The Effect of Earplugs and Eye Masks on the Melatonin and Cortisol Levels of Patients Hospitalized in Cardiac Critical Care Units

To determine the effectiveness of using earplugs and eye masks on the melatonin and cortisol levels of patients hospitalized in cardiac critical care units (CCUs). The research population of this study included all patients with acute coronary syndrome hospitalized in the CCU of Shahid Rajaei Hospital affiliated with to Alborz University of Medical Sciences. A total of 60 patients were selected by the available sampling method based on the inclusion criteria and then were divided into 2 control and intervention groups by block randomization method with blocks of 4 (n = 30 in the intervention group, and n = 30 in the control group). Patients in the intervention groups used blindfolds and earmuffs during the night sleep for 3 nights, but patients in the control group received the routine care. Cortisol and melatonin levels of both groups were measured at 8 am, using the urine samples. The findings of the 2 groups were compared and statistically analyzed by SPSS software version 16. The findings showed no significant difference between the 2 groups in terms of demographic characteristics and clinical variables. The intervention had no effect on the cortisol level of patients in the intervention group (P = .24). After the intervention, a statistically significant difference was observed between the control and intervention groups in terms of the melatonin level in the nocturnal urine (P ≤ .001). A statistically significant difference was also observed between the 2 groups in terms of the time taken for patients to fall asleep (P ≤ .001) and the number of times waking up at night (P ≤ .001). The use of earplugs and eye masks had no impact on the level of cortisol hormone, but it affected the level of melatonin hormone and the sleep quality of patients hospitalized in the CCU.

Nursing-Based Sleep Promotion Intervention Effectiveness for Post Cardiac Surgery Patients: Systematic Review

BACKGROUND

Sleep is a fundamental prerequisite for physical and mental health. Poor quality of sleep is common among post-cardiac surgery patients and leads to serious health conditions.

OBJECTIVE

To conduct a systematic review that investigates the effectiveness of eye masks, earplugs and deep-breathing exercise on sleep quality among post-cardiac surgery patients.

DESIGN

A systematic review of interventional studies was established to meet the PRISMA guidelines.

METHODS

PRISMA guidelines were used to assess the findings of 11 selected studies that met the inclusion criteria, published between 2007 and 2023 across four databases: CINAHL, JDNR, MEDLINE and PubMed. The search was conducted on 23 November 2023.

RESULTS

The 11 most eligible studies were analysed. All of them were interventional, encompassing a total of 787 participants. Randomised controlled trials were the most common design. Interventions included eye masks, earplugs and deep-breathing exercises. The Richards-Campbell Sleep Questionnaire was the most used assessment scale. Most of the reviewed studies found that the use of non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) significantly improves the quality of sleep. These interventions were also found to have potentially positive effects on reducing pain and delirium experienced by patients after undergoing cardiac surgery.

CONCLUSIONS

Non-pharmacological interventions (eye masks, earplugs and deep-breathing exercise) were found to be cost-effective interventions that could be easily applied in the clinical setting and are effective in improving the quality of sleep among patients after cardiac surgery.

The effect of eye mask on sleep quality and pain in patients undergoing coronary artery bypass graft surgery: A double-blind randomized controlled trial

BACKGROUND

Pain is one of the common postoperative issues that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. It leads to prolonged recovery and sleep disturbances in patients.

AIM

This study was conducted to examine the effect of eye mask use on sleep quality and pain in patients undergoing CABG surgery.

STUDY DESIGN

A double-blind randomized trial design was employed. The study included 60 patients undergoing CABG surgery. They were divided into intervention and control groups through block randomization. Data were collected using a 'Demographic Characteristics Form', the 'Richards-Campbell Sleep Questionnaire (RCSQ)' and a 'Visual Analogue Scale' (VAS) through face-to-face interviews. While patients in the control group received standard care throughout the night, patients in the intervention group received standard care and used eye mask. All patients were followed up for three nights. The CONSORT was used to report the study.

