International Journal of Nursing Studies 51 (2014) 5162

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International Journal of Nursing Studies

journal homepage: www.elsevier.com/ijns

Review

Music therapy improves sleep quality in acute and chronic

sleep disorders: A meta-analysis of 10 randomized studies
Chun-Fang Wang *, Ying-Li Sun, Hong-Xin Zang
Department of Cardiovascular Surgery, Center for Cardiovascular Disease, Pingjin Hospital, Logistics University of Chinese Peoples Armed
Police Forces, Tianjin, PR China

A R T I C L E I N F O A B S T R A C T

Article history: Objective: To evaluate the efcacy of music therapy for acute and chronic sleep disorders in
Received 14 November 2012 adults.
Received in revised form 5 March 2013 Design: Systematic review and meta-analysis.
Accepted 16 March 2013
Data sources: A systematic search of publications in PubMed, Embase, and the Cochrane
Library without language restriction was performed.
Keywords:
Review methods: Studies with randomized controlled design and adult participants were
Music
included if music was applied in a passive way to improve sleep quality. Subgroup analysis
Sleep disorders
Sleep quality was conducted to explore the sources of heterogeneity.
Meta-analysis Results: Ten studies involving 557 participants were identied. The sleep quality was
improved signicantly by music (standard mean difference: 0.63; 95% CI: 0.92 to
0.34; p < 0.001), with signicant heterogeneity across studies. Subgroup analysis found
heterogeneity between subgroups with objective or subjective assessing methods of sleep
quality, and between subgroups with difference follow-up durations. No evidence of
publication bias was observed.
Conclusion: Music can assist in improving sleep quality of patients with acute and chronic
sleep disorders. For chronic sleep disorders, music showed a cumulative dose effect and a
follow-up duration more than three weeks is necessary for assessing its efcacy.
2013 Elsevier Ltd. All rights reserved.

What is already known about the topic? What this paper adds

 Chronic sleep disorders are associated with adverse  Music can assist in treating both acute and chronic sleep
health outcomes. disorders.
 Acute sleep disorders of patients after operation or  For chronic sleep disorders, music therapy shows a
patients in intensive care unit are associated with worse cumulative dose effect.
prognosis.  A follow-up duration more than three weeks is necessary
 Music has been used to improve the sleep quality from an for assessing the efcacy of music for chronic sleep
ancient time, but prospective clinical trials presented disorders.
conicting results.
1. Introduction

Sleep is a primitive behavior of humans. Unfortunately,

* Corresponding author at: Department of Cardiovascular Surgery,
Pingjin Hospital, No. 220 Chenglin Street, 300126 Tianjin, China.
Tel.: +86 022 60577599; fax: +86 022 60577600.
E-mail address: wangchunfangemail@gmail.com (C.-F. Wang).
according to epidemiological studies, about one third of
adults reported sleep disorders (Krueger and Friedman,
2009), especially in older and shift-workers (Kronholm

