Noise levels link to increased incidence of atrial fibrillation

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AtrialFibrillationWith an increasing level of noise, the incidence of atrial fibrillation also increases dramatically. Scientists from the department of cardiology at the Mainz University Medical Centre were able to prove this with data from the Gutenberg Health Study (GHS). They found that the incidence of atrial fibrillation in subjects with extreme noise annoyance reactions increases to 23%, compared to just 15% without this environmental impact. Looking at the proportion of sources of extreme noise pollution, aircraft noise came first with 84% during the day and 69% during sleep.

Noise annoyance is a very important indicator in order to decide which noise levels may be considered significant or unacceptable and may be even harmful for our health. Anger, disturbed sleep, exhaustion, and stress symptoms due to noise permanently impair wellbeing, health, and the quality of life. “We have already been able to prove the connection between noise and vascular disease in several studies in healthy volunteers and patients with established coronary artery disease as well as in in preclinical studies.

To date, there has been no explicit study being published which addresses to what extent noise annoyance can cause cardiac arrhythmia,” emphasised Professor Thomas Münzel, director of cardiology I at the department of cardiology at the Mainz University Medical Centre and senior author of the study.

The effects of noise pollution have been a subject of research within the framework of the GHS. The GHS is one of the world’s largest studies of its kind, including more than 15,000 men and women aged 35 to 74 from the state capital of Rhineland-Palatinate and the district of Mainz-Bingen.

The researchers investigated the relationship between different noise sources during the day and at night during sleep and the most common arrhythmia in the general population (atrial fibrillation). The study found that increasing annoyance is associated with a significant increase in the frequency of atrial fibrillation. This grew up to 23% in subjects experiencing extreme noise annoyance, while only 15% experienced no noise annoyance at all. In this context, it has been shown that aircraft noise accounts for the largest share of extreme noise pollution: 84% during the day and 69% during sleep. The aircraft noise annoyance affected 60% of the population, more than every second in the Mainz-Bingen region. Thus, it clearly outperformed other noise sources such as road, rail, or neighbourhood noise.

“The study shows for the first time that noise annoyance caused by various noise sources during the day and night is associated with an increased risk of atrial fibrillation,” concluded study leader Omar Hahad, research associate at the department cardiology, cardiology I. “Overall, we were able to demonstrate a stronger influence of annoyance caused by nocturnal noise on the heart rhythm.”

The study leaders, however, point out that noise annoyance was measured, not physical noise. Since this is a cross-sectional study, no statements can be made with respect to a causal relationship.

Participants in the GHS study were asked to rate how much they had been harassed in recent years by road, rail, construction, trade, neighbourhood noise and aircraft noise, both day and night. Noise annoyance was recorded using internationally accepted, standardised questionnaires. Atrial fibrillation was diagnosed on the basis of the medical history (anamnestic) and / or on the study ECG.

“The relationship between noise annoyance and atrial fibrillation is an important finding that may also explain why noise can lead to more strokes. However, one must not forget that noise also leads to damage to health without the need for an anger reaction,” said Münzel.

In addition, the impact of the night-time ban introduced by Frankfurt am Main Airport (11pm to 5am) in October 2011 on the aircraft noise reported by the participants was examined. “Interestingly, there was a significant increase in aircraft noise after the introduction of the no-fly ban, both during the day and at night,” commented Münzel.

“This could be due to the fact that in spite of the ban on night flights altogether the number of flight movements has not decreased and the flight movements have been concentrated more in the marginal hours of 10pm to 11pm and 5am to 6am”. The authors conclude that, for example, the total ban on scheduled aircraft movements at the Frankfurt Airport has to be expanded from 11pm to 5am to 10pm to 6am, in accordance with the definition of night-time in Germany.

Background: Annoyance is a common reaction in populations exposed to environmental noise and is associated with cardiovascular diseases. We investigated for the first time the existence of an association between noise annoyance and atrial fibrillation (AF).
Methods and results: Cross-sectional data from 14,639 participants of the Gutenberg Health Study were collected between 2007 and 2012. Annoyance from road traffic, aircraft, railways, industrial/construction and neighbourhood noise during daytime and sleep were collected from all participants through questionnaires using a 5-point scale. AF was assessed via self-reported medical history and/or documentation of AF on the study electrocardiogram. 80% of the study participants were annoyed by noise to a certain degree. The major sources of annoyance during daytime and sleep were aircraft, road traffic and neighbourhood noise. We found significant associations between annoyance (per point increase) and AF for aircraft noise annoyance during daytime (odds ratio (OR) 1.04; 95% confidence interval (CI) 1.00–1.08) and during sleep (OR 1.09; 95% CI 1.05–1.13), road traffic noise annoyance during sleep (OR 1.15; 95% CI 1.08–1.22), neighbourhood noise annoyance during daytime (OR 1.14; 95% CI 1.09–1.20) and during sleep (OR 1.14; 95% CI 1.07–1.21), industrial noise annoyance during daytime (OR 1.11; 95% CI 1.04–1.18) and railway noise annoyance during sleep (OR 1.13; 95% CI 1.04–1.22). Different degrees of annoyance were not associated with changes in cardiovascular risk factors.
Discussion: The results suggest for the first time that noise annoyance is associated with AF. Further studies are warranted to gain insight in the mechanisms underlying the noise-annoyance-disease relationship.

Omar Hahad, Manfred Beutel, Tommaso Gori, Andreas Schulz, Maria Blettner, Norbert Pfeiffer, Thomas Rostock, Karl Lackner, Mette Sørensen, Jürgen H Prochaska, Philipp S Wild, Thomas Münzel

Johannes Gutenburg Universitat Mainz material
International Journal of Cardiology abstract

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