RESULTS

The main outcome of the study, the RCSQ score, was higher in the intervention group at baseline. The intervention group had higher RCSQ scores than the control group at time 1 and time 2. There were no differences between the groups in the secondary outcome, pain levels. The control group had higher pain scores at time 1 and time 2 than the intervention group.

CONCLUSION

The use of an eye mask after CABG surgery is an effective, safe and simple nursing intervention to improve sleep quality and control pain.

RELEVANCE TO CLINICAL PRACTICE

Because the use of an eye mask is an independent and unique nursing intervention, nurses should be supported and allowed to practise it.

Non-pharmacological interventions to improve sleep quality and quantity for hospitalized adult patients-co-produced study with surgical patient partners: systematic review

BACKGROUND

Hospitalized patients experience sleep disruption with consequential physiological and psychological effects. Surgical patients are particularly at risk due to surgical stress and postoperative pain. This systematic review aimed to identify non-pharmacological interventions for improving sleep and exploring their effects on sleep-related and clinical outcomes.

METHODS

A systematic literature search was performed in accordance with PRISMA guidelines and was preregistered on the Open Science Framework (doi: 10.17605/OSF.IO/EA6BN) and last updated in November 2023. Studies that evaluated non-pharmacological interventions for hospitalized, adult patients were included. Thematic content analysis was performed to identify hypothesized mechanisms of action and modes of administration, in collaboration with a patient partner. Risk of bias assessment was performed using the Cochrane Risk Of Bias (ROB) or Risk Of Bias In Non-Randomized Studies - of Interventions (ROBINS-I) tools.

RESULTS

A total of 59 eligible studies and data from 14 035 patients were included; 28 (47.5%) were randomized trials and 26 included surgical patients (10 trials). Thirteen unique non-pharmacological interventions were identified, 17 sleep measures and 7 linked health-related outcomes. Thematic analysis revealed two major themes for improving sleep in hospital inpatients: enhancing the sleep environment and utilizing relaxation and mindfulness techniques. Two methods of administration, self-administered and carer-administered, were identified. Environmental interventions, such as physical aids, and relaxation interventions, including aromatherapy, showed benefits to sleep measures. There was a lack of standardized sleep measurement and an overall moderate to high risk of bias across all studies.

CONCLUSIONS

This systematic review has identified several sleep interventions that are likely to benefit adult surgical patients, but there remains a lack of high-quality evidence to support their routine implementation.

The effects of ergonomic sleep mask use on sleep quality and comfort in intensive care patients

This study was conducted to determine the effects of the use of ergonomic sleep mask on sleep quality and comfort in intensive care patients. This randomised controlled experimental study was completed with 128 surgical intensive care patients (control = 64, experimental = 64). During the second night of their stay in the unit, ergonomic sleep masks were given to the patients in the experimental group, and earplugs and eye masks were given to the patients in the control group. A Patient information form, Visual analogue scale for discomfort, and the Richard-Campbell sleep questionnaire were used to collect data. While 51.6% of the patients were female, the mean age of the patients was 63.87 ± 14.94 years. The highest rates of patients had undergone cardiovascular surgery (28.9%) and general anaesthesia (57.8%). It was determined that the sleep quality of the patients in the experimental group was statistically and clinically significantly higher after the intervention (50.86 ± 21.46 vs 37.64 ± 14.97, t = -5.355, Cohen's d = 0.450, p < 0.001). Likewise, the patients who used ergonomic sleep masks had a statistically significantly lower mean VAS for Discomfort score, and their comfort level was higher (p < 0.001), but the difference was not clinically significant (Cohen's d = 0.208). The results of this study showed that the use of ergonomic sleep masks in surgical intensive care patients had a more positive effect on both the sleep quality and comfort levels of patients compared with earplugs and eye masks. The use of an ergonomic sleep mask is recommended in the early period to facilitate sleep and rest in surgical intensive care patients.

Effectiveness of sound and darkness interventions for critically ill patients' sleep quality: A systematic review and component network meta-analysis

BACKGROUND

Noise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications.

AIM

To identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients.