0020-7489/$ see front matter 2013 Elsevier Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijnurstu.2013.03.008
52 C.-F. Wang et al. / International Journal of Nursing Studies 51 (2014) 5162
et al., 2008; Rowshan Ravan et al., 2010). As to in-hospital
patients, duo to the change of environments and the noise
of medical equipments, acute sleep deprivation is com-
mon, especially in peri-operative patients or patients in
intensive care unit (Hardin, 2009; Kamdar et al., 2012).
Chronic sleep disorders have proved to be associated
with adverse health outcomes, including cardiovascular
disorders (Cappuccio et al., 2011; Chien et al., 2010), total
mortality (Cappuccio et al., 2010a, 2010b; Castro-Costa
et al., 2011; Kronholm et al., 2011), type 2 diabetes
(Cappuccio et al., 2010a, 2010b), respiratory disorders
(Penzel et al., 2007), and obesity (Cappuccio et al., 2008). In
addition, acute sleep deprivation can also worsen the
prognosis.
Pharmacological therapy has been wildly used to treat
sleep disorders, but the potential side effects limit a long-
term intervention. Realizing that sleep is affected by both
physiological and psychological factors, people resorted to
kinds of mind-body interventions such as music therapy,
which indeed have been used from a very ancient time
(Cervellin and Lippi, 2011). In fact, music is the most
welcomed method used by nurses to improve the patients
sleep quality (Bouhairie et al., 2006).
Some earlier studies succeeded to prove the efcacy of
music in improving sleep quality (Kullich et al., 2003; Lai
and Good, 2005; Renzi et al., 2000; Zimmerman et al.,
1996). Although a previous meta-analysis (de Niet et al.,
2009) recommended the music-assisted relaxation to
patients with sleep disorders, the evidence was limited
because only 5 studies were available at that time. The
result was challenged by several recent studies with
negative results (Chan et al., 2010; Chang et al., 2012), and
we noticed that only one study included in that mate-
analysis showed negative result (Hernandez-Ruiz, 2005).
With accumulating evidence, our goal was to evaluate the
efcacy of music for sleep disorders by conducting a meta-
analysis of prospective cohort studies.
2. Methods
2.1. Search strategy and study selection
We attempted to follow the PRISMA (Preferred
Reporting Items for Systematic reviews and Meta-Analy-
ses) guideline to report the present meta-analysis (Moher
et al., 2009). We systematically searched the electronic
databases PubMed, Embase, and the Cochrane Library
without language restriction. The following search terms
were used: sleep, sleep quality, insomnia, music, music
intervention, music relaxation, music therapy. The refer-
ence lists of original and review articles were reviewed to
identify any additional relevant studies.
Studies were included in the meta analysis if they met
the following criteria: (1) a randomized controlled design,
(2) adult population over 18 years of age were involved, (3)
music was applied in a passive way to improve sleep
quality, (4) the sleep quality was assessed using a
subjective or objective method. Studies were excluded
if: (1) participants suffering neurological or severe cogni-
tive disorders were enrolled, (2) active use of music was
used as intervention, such as playing instruments. If
multiple published articles from the same study were
available, only the article with the most detailed informa-
tion was included.
2.2. Data extraction and study quality
Our primary outcome was the sleep quality which was
assessed using subjective methods such as questionnaire, or
objective methods such as polysomnography. All literature
search results were screened independently by two authors
(W-CF and S-YL) for potentially relevant articles, and
uncertainty or disagreement were resolved by discussion
and consensus. Data extraction was performed using a
standardized protocol and data-collection form. Extracted
data included the rst authors name, year of publication,
study population, the sample size, participants age and
gender, duration of follow-up, the intervention for each
group, method to assess the sleep quality, and result in each
group. Studies were assessed for quality by randomization,
blinding, reporting of withdrawals, generation of random
numbers, and concealment of allocation. Trials scored one
point for each area addressed, with a possible score between
0 and 5 (Moher et al., 1998).
2.3. Statistical analysis
Since continuous data from different scales were
extracted, the standardized mean difference (SMD) was
used as the measure of effect and the results were expressed
as a SMD with 95% condence intervals (CIs). SMD is
calculated by dividing the mean difference in each study by
the studys deviation, which makes the results comparable
across studies. It should be noted that SMD is an index
without unit, and the results of 0.2 are usually interpreted as
small, those of 0.5 as moderate and from 0.8 as large.
The heterogeneity among studies was tested by Q-
statistic (signicance level at p < 0.10) and I-statistic
(Higgins et al., 2003). The result of I-statistic is I2, which
describes the percentage of total variation across studies
that is due to heterogeneity rather than due to chance,
where high values of the index (I2 > 50%) indicate the
existence of heterogeneity.
The combined SMD were computed using xed-effects
models with no evidence of signicant heterogeneity. In the
presence of heterogeneity, random-effects models are more
appropriate because they assume that the effect being
estimated in the different studies are not identical. Publica-
tion bias was assessed with funnel plots and Egger regression
test (Egger et al., 1997). Sensitivity analysis was performed
to explore the inuence of individual studies by deleting 1
study in each turn. Subgroup analysis was conducted to
assess possible sources of heterogeneity by checking the
heterogeneity between subgroups with different average
ages, geographical locations, or follow-up durations, with
acute or chronic sleep disorders, and with subjective or
objective sleep quality assessing methods. Signicant
heterogeneity between subgroups indicates that the sub-
group factor may explain part of the total heterogeneity.
A p-value < 0.05 was considered to be statistically
signicant. All statistical analyses were performed using
Stata software (version 11.0; Stata Corporation, College
 C.-F. Wang et al. / International Journal of Nursing Studies 51 (2014) 5162 53

Fig. 1. Flow chart of study selection.

