and vibrations. Concern for physical safety and closing bedroom windows to reduce WTN during sleep also increased with increasing WTN levels. Other sample characteristics are discussed in relation to WTN levels. Beyond annoyance, results do not support an association between exposure to WTN up to 46 dBA and the evaluated health-related endpoints.

Personal and situational variables associated with wind turbine noise annoyance.

The possibility that wind turbine noise (WTN) affects human health remains controversial. The current analysis presents results related to WTN annoyance reported by randomly selected participants (606 males, 632 females), aged 18-79, living between 0.25 and 11.22 km from wind turbines. WTN levels reached 46 dB, and for each 5 dB increase in WTN levels, the odds of reporting to be either very or extremely (i.e., highly) annoyed increased by 2.60 [95% confidence interval: (1.92, 3.58), p < 0.0001]. Multiple regression models had R(2)'s up to 58%, with approximately 9% attributed to WTN level. Variables associated with WTN annoyance included, but were not limited to, other wind turbine-related annoyances, personal benefit, noise sensitivity, physical safety concerns, property ownership, and province. Annoyance was related to several reported measures of health and well-being, although these associations were statistically weak (R(2 )< 9%), independent of WTN levels, and not retained in multiple regression models. The role of community tolerance level as a complement and/or an alternative to multiple regression in predicting the prevalence of WTN annoyance is also provided. The analysis suggests that communities are between 11 and 26 dB less tolerant of WTN than of other transportation noise sources.

Self-reported and measured stress related responses associated with exposure to wind turbine noise.

The current study was the first to assess stress reactions associated with wind turbine noise (WTN) exposure using self-reported and objective measures. Randomly selected participants, aged 18-79 yr (606 males; 632 females), living between 0.25 and 11.22 km from wind turbines, were exposed to outdoor calculated WTN levels up to 46 dBA (response rate 78.9%). Multiple regression modeling left the great majority (77%-89%) of the variance in perceived stress scale (PSS) scores, hair cortisol concentrations, resting blood pressure, and heart rate unaccounted for, and WTN exposure had no apparent influence on any of these endpoints. PSS scores were positively, but weakly, related to cortisol concentrations and resting heart rate (Pearson r = 0.13 and r = 0.08, respectively). Across WTN categories, modeled mean PSS scores ranged from 13.15 to 13.84 (p = 0.8614). Modeled geometric means for hair cortisol concentrations, resting mean systolic, diastolic blood pressure, and heart rate were 150.54-191.12 ng/g (p = 0.5416), 113.38-116.82 mmHg (p = 0.4990), 67.98-70.34 mmHg (p = 0.5006), and 68.24-70.71 bpm (p = 0.5223), respectively. Irrespective of WTN levels, diastolic blood pressure appeared to be slightly (2.90 mmHg 95% CI: 0.75,5.05) higher among participants highly annoyed by blinking lights on turbines (p = 0.0081). Collectively, the findings do not support an association between exposure to WTN up to 46 dBA and elevated self-reported and objectively defined measures of stress.

Estimating annoyance to calculated wind turbine shadow flicker is improved when variables associated with wind turbine noise exposure are considered.

The Community Noise and Health Study conducted by Health Canada included randomly selected participants aged 18-79 yrs (606 males, 632 females, response rate 78.9%), living between 0.25 and 11.22 km from operational wind turbines. Annoyance to wind turbine noise (WTN) and other features, including shadow flicker (SF) was assessed. The current analysis reports on the degree to which estimating high annoyance to wind turbine shadow flicker (HAWTSF) was improved when variables known to be related to WTN exposure were also considered. As SF exposure increased [calculated as maximum minutes per day (SFm)], HAWTSF increased from 3.8% at 0 ≤ SFm < 10 to 21.1% at SFm ≥ 30, p < 0.0001. For each unit increase in SFm the odds ratio was 2.02 [95% confidence interval: (1.68,2.43)]. Stepwise regression models for HAWTSF had a predictive strength of up to 53% with 10% attributed to SFm. Variables associated with HAWTSF included, but were not limited to, annoyance to other wind turbine-related features, concern for physical safety, and noise sensitivity. Reported dizziness was also retained in the final model at p = 0.0581. Study findings add to the growing science base in this area and may be helpful in identifying factors associated with community reactions to SF exposure from wind turbines.