STUDY DESIGN

This systematic review and component network meta-analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta-Analyses (PRISMA-NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk-of-bias tool (V.2.0) and the online Confidence in Network Meta-Analysis (CINeMA) application.

RESULTS

Twenty-four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs.

CONCLUSIONS

This study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality.

RELEVANCE TO CLINICAL PRACTICE

This study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.

Effect of using eye masks and earplugs in preventing delirium in intensive care patients: A single-blinded, randomized, controlled trial

BACKGROUND

Delirium, which is frequently encountered in intensive care patients, can be prevented with multicomponent nursing interventions, and thus the negative consequences can be reduced.

AIM

To examine the effect of using eye masks and earplugs in preventing delirium in intensive care units (ICUs).

STUDY DESIGN

A randomized, controlled, single-blind intervention study. This study was conducted in the medical and surgical ICUs of a tertiary hospital, and nurses were given pre-study training on delirium risks, diagnosis, prevention, and management. Data were collected using the patient information form, the Nursing Delirium Screening Scale, the Richard-Campbell Sleep Scale, and the daily follow-up form. Various environmental modifications were made in the ICUs for all patients, and evidence-based nonpharmacological nursing interventions were applied to the patients in both groups during the day and night shifts for 3 days. In addition, the patients in the intervention group were provided with eye masks and earplugs for three nights.

RESULTS

The study included a total of 60 patients (30 in the intervention group and 30 in the control group). There was a statistically significant difference in the development of delirium between the intervention and control groups (night of the 2nd day, p = .019; day of the 3rd day p < .001; night of the 3rd day p ≤ .001). The average total sleep quality score of the intervention group was found to be significantly higher than the control group (p ≤ .001 for three nights). Staying in the internal medicine ICU affected (odds ratio [OR], 11.84; 95% confidence interval [CI], 3.00-46.66; p = .017) more on the development of delirium than in coronary ICU, being in the age group of 65 and over, having a hearing impairment, coming to ICU from the operating room, and education level had an effect.

CONCLUSIONS

The earplugs and eye masks used by the intensive care patients overnight were found to be effective in increasing sleep quality and preventing delirium.

RELEVANCE TO CLINICAL PRACTICE

The use of eye masks and earplugs is recommended for ICUs in preventing delirium.

The effectiveness of non-pharmacological sleep interventions for improving inpatient sleep in hospital: A systematic review and meta-analysis

BACKGROUND

Sleep disturbance is common in hospital. The hospital environment can have a negative impact on sleep quality, through factors such as noise, light, temperature, and nursing care disruptions. Poor sleep can lead to delays in recovery, wound healing, and increase risk of post-operative infection.

METHODS

We conducted a systematic review evaluating the effectiveness of non-pharmacological sleep interventions for improving inpatient sleep. The primary outcome was sleep quality, the secondary outcome was length of hospital stay, the harm outcome was adverse events. MEDLINE, Embase, CINAHL, PsycINFO and the Cochrane Library were searched from inception to 17^th February 2022. Meta-analysis was conducted using a fixed effects model, with narrative synthesis for studies with no useable data. Risk of bias was assessed with the Cochrane tool.

RESULTS

76 studies identified with 5375 people randomised comparing 85 interventions. Interventions focused on physical sleep aids (n = 26), relaxation (n = 25), manual therapy (n = 12), music (n = 9), psychological therapy (n = 5), light therapy (n = 3), sleep protocols (n = 2), milk and honey (n = 1), exercise (n = 1), and nursing care (n = 1). In meta-analysis, medium to large improvements in sleep quality were noted for sleep aids, relaxation, music, and manual therapies. Results were generally consistent in studies at lower risk of bias. Length of hospital stay and adverse events were reported for some studies, with benefit in some trials but this was not consistent across all interventions.

CONCLUSIONS

Physical sleep aids, relaxation, manual therapy and music interventions have a strong evidence base for improving inpatient sleep quality. Research is needed to evaluate how to optimise interventions into routine care.