Station, TX) and REVMAN software (version 5.0; Cochrane
Collaboration, Oxford, United Kingdom).
3. Results
3.1. Main features of included studies
Two hundred and twenty-seven articles were obtained
from the initial search. Ten studies involving 557
participants were identied based on our criteria (Chan
et al., 2010; Chang et al., 2012; Harmat et al., 2008;
Hernandez-Ruiz, 2005; Kullich et al., 2003; Lai and Good,
2005; Renzi et al., 2000; Richards, 1998; Ryu et al., 2012;
Zimmerman et al., 1996) (Fig. 1). The excluded studies are
listed in the Appendix. All articles were in English except
one in German. Two studies were found to be published
twice in separate articles (Chan, 2011; Chan et al., 2010;
Lai and Good, 2005, 2006), and the most detailed one was
selected. The characteristics of these studies are presented
in Table 1. Four studies focused on post-operative acute
sleep disorders in hospital with the follow-up durations
less than 4 days. The other 6 studies focused on chronic
sleep disorders, 2 of them with the follow-up durations
between 4 and 5 days and the remaining 4 studies with the
durations between 3 and 4 weeks.
Eight studies used subjective, self-rating scale to
measure the quality of sleep. One study used the
Richards-Campbell Sleep Questionnaire (RCSQ), ve stud-
ies used the Pittsburgh Sleep Quality Index (PSQI), another
one study used the Verran and Synder-Halpern (VSH)
sleeping scale, and the remaining study used a visual
analog scale (VAS). Two studies used polysomnography to
measure the quality of sleep. Among the objective sleep
measures that polysomnography supplied, we selected the
sleep efciency (total sleep time/total recording time) as
our primary outcome.
3.2. Music and sleep quality
The outcomes with different methods were not
directly comparable. A high PSQI value means a lower
sleep quality, while a high RCSQ, VSH or SE value means
the opposite. The scores of RCSQ, VSH or SE were
converted by subtracting the real score from the maxi-
mum score.
The quality of sleep was improved signicantly by
music (SMD: 0.63; 95% CI: 0.92 to 0.34; Z = 4.24,
p < 0.001; Fig. 2) using random-effect model, with
signicant heterogeneity (I2 = 64%; X2 = 24.88, p = 0.003).
Similar effects were shown between subgroups with acute
or chronic sleep disorders ((I2 = 0%; X2 = 0.40, p = 0.53). The
funnel plot was inspected and found to be roughly
symmetrical, and the Egger regression test also showed
no evidence of signicant publication bias (p = 0.42).

Table 1
Characteristics of included studies.

Author Year Age Male (%) Simple Country Followup Participants characteristics Measure Quality
(mean) size duration score

Zimmerman 1996 67 68 96 USA 2 days In hospital, post-CABG RCSQ 2

Richards 1998 66 100 69 USA 1 day In hospital, CCU PSG 2
Renzi 2000 46 60 86 Italy 1 day In hospital, post-anorectal VAS 3
operation
Kullich 2003 48 63 65 Austria 3 weeks In stationary rehabilitation PSQI 2
Hernandez-Ruiz 2005 35 0 28 USA 5 days Abused women in shelter PSQI 2
Lai 2005 67 /* 60 Taiwan 3 weeks In community PSQI 4
Harmat 2008 23 22 94 Hungary 3 weeks Students in university PSQI 4
Chan 2010 76 45 42 Hong Kong 4 weeks In community PSQI 4
Chang 2012 32 6 50 Taiwan 4 days Volunteer PSG 4
Ryu 2012 61 66 58 South Korea 1 day In hospital, post-coronary angiography VSH 4

CABG = Coronary artery bypass grafting; CCU = Coronary care unit; RCSQ = Richards-Campbell Sleep Questionnaire; PSG = Polysomnography; VAS = Visual
analog scale; PAQI = Pittsburgh Sleep Quality Index; VSH = Verran and Synder-Halpern sleeping scale.
* Data were not reported.
54 C.-F. Wang et al. / International Journal of Nursing Studies 51 (2014) 5162

Fig. 2. Forest plot shows difference of sleep quality between participants with music therapy and control group, expressed as standardized mean difference
(SMD).

