hemodynamic and hormonal changes induced by noise

6
HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE Lennart AndrBn, Lennart Hansson, Martin Bjorkman, Anders Jonsson and Karl Olof Borg From the Department of Medicine, Ostra Hospital, Institute of Occupational Medicine, Sahlgrenska Hospital, Department of Hygiene, University of Goteborg, and Hassle AB, Goteborg, Sweden Abstract. Eighteen healthy male volunteers with normal hearing were exposed to industrial noise at different sound levels (75, 85 and 95 dB A) in a noise laboratory. Blood pressure, heart rate, stroke volume and cardiac output were recorded with non- invasive techniques. Adrenaline and noradrenaline concentration i n venous plasma were analyzed before and during noise exposure. The mean resting blood pressure of the whole group was 120/70 mm Hg. During noise stimulation diastolic blood pressure increased (12.276, p < 0.001) as did mean arterial pressure (6.6%, p< 0.001) and total peripheral resistance (12.7%, p < 0.001). Stroke volume (7.3%, p 4 0.001) and cardiac output (5.0%, p 4 0.01) were both reduced a t 95 dB A. Heart rate and systolic blood. pressure did not change significant- ly, At 75 and 85 dB A there were similar but smaller changes in the hernodynamic parameters. There were no changes in adrenaline and noradrenaline in plasma during maximal noise exposure. The noise induced hemodynamic changes remained 5 minutes after the noise stimulation was stopped but had disappeared after 10 minutes of rest. 13

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Page 1: HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE

H E M O D Y N A M I C AND HORMONAL C H A N G E S I N D U C E D B Y N O I S E

L e n n a r t AndrBn , L e n n a r t Hansson , M a r t i n B j o r k m a n ,

A n d e r s J o n s s o n and K a r l O l o f B o r g

From t h e D e p a r t m e n t o f M e d i c i n e , O s t r a H o s p i t a l ,

I n s t i t u t e o f O c c u p a t i o n a l M e d i c i n e , S a h l g r e n s k a H o s p i t a l ,

D e p a r t m e n t o f H y g i e n e , U n i v e r s i t y o f G o t e b o r g , and

H a s s l e A B , G o t e b o r g , Sweden

Abstract . Eighteen hea l thy male vo lun teers with normal hear ing

were exposed t o i n d u s t r i a l no i se a t d i f f e r e n t sound l e v e l s (75,

85 and 95 dB A) i n a no ise l abo ra to ry . Blood pressure, hea r t

r a t e , s t roke volume and ca rd iac ou tpu t were recorded with non-

i nvas i ve techniques. Adrenal ine and noradrena l ine concen t ra t i on

i n venous plasma were analyzed be fore and du r ing no ise exposure.

The mean r e s t i n g b lood pressure o f t h e whole group was 120/70 mm

Hg. Dur ing no ise s t i m u l a t i o n d i a s t o l i c b lood pressure inc reased

(12.276, p < 0.001) as d i d mean a r t e r i a l pressure (6.6%, p < 0.001)

and t o t a l p e r i p h e r a l res i s tance (12.7%, p < 0.001). Stroke volume

(7.3%, p 4 0.001) and ca rd iac ou tpu t (5.0%, p 4 0.01) were bo th

reduced a t 95 dB A.

Heart r a t e and s y s t o l i c blood. pressure d i d n o t change s i g n i f i c a n t -

l y , A t 75 and 85 dB A t he re were s i m i l a r b u t smal le r changes i n

the hernodynamic parameters.

There were no changes i n adrena l ine and noradrena l ine i n plasma

du r ing maximal no i se exposure.

The no ise induced hemodynamic changes remained 5 minutes a f t e r t h e

no ise s t i m u l a t i o n was stopped b u t had disappeared a f t e r 10 minutes

o f r e s t .

13

Page 2: HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE

I t h a s b e e n known f o r s e v e r a l d e c a d e s t h a t n o i s e c a n

c a u s e t e m p o r a r y b l o o d p r e s s u r e i n c r e m e n t s i n a n i m a l s ,

e .g . d i f f e r e n t s t r a i n s o f r a t s . I n 1 9 4 8 Y e a k e l e t a l .

( 1 ) showed t h a t d a i l y n o i s e e x p o s u r e t o r a t s f o r s e v e r a l

m o n t h s r e s u l t e d i n a b l o o d p r e s s u r e i n c r e a s e w h i c h

r e m a i n e d f o r f o u r m o n t h s a f t e r t h e n o i s e s t i m u l a t i o n

h a d s t o p p e d . F u r t h e r m o r e , t h e y showed t h a t i f t h e

a n i m a l was r e e x p o s e d t o n o i s e , t h e b l o o d p r e s s u r e i n c r e -

men t came f a s t e r t h a n d u r i n g t h e i n i t i a l e x p o s u r e , i n d i -

c a t i n g a mechan ism o f s e n s i t a t i o n i n t h e a n i m a l .