Sleep assessment in critically ill adults: A systematic review and meta-analysis

PURPOSE

To systematically review sleep evaluation, characterize sleep disruption, and explore effects of sleepdisruption on outcomes in adult ICU patients.

MATERIALS AND METHODS

We systematically searched databases from May 1969 to June 2021 (PROSPERO protocol number: CRD42020175581). Prospective and retrospective studies were included studying sleep in critically ill adults, excluding patients with sleep or psychiatric disorders. Meta-regression methods were applied when feasible.

RESULTS

132 studies (8797 patients) were included. Fifteen sleep assessment methods were identified, with only two validated. Patients had significant sleep disruption, with low sleep time, and low proportion of restorative rapid eye movement (REM). Sedation was associated with higher sleep efficiency and sleep time. Surgical versus medical patients had lower sleep quality. Patients on ventilation had a higher amount of light sleep. Meta-regression only suggested an association between total sleep time and occurrence of delirium (p < 0.001, 15 studies, 519 patients). Scarce data precluded further analyses. Sleep characterized with polysomnography (PSG) correlated well with actigraphy and Richards Campbell Sleep Questionnaire (RCSQ).

CONCLUSIONS

Sleep in critically ill patients is severely disturbed, and actigraphy and RCSQ seem reliable alternatives to PSG. Future studies should evaluate impact of sleep disruption on outcomes.

Non-pharmacological sleep interventions for adult patients in intensive care Units: A systematic review

OBJECTIVES

To synthesize and evaluate current non-pharmacological sleep interventions for critically ill adult patients in intensive care units and provide recommendations for future studies of non-pharmacological means of improving this population's sleep quality.

RESEARCH METHODOLOGY/DESIGN

The literature search was conducted following PRISMA guidelines. Seven databases CINAHL, PsycINFO, Embase, Medline, Cochrane Library, Web of Science, and Scopus and three keywords, sleep, intervention and intensive care unit were employed. All possible combinations of the keywords and similar words were considered. Included studies were primary studies, involved adult intensive care unit patients, focused on non-pharmacological sleep interventions, measured subjective and/or objective sleep quality and were published in English between January 2010 and September 2020.

RESULTS

The 20 included studies examined different types of non-pharmacological sleep interventions involving use of earplugs, an eye mask, white noise, music, aromatherapy, massage, acupressure, light intensity, a sleep hygiene protocol, quiet time and minimization of nursing care. Of 18 studies employing an experimental design, most reported that non-pharmacological interventions improved sleep quality. All these interventions involved environmental factors or complementary relaxation strategies.

CONCLUSIONS

Non-pharmacological sleep interventions can have a positive influence on sleep quality in critically ill patients, but more research is needed to determine their effectiveness.

Environmental factors related to sleep latency among inpatients in rehabilitation wards according to functional independence measure cognitive scores

BACKGROUND

No study has investigated sleep-related environmental factors in patients according to their functional independence measure (FIM) cognitive scores.

AIMS

The aim of this study is to examine the associations between environmental factors such as noise and sleep latency according to the FIM cognitive scores among inpatients in rehabilitation wards.

DESIGN

This is a prospective longitudinal study.

METHODS

This study measured the sleep state using a bed-based actigraphy, environmental data from Environmental Sensor®, and medical record information of 33 inpatients in the rehabilitation wards during 2018. A linear mixed-effect model was used to analyse the associations between sleep latency and environmental factors. Participants were grouped according to high or low FIM cognitive scores.

RESULTS

The average patient age was 77.2 ± 10.9 years, and 48.5% were male. In the high FIM cognitive score group, the loudness and frequency of noise exceeding 40 dB during sleep latency were significantly associated with sleep latency. In the low FIM cognitive score group, only the noise frequency was associated with sleep latency, and intra-individual variance was larger than that of the high group.

CONCLUSION

These findings suggest that providing night care with attention to subdued noise is important, particularly for patients with low cognitive functional independence levels measured by the FIM cognitive score.