3.3. Sensitivity and subgroup analysis 4. Discussion

Exclusion of any single study did not materially alter the This study shows music can help to improve the
overall SMD, with a range from 0.55 (95% CI: 0.83 to quality of sleep in a wild range of populations, including
0.28) to 0.72(95% CI: 0.98 to 0.47). No heterogeneity patients after operation with acute sleep disorders, as
was found between subgroups with different average ages, well as students in university and elders in community
participants from hospital or not, or different geographical with chronic sleep disorders. Similar results were shown
locations. Signicant heterogeneity was presented between in subgroups with different ages or geographical
studies with different follow-up durations, and with locations.
subjective or objective sleep quality assessing methods. Substantial heterogeneity was observed among all
Signicant pooled effect was only shown in studies with studies. Subgroup analysis found heterogeneity between
follow-up duration shorter than 4 days or longer than 2 subgroups with objective or subjective methods, and with
weeks, and with subjective methods (Table 2). different follow-up durations, but not between inpatients
and participants out of hospital. The heterogeneity could
Table 2 mostly be explained by the negative results in studies
Subgroup analyses to explore sources of heterogeneity. which focused on chronic sleep disorders but with the
Subgroups Sleep quality follow-up durations less than 3 weeks. Actually, a
cumulative dose effect was showed in four of the included
Studies SMD (95% CI), p for
heterogeneity studies (Chan et al., 2010; Harmat et al., 2008; Kullich et
al., 2003; Lai and Good, 2005), and the effect reached no
Geographic location
USA and Europe 6 0.65( 0.91 to 0.38) plateau after 3 weeks. Previous studies also pointed out
Asia 4 0.61( 1.03 to 0.08) that 3 weeks is a recommended period of time for
p = 0.91 observing chronic changes of sleep patterns and the
Average age (years) effects of a new intervention on sleep quality (Chan et
35 3 0.47( 1.41 to 0.48)
al., 2010). It is a follow-up duration less than 3 weeks that
3565 3 0.81( 1.29 to 0.33)
>65 4 0.60( 0.91 to 0.29) resulted in the absence of positive efcacy of music
p = 0.72 therapy for chronic sleep disorders.
Follow-up duration Although the results of objective methods have proved
<4 days 4 0.74( 1.13 to 0.34)
to be closely related to subjective sleep quality, especially
4 days to 2 weeks 2 0.02( 0.44 to 0.48)
3 weeks to 4 weeks 4 0.79( 1.21 to 0.37) the index of sleep efciency (Akerstedt et al., 1994;
p = 0.02 Kushida et al., 2001), no tool is available for a
Sleep quality assessing methods comprehensive assessment of sleep quality with varied
Objective 2 0.06( 0.60 to 0.48) objective indices like the subjective questionnaires, which
Subjective 8 0.77( 1.04 to 0.50)
may explains the slight heterogeneity between them.
p = 0.02
The consistence of results between participants from
SMD = standardized mean difference.
different geographical locations implies that music is a
 C.-F. Wang et al. / International Journal of Nursing Studies 51 (2014) 5162
fundamental aspect of human experience and deeply
ingrained in all cultures. Although some studies in Asia
used traditional music other than western classic music
which was mostly used in other studies, these music
pieces are all characterized by a tempo of 6080 beats per
minute, slow stable rhythm, low-frequency tones, and
soothing and relaxing melodies. Familiarity to the
selected music may improve the compliance which
should be considered when implying the music therapy
(Chi and Young, 2011).
The possible underlying mechanisms are not fully
understood. As to acute sleep disorders, previous evidence
showed that music was effective for pre-operative anxiety
(Beccaloni, 2011; Pittman and Kridli, 2011), as well as post-
operative pain (Engwall and Duppils, 2009). The improve-
ment of sleep quality presented in the studies with
postoperative patients can be obviously attributed to the
music-induced relief of anxiety and pain, which may cause
acute sleep disorders. Music acts upon the central nervous
system, especially the deeper, more ancient parts of the
brain such as limbic system. In addition, music also has an
effect on the modulation of endogenous opioids and
oxytocin (Bernatzky et al., 2011), which may contribute to
the efcacy of music therapy for chronic sleep disorders.
However, more researches are needed to explore the
mechanisms of kinds of sleep disorders and how music
affects them in different ways.
Music therapy is low cost and safe, is easy to learn, and
could be used readily by nurses in hospital as well as
health-care professionals in community. For peri-opera-
tive patients, nurses can offer sleep-inducing music to help
