This paper summarizes the findings from the past 3 year's research on the effects of environmental noise on sleep and identifies key future research goals. The past 3 years have seen continued interest in both short term effects of noise on sleep (arousals, awakenings), as well as epidemiological studies focusing on long term health impacts of nocturnal noise exposure. This research corroborated findings that noise events induce arousals at relatively low exposure levels, and independent of the noise source (air, road, and rail traffic, neighbors, church bells) and the environment (home, laboratory, hospital). New epidemiological studies support already existing evidence that night-time noise is likely associated with cardiovascular disease and stroke in the elderly. These studies collectively also suggest that nocturnal noise exposure may be more relevant for the genesis of cardiovascular disease than daytime noise exposure. Relative to noise policy, new effect-oriented noise protection concepts, and rating methods based on limiting awakening reactions were introduced. The publications of WHO's ''Night Noise Guidelines for Europe'' and ''Burden of Disease from Environmental Noise'' both stress the importance of nocturnal noise exposure for health and well-being. However, studies demonstrating a causal pathway that directly link noise (at ecological levels) and disturbed sleep with cardiovascular disease and/or other long term health outcomes are still missing. These studies, as well as the quantification of the impact of emerging noise sources (e.g., high speed rail, wind turbines) have been identified as the most relevant issues that should be addressed in the field on the effects of noise on sleep in the near future.

SUMMARYThe sleep of 52 healthy paid subjects (23 male) divided into three age-bands (20-34, 35-49 and 50-70 y) were recorded at night in their homes for a total of 190 subjectnights while following their normal daily activities and habitual sleep-wake schedule.There was a shortening in both nocturnal total sleep period and total sleep time (TST) with age, the oldest group sleeping 46 min less than the youngest. Also, the mid-point of sleep occurred 32 min earlier in the oldest group compared with the youngest group. The reduction in TST with age was due, in part, to increased wake periods within sleep. The youngest subjects showed more Movement Time which progressively decreased with age while the amount of stage 1 increased with age. The amount of slow-wave sleep (SWS, stages 3+4) was reduced, stage 4 was more than halved, while REM was slightly reduced with age. There were far fewer significant gender differences in the sleep variables: males, particularly in the middle and oldest age bands, had more stage 1 than females, while females had more SWS, particularly stage 3, than males. In general, despite relatively limited subject selection criteria, there was good agreement with previous laboratory-based normative sleep values for the effect of age and gender.

It is common knowledge that our feelings of alertness or drowsiness vary throughout the day. Indeed, this diurnal variation is so widely accepted that it has been used to validate the drowsy/alert component of activation obtained from mood adjective checklists. There is, however, some evidence from sleep deprivation and shiftwork studies that this variation is not simply a reflection of our sleep/wake cycle, as might be expected, but is at least partially dependent on an endogenous circadian (approximately 24 h) oscillator such as that proposed to account for the circadian rhythm in body temperature and other physiological variables. Here we have tested this suggestion by separating the body-temperature rhythm from the sleep/wake cycle by progressively shortening artificial time cues (zeitgebers). Our results indicate that the circadian rhythm in alertness can become independent of both the sleep/wake cycle and the rhythm in body temperature. Further, and contrary to our expectations, the results suggest that the sleep/wake cycle exerts less influence on the alertness rhythm than it does on that of temperature.

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Accurate assessment strategies underpin appropriate implementation and review of surgical and therapeutic intervention. This paper explores some of the commonly described assessment methods used following hand injury, including measures of range of motion (ROM), strength, sensation, hand function and patient self-evaluation. The strengths and limitations of some methods are discussed. It is suggested that accurate assessment tools and standardised approaches to assessment will promote effective evaluation of intervention. In addition long-term review and comparative studies may be facilitated by such an approach.