The Impact of Nonpharmacological Interventions on Sleep Quality Among Older Adult Patients in the Intensive Care Unit

Sleep is a basic human need that is required for good health and overall well-being. Adequate sleep is critical for cognitive functioning, memory consolidation, and emotional regulation by rejuvenating the body. Sleep may not be of significant concern unless it becomes lacking or disturbed as it alters the immune function, neurological processes, and intellectual and decision making of individuals. Hospitalized older adults are particularly vulnerable for the negative impact of poor sleep due to reduced physiological reserve and comorbidities. The purpose of this review is to appraise current evidence on nonpharmacological sleep interventions to promote better sleep quality and overall health outcomes among the general adult and older patients in the intensive care unit compared with no intervention at all. The findings of this integrative review will be useful in designing and implementing interdisciplinary plans of care that promote the use of nonpharmacological sleep protocols within the hospital setting.

The Effect of Using Eye Masks and Earplugs on Intensive Care Patients Quality of Sleep and Vital Signs

ABSTRACT

BACKGROUND: Intensive care unit (ICU) patients with severe health problems experience a high rate of sleep deprivation that harms their psychological and physiological health. Environmental factors are considered to be the greatest cause of sleep deprivation in the ICU, and noise and light are leading among these factors. This study aimed to investigate the effect of eye masks and earplugs on the sleep quality and vital signs of conscious ICU patients. METHODS: This study used a quasi-experimental, in similar groups, pretest-posttest design with a control group. The Richards-Campbell Sleep Questionnaire (RCSQ) was used to collect data, and vital signs were recorded every 2 hours. On day 1, standard care was provided to the experimental group (n = 32), and they were provided with eye masks and earplugs on day 2. The control group (n = 32) was provided with standard care on both days. Chi-square, t, and McNemar and McNemar-Bowker tests were used to analyze the data. Multiple regression analysis was used for predictive analysis. RESULTS: The RCSQ mean (SD) pretest and posttest scores were 50.21 (16.02) and 68.50 (17.57), respectively, for the experimental group and 55.34 (16.62) and 49.03 (15.53), respectively, for the control group. In the experimental group, the posttest RCSQ score was significantly higher than the pretest RCSQ score (P < .01). No differences in vital signs were observed in the control group. All the vital signs were found to be similar in the experimental group, except for the mean daily pulse rate. CONCLUSION: The use of earplugs and eye masks may help reduce sleep deprivation. Eye masks and earplugs can be used by nurses to improve the sleep quality of patients in ICUs.

The Efficacy of Eye Masks and Earplugs Interventions for Sleep Promotion in Critically Ill Patients: A Systematic Review and Meta-Analysis

Using physical devices such as eye masks and earplugs to improve to the quality of sleep in intensive care units (ICUs) is a very important issue. This study was conducted to assess the efficacy of eye masks and earplugs for sleep promotion in critically ill adult patients in the ICU based on various sleep quality assessment tools. PubMed, Scopus, Web of Science, and ProQuest were systematically retrieved until May 2021. Both randomized and non-randomized experimental and quasi-experimental studies were included if they evaluated the efficacy of eye masks and earplugs interventions on sleep outcomes in critically ill patients. The methodological quality was assessed by the Joanna Briggs Institute (JBI) critical appraisal tool. For the main outcome (sleep quality), a mean difference (MD) and confidence intervals (CIs) of 95% were determined. A total of 2,687 participants from 35 studies met the inclusion criteria. Twenty one studies were included in meta-analysis and 14 studies were included in the qualitative analysis. According to the results based on sleep quality assessment tools; overall scores of Pittsburgh Sleep Quality Index (PSQI) and Richards-Campbell Sleep Questionnaire (RCSQ), eye mask and/or earplug interventions have a positive effect on sleep quality. Based on Verran-Snyder-Halpern Sleep Scale (VSHSS), sleep disturbance was significantly lower in the intervention groups. In terms of polysomnography, the use of eye masks and/or earplugs resulted in a significant increase in total sleep time, sleep efficiency, rapid eye movement (REM) time, significant reduction of awaking, and sleep arousals index. The results of the present study suggest that the use of earplugs or eye masks, separately or combined affects sleep improvement in critically ill patients. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145830, PROSPERO: CRD42020145830.