them sleep and relax. The accidence of chronic sleep
disorders is high in elderly people. Health-care profes-
sionals can encourage them to listen to appropriate music
as an alternative self-care skill and provide them with
adequate advice, which may help to improve their quality
of sleep and life. It should be noted that our results were
limited because of the relatively small size of each included
study, and the efcacy of music for sleep disorders should
be tested in larger studies involving populations with acute
or chronic sleep disorders separately.
When music is used to improve sleep quality, the key
issues are the selection of music and the protocol to
conduct the intervention. Although the pieces of music
selected in previous studies shared in some common
characteristics, some studies identied that the efcacy of
music is affected by the listeners enjoyment of music
(Nilsson, 2011) and preferred music has the most
benecial effects (Lai, 2004). There is a need to compare
the different types of music on sleep and investigate how
the music affects sleep in a different way. A comprehensive
list of recommended pieces of music should be developed
in the future research, which can offer a wide range of
selection to meet various preferences. Standard protocol or
guideline to conduct the music therapy has not been
established. Future researches are needed to determine the
preferred duration of music playing, the appropriate time
to play the music before bedtime, and how to make a
comfortable condition which is necessary to ensure the
participants paying all their attention on listening to the
music.
55
4.1. Limitations
There are several limitations to our analysis. First, the
nature of this intervention makes a double-blinding design
impossible. Secondly, the sample size in each study is
relatively small. Thirdly, the quality of some studies is
relatively low. Some earlier studies did not detail the
methods to generate the random numbers and/or declare
the concealment of allocation, which got quality scores 2 or
3. Fourthly, substantial heterogeneity was presented.
Although the major source of heterogeneity was detected
through subgroup analysis, uncontrolled or unmeasured
factors potentially produce bias. Fifthly, the longest follow-
up duration was no more than 4 weeks which left it unclear
that whether the efcacy of music can maintain or even be
better after a longer follow-up. Sixthly, although SMD was
used to pool the results, the difference between various
subjective methods used in studies could still induce a
signicant heterogeneity and bias. Finally, various objec-
tive indices were presented by polysomnography, but we
only assessed the sleep efciency which may miss some
other useful information.
5. Conclusion
Music appears to be effective in treating acute and
chronic sleep disorders. It is low cost and safe, and could be
used to improve sleep quality in various populations with
different ages and culture backgrounds, in hospital or in
community. Our study also gives an indication that music
shows a cumulative dose effect for chronic sleep disorders.
A follow-up duration more than three weeks is necessary
for assessing the efcacy of music, which have an
implication for the design of trial evaluating the efcacy
of music therapy for chronic sleep disorders.
Conict of interest: None declared.
Funding: None.
Ethical approval: None.
Appendix 1. List of the excluded articles and the
reasons for exclusion
Wrong exposure
Anseld, M.E., Wegner, D.M., Bowser, R., 1996. Ironic
effects of sleep urgency. Behav. Res. Ther. 34 (7), 523531.
(The effects of low mental load music and high mental load
music were compared.)
Gitanjali, B., 1998. Effect of the Karnatic music raga
Neelambari on sleep architecture. Indian J. Physiol.
Pharmacol. 42 (1), 119122.
(Neelambai rage and Kalyani rage (rage is a kind of classic
Indian Karnatic system of music) were compared.)
Lai, H.L., Li, Y.M., Lee, L.H., 2012. Effects of music
intervention with nursing presence and recorded music on
psycho-physiological indices of cancer patient caregivers. J.
Clin. Nurs. 21 (56), 745756.
(Two music interventions (music with and without nursing
presence) were compared.)
56 C.-F. Wang et al. / International Journal of Nursing Studies 51 (2014) 5162
Levin Ia, I., 1997. [Music of the Brain in the treatment of
insomnia patients]. Zh. Nevrol. Psikhiatr. Im. S S Korsakova 97
(4), 3943.
Levin Ya, I., 1998. Brain music in the treatment of patients
with insomnia. Neurosci. Behav. Physiol. 28 (3), 330335.
(The brain music was investigated in these two studies,
which was created by a program that could transform the
spontaneous bioelectrical activity of the brain to music. The
participants in the exprimental group was treated with their
individual brain music, while the participants in the control
group with other ones music.)
