Soundscape and health

I aim to develop integrative methodologies bridging perceptual and simulation-based approaches, extending the group’s work on outdoor sound environments to multisensory and health-related indoors contexts. I am currently involved in a study on neonatal intensive care units (NICUs). Both premature infants and caregivers are exposed to long periods of excessive noise from machines, alarms, voices, and activities, which are known to exceed WHO  safe levels (45 dBA) 90% of the time. This disrupts their sleep, vital signs, and general cognitive development. Responding to this challenge, I collaborate with the University of Deusto’s design research group and Hospital de Donostia in San Sebastián to model layered NICU soundscapes using machine listening to assess emotional/acoustic quality, raise staff awareness, and develop automated interventions for better infant and caregiver wellbeing.

Funding

• Incoming Research Mobility for Research Staff from Foreign Universities and Centres,, Seed funding from University of Deusto, Spain, 2025/12–2026/03, 3,755 EUR.

Output

• Lindborg PM, Lenzi S, de la Cuevas I (2026/09). “SoundSafe: Towards an Integrated Assessment of Soundscape Quality in a Neonatal Intensive Care Unit”. Forum Acousticum, Graz 2026.
• Lindborg, Lenzi (2026). “Sound Safe: Plataforma integrada para la evaluación de la calidad acústica en cuidados intensivos neonatales”. (invited talk). Donostia University Hospital, Basque Country.
• Lenzi S, Lindborg PM (2026/03/11). Sound Safe: Plataforma integrada para la evaluación de la calidad acústica en cuidados intensivos neonatales. (invited talk). Donostia University Hospital, Osakidetza, Pays Vasco. Basque Country.
• Lenzi S, Lindborg PM, Spagnol S, Kamphuis D, Özcan E. (2024/06). “Perceived quality of a nighttime hospital soundscape” Noise Mapping, vol. 11, no. 1, 2024, pp. 20240010. https://doi.org/10.1515/noise-2024-0010
• Lindborg PM, Lenzi S, Li SX, Li X (2025/01). “SleepSound: Charting the Nighttime Soundscape and Sleep Quality in Hong Kong through Machine Listening and AI-supported Information Design”. In Pauletto, S. (2025, January 29) Proceedings of the 3rd Conference on Sonification of Health and Environmental Data (SoniHED 2025, https://soundforenergy.net/sonihed2025). Stockholm, Sweden. https://doi.org/10.5281/zenodo.15032831, p. 30-37.
• Sara Lenzi, PerMagnus Lindborg, Ningze Han, Simone Spagnol, Daan Kamphuis, Elif Özcan (2023/09). “Disturbed Sleep: Estimating Night-time Sound Annoyance at a Hospital Ward”. Forum Acousticum, 10th Convention of the European Acoustics Association 2023, Torino, Italy.
• Lenzi S, Sadaba J & Lindborg PM (2021/03.). “Soundscape in Times of Change: Case Study of a City Neighbourhood during the COVID-19 Lockdown”. Frontiers in Psychology. https://www.frontiersin.org/articles/10.3389/fpsyg.2021.570741/

Having a prematurely born baby taken into a neonatal intensive care unit (NICU) is an extremely stressful experience for both the infant patient and their caretakers. The optimal functioning of life support, such as respiratory support systems and medical interventions, are of primary importance. Of secondary importance is, one could say, all the rest: comprehensive environmental safety, continuous emotional support, immense patience, and perhaps – luck. The present study focuses on one of the most important environmental stressors: noise. While it is well known that noisy acoustic environments at hospitals negatively impact patients, families, and healthcare staff (de Lima Andrade et al., 2021; Özcan et al., 2019), it might appear intractable. Noise, per definition, is an ‘unwanted side effect’ from some other action or event, which might be of primary importance, yet improvable. More than any other environmental stressor, noise tends to escape our attention yet has insidious long-term effects.

