Effect of Nighttime Earplugs and Eye Masks on Sleep Quality in Intensive Care Unit Patients

Abstract

Purpose: Poor sleep quality in intensive care unit (ICU) can be associated with poor outcome. Excessive noise and lights in ICU are known to disrupt patients' sleep by causing arousals. Study design: A prospective randomized controlled study. Materials and methods:The patients admitted to the medical ICU were prospectively included and randomized to receive earplugs and eye masks or no intervention during their first 5 nights in ICU. Their arousal index and other sleep parameters were measured during the first night by polysomnography. Secondary outcomes including wrist actigraphy profiles and subjective sleep quality were recorded during all study nights. Results: Seventeen patients were enrolled. Eight patients were randomized to earplugs and eye masks group and nine patients were randomized to control group during their first 5 nights in the ICU. The use of earplugs and eye masks demonstrated the trend toward lower arousal index during the first night (21.15 (14.60) vs 42.10 (18.20) events per hour, p = 0.086) and increased activity index (activity count/hour) (16.12 (7.99) vs 10.84 (10.39) count/hour, p = 0.059) compared to control group. Polysomnography and actigraphy did not demonstrate good agreement. Conclusion:The use of earplugs and eye masks has a trend toward reduction in arousal index and increased activity in patients admitted to ICU. Limited sample size most likely explained insignificant difference in outcomes. Wrist actigraphy did not accurately measure sleep parameters in ICU patients. Trial registration: www.clinicaltrials.in.th, TCTR20170727003.

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

“…The studies were conducted in USA ( 14 , 21 , 36 , 48 , 50 , 51 ), UK ( 13 , 22 , 43 ), Belgium ( 23 ), China ( 24 , 25 , 27 , 38 ), Iran ( 26 , 28 – 32 , 35 , 39 , 42 , 49 ), France ( 33 , 34 ), India ( 37 , 41 , 46 ), Australia ( 40 ), Jordan ( 44 ), Canada ( 45 ), Turkey ( 47 ), Egypt ( 52 ), and Singapore ( 53 ). Twenty eligible studies were RCTs ( 23 , 24 , 26 , 28 , 29 , 33 – 35 , 37 – 43 , 46 , 48 , 51 – 53 ), six were randomized quasi-experimental ( 3 , 21 , 25 , 27 , 30 ), four were pre-post studies ( 5 , 22 , 31 , 47 ), two were randomized cross-over studies ( 32 , 49 ), and three were non-randomized quasi-experimental ( 13 , 14 , 45 ). Twenty-four trials were conducted in ICU which including medical ICU ( 5 , 41 , 46 ), cardiac ICU ( 13 ), general ICU ( 22 , 33 ...…”

“…Twenty eligible studies were RCTs ( 23 , 24 , 26 , 28 , 29 , 33 – 35 , 37 – 43 , 46 , 48 , 51 – 53 ), six were randomized quasi-experimental ( 3 , 21 , 25 , 27 , 30 ), four were pre-post studies ( 5 , 22 , 31 , 47 ), two were randomized cross-over studies ( 32 , 49 ), and three were non-randomized quasi-experimental ( 13 , 14 , 45 ). Twenty-four trials were conducted in ICU which including medical ICU ( 5 , 41 , 46 ), cardiac ICU ( 13 ), general ICU ( 22 , 33 , 37 , 44 , 53 ), surgical ICU ( 32 , 40 , 48 , 51 ), mixed medical and surgical ICU ( 23 , 43 ), mixed medical and cardiac ICU ( 14 ), mixed medical and general ICU ( 42 , 45 , 50 ), neurology ICU ( 47 ), cardiac surgery intensive care unit (CSICU) ( 24 , 52 ), and post-anesthesia care units (PACUs) ( 34 ). Nine trials were conducted in coronary care unit (CCU) ( 26 – 31 , 35 , 39 , 49 ), and three trials were conducted in simulated ICU environment among healthy subjects ( 21 , 25 , 38 ).…”

“…Several sleep assessment tools have been used in the reviewed studies. The majority of the publications used subjective tools, while only five of them employed the form of objective evaluation ( 21 , 25 , 33 , 38 , 46 ). Polysomnography (PSG) was the only form of objective method of assessment that used in these studies.…”

“…Polysomnography (PSG) was the only form of objective method of assessment that used in these studies. Among the subjective tools for sleep evaluation, the Richards- Campbell Sleep Questionnaire (RCSQ) ( 5 , 24 , 44 , 46 – 48 , 51 – 54 ), and the Verran and Snyder-Halpern Sleep Scale (VSHSS) ( 14 , 27 , 31 , 32 , 37 , 42 , 45 , 49 ) were the most frequently used in 11 and eight studies, respectively. Five trials used Pittsburgh sleep quality index (PSQI) as sleep assessment tool ( 26 , 28 , 29 , 35 , 39 ).…”

“…Ten studies ( 3 , 5 , 24 , 40 , 46 – 48 , 51 – 53 ), with 1,078 participants (568 and 510 patients in the intervention and control group, respectively), reported data on sleep outcomes using the RCSQ scale. RCSQ responses were graded on a 0–100 mm visual analog scale, with higher scores indicating better sleep.…”