Robinson, S.B., Weitzel, T., Henderson, L., 2005. The Sh-h-
h-h Project: nonpharmacological interventions. Holist. Nurs.
Pract. 19 (6), 263266.
(A complex intervention was assessed, and music was only a
little part of this intervention.)
Wrong outcome
Bonnet, M.H., Arand, D.L., 2000. The impact of music upon
sleep tendency as measured by the multiple sleep latency test
and maintenance of wakefulness test. Physiol. Behav. 71 (5),
485492.
(The ability to remain awake was used as the outcome.)
Bozcuk, H., Artac, M., Kara, A., Ozdogan, M., Sualp, Y.,
Topcu, Z., Karaagacli, A., Yildiz, M., Savas, B., 2006. Does music
exposure during chemotherapy improve quality of life in
early breast cancer patients? A pilot study. Med. Sci. Monit.
12 (5), CR200205.
(The outcome was the quality of life.)
de Niet, G., Tiemens, B., van Achterberg, T., Hutschemae-
kers, G., 2011. Applicability of two brief evidence-based
interventions to improve sleep quality in inpatient mental
health care. Int. J. Ment. Health Nurs. 20 (5), 319327.
(The appliability of music therapy was assessed.)
Diaz, M., Larsen, B., 2005. Preparing for successful surgery:
an implementation study. Perm. J. 9 (3), 2327.
(Postoperative pain and perioperative anxity but not the
qulity of sleep were evaluated.)
Iwaki, T., Tanaka, H., Hori, T., 2003. The effects of preferred
familiar music on falling asleep. J. Music Ther. 40 (1), 1526.
(The purpose of this study was to examine whether or not
listening to music promotes falling sleep. The quality of sleep was
not assessed.)
Wrong population
de Niet, G., Tiemens, B., Hutschemaekers, G., 2010. Can
mental healthcare nurses improve sleep quality for inpa-
tients? Br. J. Nurs. 19 (17), 11001105.
(The participants were all with severe mental health
problems and in psychiatric admission ward.)
Tan, L.P., 2004. The effects of background music on quality
of sleep in elementary school children. J. Music Ther. 41 (2),
128150.
(Elementary school children were involved in this study.)
Self-control design
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quality and emotional measures in people living with
schizophrenia. J. Music Ther. 47 (1), 2752.
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Hume, D., Yuan, J., Quinn, F., McDonough, S.M., 2009.
Acupuncture and reexology for insomnia: a feasibility
study. Acupunct. Med. 27 (4), 163168.
Johnson, J.E., 2003. The use of music to promote sleep in
older women. J. Community Health Nurs. 20 (1), 2735.
Lazic, S.E., Ogilvie, R.D., 2007. Lack of efcacy of music to
improve sleep: a polysomnographic and quantitative EEG
analysis. Int. J. Psychophysiol. 63 (3), 232239.
Mornhinweg, G.C., Voignier, R.R., 1995. Music for
sleep disturbance in the elderly. J. Holist. Nurs. 13 (3),
248254.
Ziv, N., Rotem, T., Arnon, Z., Haimov, I., 2008. The effect of
music relaxation versus progressive muscular relaxation on
insomnia in older people and their relationship to personality
traits. J. Music Ther. 45 (3), 360380.
Review
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Not relevant based on Abstract
Ambesh, S.P., Kumar, A., Sarkar, P., Bajaj, A., 1991.
Emergence phenomena after ketamine anesthesia: the
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Aritake-Okada, S., Kaneita, Y., Uchiyama, M., Mishima, K.,
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sleep among the Japanese general population. J. Clin. Sleep
Med. 5 (5), 464469.
Arnon, S., Shapsa, A., Forman, L., Regev, R., Bauer, S.,
Litmanovitz, I., Doln, T., 2006. Live music is benecial to
preterm infants in the neonatal intensive care unit environ-
ment. Birth 33 (2), 131136.
Azad, N., Byszewski, A., Sarazin, F.F., McLean, W., Koziarz,
P., 2003. Hospitalized patients preference in the treatment of
insomnia: pharmacological versus non-pharmacological.
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Bellieni, C.V., Cordelli, D.M., Bagnoli, F., Buonocore, G.,
2004. 11- to 15-Year-old children of women who danced
during their pregnancy. Biol. Neonate 86 (1), 6365.
Bentes, C., Pimentel, J., Costa, J., Santos, R., Rolo, V., 2008.
Ictal singing: case report and reappraisal of the literature.
Epileptic Disord. 10 (2), 113118.
Bettermann, H., Amponsah, D., Cysarz, D., van
Leeuwen, P., 1999. Musical rhythms in heart period
dynamics: a cross-cultural and interdisciplinary approach
to cardiac rhythms. Am. J. Physiol. 277 (5 Pt 2), H1762
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Bonnefond, A., Tassi, P., Roge, J., Muzet, A., 2004. A critical
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14.
Borchgrevink, H.M., 2003. Does health promotion work in
relation to noise? Noise Health 5 (18), 2530.
Bouhairie, A., Kemper, K.J., Martin, K., Woods, C., 2006.
Staff attitudes and expectations about music therapy:
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