S e v e r a l s t u d i e s h a v e shown t h a t d i f f e r e n t s t r e s s

s t i m u l i , e .g . n o i s e , c a n p r o d u c e t e m p o r a r y b l o o d p r e s s u r e

i n c r e m e n t s i n S H R - r a t s a n d t h a t t h e s e s t i m u l i a c c e l e r a t e

t h e d e v e l o p m e n t o f p e r m a n e n t h y p e r t e n s i o n ( 2 , 4 -71 , J o n s s o n

a n d Hansson h a v e shown t h a t i n d u s t r i a l w o r k e r s w i t h a

s e v e r e n o i s e i n d u c e d h e a r i n g i m p a r m e n t ( d e f i n e d a s m o r e

t h a n 65 d 8 A h e a r i n g l o s s a t t h e f r e q u e n c i e s 3000 , 4000

o r 6 0 0 0 H Z ) , h a d s i g n i f i c a n t l y h i g h e r b l o o d p r e s s u r e com-

p a r e d t o a n a g e - m a t c h e d c o n t r o l g r o u p w i t h n o r m a l h e a r i n g

( d e f i n e d a s l e s s t h a n 20 dB h e a r i n g l o s s a t a n y f r e q u e n c y ) ;

8 . F u r t h e r m o r e , i n t h e g r o u p w i t h n o i s e i n d u c e d h e a r i n g

l o s s t h e r e were s i g n i f i c a n t l y m o r e h y p e r t e n s i v e s c o m p a r e d

w i t h t h e c o n t r o l g r o u p ( 8 ) . T h i s made u s i n t e r e s t e d i n

f u r t h e r e v a l u a t i o n s o f t h e e f f e c t o f n o i s e o n b l o o d p r e s s u r e

and o t h e r hemodynamic v a r i a b l e s . T h u s , t h e a i m o f t h e p r e s e n t

s t u d y was t o i n v e s t i g a t e t h e hemodynamic a n d h o r m o n a l

e f f e c t s o f a c u t e n o i s e s t i m u l a t i o n i n man.

P A T I E N T S AND METHODS

E i g h t e e n m a l e h e a l t h y v o l u n t e e r s w i t h n o r m a l h e a r i n g ( a u d i o -

m e t r y ) p a r t i c i p a t e d i n t h e i n v e s t i g a t i o n . T h e i r mean a g e

was 26 y e a r s , r a n g e 23 -31 . They w e r e s t u d i e d i n t h e a f t e r -

n o o n u n d e r s t r i c t l y s t a n d a r d i z e d c o n d i t i o n s i n a n o i s e

l a b o r a t o r y . F o l l o w i n g 20 m i n u t e s ' r e s t i n t h e s u p i n e p o s i t i o n ,

a t a s o u n d l e v e l o f 4 0 dB A n o i s e s t i m u l a t i o n s t a r t e d . The

p a t i e n t s were d i v i d e d i n t o t w o g r o u p s . The f i r s t g r o u p ( n = 8 )

was e x p o s e d t o i n c r e a s i n g n o i s e l e v e l s i n 1 0 - m i n u t e p e r i o d s ,

s t a r t i n g w i t h 75 dB A f o l l o w e d b y 85 dB A a n d 95 dB A . The

o t h e r g r o u p ( n = 1 0 ) was e x p o s e d d i r e c t l y t o 95 dB A f o r 2 0

m i n u t e s . T h e r e w e r e a l s o i n t e r m i t t e n t b r i e f s o u n d d i s t u r b a n c e s 14

Page 3: HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE

w i t h s o u n d l e v e l s u p t o 1 0 5 dB A . The h e m o d y n a m i c p a r a m e t e r s

were r e c o r d e d s e v e r a l t i m e s b e f o r e , d u r i n g a n d a f t e r t h e

n o i s e s t i m u l a t i o n . A d r e n a l i n e a n d n o r a d r e n a l i n e i n v e n o u s

p l a s m a were s t u d i e d a f t e r 2 0 m i n u t e s ' r e s t i n t h e s u p i n e

p o s i t i o n a n d a f t e r 5 m i n u t e s o f n o i s e e x p o s u r e a t 9 5 dB A .

The s u b j e c t i v e e x p e r i e n c e o f t h e n o i s e d i s t u r b a n c e w a s

r e g i s t e r e d i n a q u e s t i o n n a i r e . The i n v e s t i g a t i o n was e n d e d

by a r e s t i n g p e r i o d a t 40 dB A .