Sleep Promotion among Critically Ill Patients: Earplugs/Eye Mask versus Ocean Sound-A Randomized Controlled Trial Study

BACKGROUND

Poor sleep quality is common in the intensive care unit (ICU), where several factors including environmental factors contribute to sleep deprivation.

OBJECTIVE

This study aims to assess and compare the effectiveness of earplugs and eye mask versus ocean sound on sleep quality among ICU patients.

DESIGN

A true experimental crossover design was used. Setting. Medical ICU of the Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana, India. Participants. Sixty-eight patients admitted in the medical ICU were randomly allocated by lottery methods into group 1 and group 2.

METHODS

Nocturnal nine-hour (10 : 00 pm to 7 : 00 am) for a four-night period were measured. Earplugs and eye mask versus ocean sound were crossed over between two groups. Subjective sleep quality of four nights was assessed using a structured sleep quality scale. Scores for each question range from 0 to 3, with a higher score indicating poor sleep quality.

RESULTS

Repeated measures ANOVA showed that there was a significant change in the sleep quality score (p=0.001), which showed that sleep quality score was improved after the administration of earplugs and eye mask and ocean sound. Fisher's LSD post hoc comparison showed a significant difference (p=0.001).

CONCLUSION

Earplugs and eye mask were better than ocean sound in improving sleep quality. Earplugs, eye mask, and ocean sound are safe and cost effective, which could be used as an adjuvant to pharmacological interventions to improve sleep quality among ICU patients. However, further research in this area needs to be conducted. This trial is registered with NCT03215212.

Effect of Morning Light Glasses and Night Short-Wavelength Filter Glasses on Sleep-Wake Rhythmicity in Medical Inpatients

Sleep and circadian rhythm disorders are common amongst medical inpatients. They are caused by a mixture of factors, including noise, loss of habitual daily routines, and abnormal exposure to light, which tends to be insufficient in the day and too high at night. The aim of the present study was to test the efficacy of morning light therapy plus night short-wavelength filter glasses on sleep quality/timing, and sleepiness/mood over the daytime hours, in a group of well-characterized medical inpatients. Thirty-three inpatients were enrolled and randomized (2:1) to either treatment (n = 22; 13 males, 48.3 ± 13.3 years) or standard of care (n = 11; 8 males, 56.9 ± 12.9 years). On admission, all underwent a baseline assessment of sleep quality/timing and diurnal preference. During hospitalization they underwent monitoring of sleep quality/timing (sleep diaries and actigraphy), plus hourly assessment of sleepiness/mood during the daytime hours on one, standard day of hospitalization. Patients in the treatment arm were administered bright light through glasses immediately after awakening, and wore short-wavelength filter glasses in the evening hours. Treated and untreated patients were comparable in terms of demographics, disease severity/comorbidity, diurnal preference and pre-admission sleep quality/timing. During hospitalization, sleep diaries documented a trend for a lower number of night awakenings in treated compared to untreated patients (1.6 ± 0.8 vs. 2.4 ± 1.3, p = 0.057). Actigraphy documented significantly earlier day mode in treated compared to untreated patients (06:39 ± 00:35 vs. 07:44 ± 00:40, p = 0.008). Sleepiness during a standard day of hospitalization, recorded between 09:30 and 21:30, showed physiological variation in treated compared to untreated patients, who exhibited a more blunted profile. The level of sleepiness reported by treated patients was lower over the 09:30-14:30 interval, i.e., soon after light administration (interaction effect: F = 2.661; p = 0.026). Mood levels were generally higher in treated patients, with statistically significant differences over the 09:30-14:30 time interval, i.e., soon after light administration (treatment: F = 5.692, p = 0.026). In conclusion, treatment with morning bright light and short-wavelength filter glasses in the evening, which was well tolerated, showed positive results in terms of sleepiness/mood over the morning hours and a trend for decreased night awakenings.