Effects of Wind Turbine Noise on Self-Reported and Objective Measures of Sleep.

STUDY OBJECTIVES: To investigate the association between self-reported and objective measures of sleep and wind turbine noise (WTN) exposure. METHODS: The Community Noise and Health Study, a cross-sectional epidemiological study, included an in-house computer-assisted interview and sleep pattern monitoring over a 7 d period. Outdoor WTN levels were calculated following international standards for conditions that typically approximate the highest long-term average levels at each dwelling. Study data were collected between May and September 2013 from adults, aged 18-79 y (606 males, 632 females) randomly selected from each household and living between 0.25 and 11.22 kilometers from operational wind turbines in two Canadian provinces. Self-reported sleep quality over the past 30 d was assessed using the Pittsburgh Sleep Quality Index. Additional questions assessed the prevalence of diagnosed sleep disorders and the magnitude of sleep disturbance over the previous year. Objective measures for sleep latency, sleep efficiency, total sleep time, rate of awakening bouts, and wake duration after sleep onset were recorded using the wrist worn Actiwatch2® from a subsample of 654 participants (289 males, 365 females) for a total of 3,772 sleep nights. RESULTS: Participant response rate for the interview was 78.9%. Outdoor WTN levels reached 46 dB(A) with an arithmetic mean of 35.6 and a standard deviation of 7.4. Self-reported and objectively measured sleep outcomes consistently revealed no apparent pattern or statistically significant relationship to WTN levels. However, sleep was significantly influenced by other factors, including, but not limited to, the use of sleep medication, other health conditions (including sleep disorders), caffeine consumption, and annoyance with blinking lights on wind turbines. CONCLUSIONS: Study results do not support an association between exposure to outdoor WTN up to 46 dB(A) and an increase in the prevalence of disturbed sleep. Conclusions are based on WTN levels averaged over 1 y and, in some cases, may be strengthened with an analysis that examines sleep quality in relation to WTN levels calculated during the precise sleep period time.

An assessment of quality of life using the WHOQOL-BREF among participants living in the vicinity of wind turbines.

Living within the vicinity of wind turbines may have adverse impacts on health measures associated with quality of life (QOL). There are few studies in this area and inconsistent findings preclude definitive conclusions regarding the impact that exposure to wind turbine noise (WTN) may have on QOL. In the current study (officially titled the Community Noise and Health Study or CNHS), the World Health Organization QOL-BREF (WHOQOL-BREF) questionnaire provided an evaluation of QOL in relation to WTN levels among randomly selected participants aged 18-79 (606 males, 632 females) living between 0.25 and 11.22 km from wind turbines (response rate 78.9%). In the multiple regression analyses, WTN levels were not found to be related to scores on the Physical, Psychological, Social or Environment domains, or to rated QOL and Satisfaction with Health questions. However, some wind turbine-related variables were associated with scores on the WHOQOL-BREF, irrespective of WTN levels. Hearing wind turbines for less than one year (compared to not at all and greater than one year) was associated with improved (i.e. higher) scores on the Psychological domain (p=0.0108). Lower scores on both the Physical and Environment domains (p=0.0218 and p=0.0372, respectively), were observed among participants reporting high visual annoyance toward wind turbines. Personal benefit from having wind turbines in the area was related to higher scores on the Physical domain (p=0.0417). Other variables significantly related to one or more domains, included sex, age, marital status, employment, education, income, alcohol consumption, smoking status, chronic diseases and sleep disorders. Collectively, results do not support an association between exposure to WTN up to 46 dBA and QOL assessed using the WHOQOL-BREF questionnaire.