B l o o d p r e s s u r e w a s m e a s u r e d i n d i r e c t l y w i t h a n a u t o m a t i c

b l o o d p r e s s u r e r e c o r d e r ( B o s c h B o s o m a t ) . T h e r e was a v e r y

g o o d c o r r e l a t i o n ( r = 0 . 9 3 , p L 0 . 0 0 1 ) b e t w e e n s i m u l t a n e o u s l y

r e c o r d e d b l o o d p r e s s u r e s w i t h a m e r c u r y m a n o m e t e r a n d t h e

a u t o m a t i c b l o o d p r e s s u r e r e c o r d e r . D i a s t o l i c b l o o d p r e s s u r e

was m e a s u r e d a t t h e d i s a p p e a r e n c e o f t h e K o r o t k o f f s o u n d s

( p h a s e V ) . H e a r t r a t e a n d s t r o k e v o l u m e were r e c o r d e d n o n -

i n v a s i v e l y w i t h i m p e d a n c e c a r d i o g r a p h y ( 9 ) . I t s c o r r e l a t i o n

w i t h d y e - d i l u t i o n t e c h n i q u e ( C a r d i o - G r e e n ) w a s r = 0 . 8 9 ,

p c 0 . 0 0 1 ( 1 3 ) . I t i s known t o b e a t l e a s t a s r e l i a b l e a s t h e d y e d i l u t i o n t e c h n i q u e i n a s s e s s i n g c h a n g e s i n s t r o k e

v o l u m e i n t h e s a m e p e r s o n ( 1 0 - 1 2 ) .

T o t a l p e r i p h e r a l r e s i s t a n c e w a s c a l c u l a t e d a s t h e q u o t i e n t

o f mean a r t e r i a l b l o o d p r e s s u r e a n d c a r d i a c o u t p u t . T h e

b l o o d s a m p l e s f o r c a t e c h o l a m i n e a n a l y s i s ( 1 3 ) were t a k e n

f r o m a c a n n u l a i n s e r t e d i n a n a n t e c u b i t a l v e i n 1 0 m i n u t e s

b e f o r e t h e r e s t i n g p e r i o d s t a r t e d .

RESULTS

A t 9 5 dB A t h e r e were h i g h l y s i g n i f i c a n t i n c r e m e n t s i n

d i a s t o l i c b l o o d p r e s s u r e ( 1 2 . 2 % , p < 0 . 0 0 1 ) , mean a r t e r i a l

p r e s s u r e ( 6 . 6 % , p c 0 . 0 0 1 a n d t o t a l p e r i p h e r a l r e s i s t a n c e ( 1 2 . 7 % , p 4 0 . 0 0 1 ) ; F i g . 1 .

The s t r o k e v o l u m e d e c r e a s e d s i g n i f i c a n t l y (7 .376, p < 0 . 0 0 1 )

a s d i d t h e c a r d i a c o u t p u t (5 .076, p C. 0 . 0 1 ) . Hear t r a t e a n d

s y s t o l i c b l o o d p r e s s u r e d i d n o t c h a n g e s i g n i f i c a n t l y .

A t 7 5 dB A t h e r e were s t a t i s t i c a l l y s i g n i f i c a n t i n c r e m e n t s

i n d i a s t o l i c b l o o d p r e s s u r e (5.076, p < 0 . 0 5 ) , mean a r t e r i a l p r e s s u r e ( 3 . 2 % , p C 0 . 0 5 ) a n d t o t a l p e r i p h e r a l r e s i s t a n c e

1 5

Page 4: HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE

1 6

15 --

Hernodynamic Changes Induced by Noise (n=18)

95 (dBA) TPR

SBP

DBP

I I sv co n P<OOOl

Fig. 1 . Hernodynamic changes i n 18 h e a l t h y s u b j e c t s caused

by n o i s e s t i m u l a t i o n a t 95 dB A .

( l l . l % , p < 0 . 0 5 ) . Hear t r a t e (3 .276 , n .s .1 , s t r o k e v o l u m e

( 3 . 6 % , n . s . 1 , s y s t o l i c b l o o d p r e s s u r e i n c r e a s e d (1 .176 ,

n . s . ) arid c a r d i a c o u t p u t (6 .276 , n . s . ) d i d n o t c h a n g e s i g -

n i f i c a n t l y . A t 85 dB A t h e r e were c h a n g e s s i m i l a r t o t h o s e a t 7 5 dB A ,

a l t h o u g h t h e y were l e s s p r o n o u n c e d .

T h e r e were n o s i g n i f i c a n t d i f f e r e n c e s a t 9 5 dB A b e t w e e n

t h e g r o u p w h i c h w a s e x p o s e d t o a s t e p - w i s e i n c r e a s e i n

n o i s e a n d t h e g r o u p w h i c h was d i r e c t l y s t i m u l a t e d w i t h 9 5

dB A .

