Skip to main content

Assessment of noise levels in the intensive care unit using Apple Watch

Alarms from monitors, medical devices and staff activities increase noise levels in the Intensive Care Unit (ICU) and may disrupt sleep patterns [1] contributing to the development of delirium and post-intensive care syndrome [2]. The World Health Organization (WHO) recommend that hospital noise levels should not exceed 35 A-weighted decibels (dBA) during the day and 30 dBA at night [3]. However, daytime noise levels in ICU were found of around 60 dBA [4]. Apple Watch (Series 4 and 5) takes advantage of the internal microphone to regularly sample sound levels in the environment and might play a role in monitoring noise in the ICU.

We investigated the feasibility of analyzing data from an Apple Watch to measure noise levels in the ICU. Accordingly, we exported Health data from the personal Apple Watch of a nurse working in a 14 beds referral cardiothoracic ICU managing patients after cardiac surgery and those with cardiogenic shock, refractory cardiac arrest, and respiratory failure. Noise levels were compared between daytime (7 a.m. - 11 p.m.) and night-time (11 p.m. - 7 a.m.). Data extraction and statistical analysis were performed with the “Pandas” Python Library. An open-source Jupyter notebook has been made available together with this publication on GitHub (https://github.com/tscquizzato/ICU-Noise-Levels-Apple-Watch) with a step-by-step guide to repeat our experience.

Consecutive 1086 samples measured during 48 shifts (48% from 7 a.m. to 7:30 p.m. and 52% from 7:15 p.m. to 7:15 a.m.) between November 1, 2019 and February 29, 2020 were extracted. The average sound level was 66 ± 6.1 dBA (Fig. 1). Sound levels significantly differed between daytime and night-time (67 ± 6.7 dBA vs. 64 ± 4.2 dBA, p < 0.001) (Fig. 2). The highest sound level was 89 dBA and was recorded on Monday between 12 a.m. and 1 p.m. The lowest one was 31 dBA between 3 p.m. and 4 p.m. on Sunday. In only 2.8% of samples, noise levels during daytime were below 35 dBA. During the night, sound levels were always above 30 dBA.

Fig. 1
figure1

Trend of average sound pressure levels over the 24 h. Values in A-weighted decibels (dBA) are expressed as mean with standard deviation

Fig. 2
figure2

Boxplot comparing sound pressure levels during daytime (7 am – 11 pm) and night-time (11 pm – 7 am)

The analysis of noise levels in the ICU using an Apple Watch is feasible and easy to perform. Overall, noise levels were almost always above the recommended values, consistent with previously published studies [4]. The role of wearable devices to measure noise levels deserves to be further investigated. Such devices might also be worn by patients to accurately quantify noise levels and compare with sleep quality and recovery.

Availability of data and materials

Not applicable.

Abbreviations

ICU:

Intensive care unit

dBA:

A-weighted decibels

WHO:

World Health Organization

References

  1. 1.

    Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med. 2001;163:451–7.

    CAS  Article  Google Scholar 

  2. 2.

    Weinhouse GL, Schwab RJ, Watson PL, Patil N, Vaccaro B, Pandharipande P, Ely EW. Bench-to-bedside review: delirium in ICU patients - importance of sleep deprivation. Crit Care. 2009;13(6):234.

    Article  Google Scholar 

  3. 3.

    Berglund B, Lindvall T, Schwela DH & World Health Organization Occupational and Environmental Health Team. Guidelines for community noise 1999. http://www.who.int/iris/handle/10665/66217.

    Google Scholar 

  4. 4.

    Simons KS, Verweij E, Lemmens PMC, et al. Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units. Crit Care. 2018;22:250 https://doi.org/10.1186/s13054-018-2182-y.

    Article  Google Scholar 

Download references

Acknowledgements

None.

Funding

None.

Author information

Affiliations

Authors

Contributions

All authors participated in study concept and design, drafting the manuscript and approved the final version.

Corresponding author

Correspondence to Tommaso Scquizzato.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Scquizzato, T., Gazzato, A., Landoni, G. et al. Assessment of noise levels in the intensive care unit using Apple Watch. Crit Care 24, 130 (2020). https://doi.org/10.1186/s13054-020-02852-3

Download citation