Field studies have evidenced noise levels that are considerably higher (Smith et al. 2018) than what. One study found that the recommended maximum level of 45 dBA was exceeded 90% of the time – day and night (Mayhew 2022). Noise is a major stressor for premature infants. The most common indicators of physiological stress and pain include changes in heart and respiratory rates, blood pressure, oxygen levels (tcP02) and saturation (O2 Sat), intracranial pressure, vagal tone, skin blood flow, and palmar sweat (Peng et. al, 2009; cited in Knutson 2012 p. 9). Excessive and unfamiliar sounds can disrupt vital signs, sleep, and behavior, and may cause long-term developmental issues, including delayed language acquisition (Boyar and Gennattasio, 2023. We are also concerned with how noise influences caregivers, in particular the mother and father. Their psychological wellbeing certainly mediates the long-term health of the baby. Ideally, the premature baby’s soundscape should be consistent with the intrauterine environment (cf. Knutson 2012 p. 11). We may understand the acoustic environment at a NICU in layers –  incubator, caregiver, room, ward – each with its own set of sound sources: some beneficial, others detrimental. We may distinguish between: Continuous background (machines, HVAC, etc); On-off midground (various sources including distant voices, foot steps), and; Occasional foreground (alarms with differing degrees of urgency, close voices, crying, furniture).

Our previous study (Lenzi et al., 2024) lent evidence to the common observation that staff conversations and activities are significant contributors to nighttime sleep disturbances Although staff training can help (Carvalhais et al., 2015), many nurses are unaware of their contribution to noise and feel powerless to effect change (Spagnol et al., 2022). Traditional noise-monitoring technologies rely on sound pressure level (SPL), which is not easily understood by non-experts and fails to capture the emotional quality of specific sound types. Machine Listening (MLi) methods offer promising alternatives but have focused mainly on outdoor settings due to privacy concerns in hospitals (Lenzi et al., 2023). As a result, there is a critical gap in developing MLi tools to assess and improve indoor soundscapes, particularly in NICUs. A sustainable, human-centered, automated solution to monitor and predict the emotional and acoustic quality of these environments is urgently needed to support better healthcare outcomes and working conditions (Lindborg 2025 p. 31-38).

The coronavirus disease 2019 (COVID-19) lockdown meant a greatly reduced social and economic activity. Sound is of major importance to people’s perception of the environment, and some remarked that the soundscape was changing for the better. But are these anecdotal reports based in truth? Has traffic noise from cars and airplanes really gone down, so that more birdsong can be heard? Have socially distanced people quietened down? This article presents a case study of the human perception of environmental sounds in an urban neighborhood in the Basque Country between 15 March and 25 May 2020. The social restrictions imposed through national legislation divided the 69-day period into three phases. We collected observations, field audio recordings, photography, and diary notes on 50 days. Experts in soundscape and architecture were presented with the recordings, in randomized order, and made two separate perceptual analyses. One group (N = 11) rated the recordings for pleasantness and eventfulness using an adapted version of the Swedish Soundscape Quality Protocol, and a partly overlapping group (N = 12) annotated perceived sound events with free-form semantic labels. The labels were systematically classified into a four-level Taxonomy of Sound Sources, allowing an estimation of the relative amounts of Natural, Human, and Technological sounds. Loudness and three descriptors developed for bioacoustics were extracted computationally. Analysis showed that Eventfulness, Acoustic Complexity, and Acoustic Richness increased significantly over the time period, while the amount of Technological sounds decreased. These observations were interpreted as reflecting changes in people’s outdoor activities and behavior over the whole 69-day period, evidenced in an increased presence of Human sounds of voices and walking, and a significant shift from motorized vehicles toward personal mobility devices, again evidenced by perceived sounds. Quantitative results provided a backdrop against which qualitative analyses of diary notes and observations were interpreted in relation to the restrictions and the architectural specifics of the site. An integrated analysis of all sources pointed at the temporary suspension of human outdoor activity as the main reason for such a change. In the third phase, the progressive return of street life and the usage of personal mobility vehicles seemed to be responsible for a clear increase in Eventfulness and Loudness even in the context of an overall decrease Soundscape in Times of Change: Case Study of a City Neighbourhood During the COVID-19 Lockdown of Technological sounds. Indoor human activity shared through open windows and an increased presence of birdsong emerge as a novel characteristic element of the local urban soundscape. We discuss how such changes in the acoustic environment of the site, in acoustic measurements and as perceived by humans, point toward the soundscape being a crucial component of a comprehensive urban design strategy that aims to improve health and quality of life for increasingly large and dense populations in the future. (Lenzi et al. 2021)

Photo of baby in NICU by Jessica Strom.