Loud s h o r t i n t e r m i t t e n t n o i s e ( 1 0 5 dB A) d i d n o t a c c e n t u a t e

t h e h e m o d y n a r n i c r e s p o n s e e l i c i t e d by c o n t i n u o u s n o i s e a t

9 5 d 8 A . T h e r e was n o c o r r e l a t i o n b e t w e e n s u b j e c t i v e l y e x p e r i e n c e d

Page 5: HEMODYNAMIC AND HORMONAL CHANGES INDUCED BY NOISE

d i s t u r b a n c e and o b j e c t i v e l y r e c o r d e d hemodynamic c h a n g e s .

The hemodynamic c h a n g e s w e r e s t i l l p r e s e n t 5 m i n u t e s

a f t e r t h e n o i s e s t i m u l a t i o n was s t o p p e d b u t t h e y h a d d i s -

a p p e a r e d a f t e r 1 0 m i n u t e s o f q u i e t r e s t a t 4 0 dB A .

T h e r e were n o s i g n i f i c a n t c h a n g e s i n a d r e n a l i n e o r n o r -

a d r e n a l i n e c o n c e n t r a t i o n i n p l a s m a d u r i n g m a x i m a l n o i s e

s t i m u l a t i o n ( 9 5 d8 A ) , n o r w e r e t h e r e a n y c o r r e l a t i o n s

b e t w e e n t h e c h a n g e i n hemodynamic p a r a m e t e r s and t h e c a t e -

c h o l a m i n e c o n c e n t r a t i o n s .

DISCUSSION

A c u t e n o i s e e x p o s u r e c a u s e d a t e m p o r a r y b l o o d p r e s s u r e

i n c r e a s e i n n o r m a l v o l u n t e e r s . The b l o o d p r e s s u r e i n c r e a s e

was a s s o c i a t e d w i t h an i n c r e a s e d t o n u s i n t h e r e s i s t a n c e

v e s s e l s , i n d i c a t e d b y t h e r i s e i n r e s i s t a n c e . T h i s was

r e v e r s i b l e when t h e n o i s e s t i m u l a t i o n was s t o p p e d . The

d e c r e a s e i n s t r o k e v o l u m e a n d c a r d i a c o u t p u t c o u l d b e

s e c o n d a r y t o b a r o r e c e p t o r r e f l e x a c t i v i t y . We d i d n o t f i n d

a l i n e a r r e l a t i o n s h i p b e t w e e n n o i s e l e v e l a n d b l o o d p r e s s u r e

i n c r e a s e s i n c e a l l hemodynamic c h a n g e s , w i t h t h e e x c e p t i o n

o f t h o s e r e g a r d i n g s t r o k e v o l u m e a n d c a r d i a c o u t p u t w e r e

l e s s p r o n o u n c e d a t 85 dB A c o m p a r e d w i t h 75 dB A .

T h e r e c o u l d be s e v e r a l d i f f e r e n t r e a s o n s f o r t h i s . The

a b r u p t change i n s o u n d l e v e l f r o m t h e v e r y q u i e t 4 0 dB A

t o 75 d8 i s a p r o p o r t i o n a l l y g r e a t e r c h a n g e i n n o i s e

l e v e l t h a n t h e c h a n g e f r o m 75 dB A t o 85 d8 A .

A n o t h e r p o s s i b l e e x p l a n a t i o n c o u l d b e t h a t t h e i n i t i a l

hemodynamic c h a n g e s a t 75 dB A m i g h t b e s e c o n d a r y t o a com-

b i n a t i o n o f t h e n o i s e e x p o s u r e and e x p e c t a n c y " s t r e s s " .

T h e r e a r e d i f f e r e n t o p i n i o n s r e g a r d i n g c h r o n i c n o i s e

e x p o s u r e and i t s p o s s i b l e a s s o c i a t i o n w i t h p e r m a n e n t h y p e r -

t e n s i o n i n man ( 8 , 1 4 - 1 5 ) .

S e v e r a l f a c t o r s c o u l d m o d i f y t h e c a r d i o v a s c u l a r r e s p o n s e

t o n o i s e i n man a s w e l l a s i n a n i m a l s . R e p e a t e d d a i l y e x p o s u r e

t o n o i s e f o r l o n g p e r i o d s c o u l d c o n c e i v a b l y c r e a t e a p e r m a n e n t

h y p e r t e n s i o n i n man due t o s t r u c t u r a l c h a n g e s i n t h e r e s i s t a n c e

v e s s e l s i n a n a l o g y w i t h f i n d i n g s i n a n i m a l s t u d i e s ( 7 ) .

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