Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment

Rong-fang Hu, Xiao-ying Jiang, Yi-ming Zeng, Xiao-yang Chen, You-hua Zhang, Rong-fang Hu, Xiao-ying Jiang, Yi-ming Zeng, Xiao-yang Chen, You-hua Zhang

Abstract

Introduction: Environmental stimulus, especially noise and light, is thought to disrupt sleep in patients in the intensive care unit (ICU). This study aimed to determine the physiological and psychological effects of ICU noise and light, and of earplugs and eye masks, used in these conditions in healthy subjects.

Methods: Fourteen subjects underwent polysomnography under four conditions: adaptation, baseline, exposure to recorded ICU noise and light (NL), and NL plus use of earplugs and eye masks (NLEE). Urine was analyzed for melatonin and cortisol levels. Subjects rated their perceived sleep quality, anxiety levels and perception of environmental stimuli.

Results: Subjects had poorer perceived sleep quality, more light sleep, longer rapid eye movement (REM) latency, less REM sleep when exposed to simulated ICU noise and light (P < 0.05). Nocturnal melatonin (P = 0.007) and cortisol secretion levels (P = 0.004) differed significantly by condition but anxiety levels did not (P = 0.06). Use of earplugs and eye masks resulted in more REM time, shorter REM latency, less arousal (P < 0.05) and elevated melatonin levels (P = 0.002).

Conclusions: Earplugs and eye masks promote sleep and hormone balance in healthy subjects exposed to simulated ICU noise and light, making their promotion in ICU patients reasonable.

Figures

Figure 1
Figure 1
Study design.
Figure 2
Figure 2
Example of sleep histograms from the same subject. Less rapid eye movement (REM) time, longer REM latency as exposure to recorded ICU noise and light. NL, recorded ICU noise and light exposure; NLEE, recorded ICU noise and light, subjects wore earplugs and eye masks.
Figure 3
Figure 3
Urinary excretion of 6-SMT for different study conditions. Nocturnal urine 6-SMT concentration during baseline, NL and NLEE nights were 26.5 ± 20.0, 15.1 ± 13.6, and 22.3 ± 22.9 μg/kg, respectively. 6-SMT, 6-sulphatoxymelatonin; NL, recorded ICU noise and light exposure; NLEE, recorded ICU noise and light, subjects wore earplugs and eye masks.
Figure 4
Figure 4
Urinary excretion of cortisol for different study conditions. Nocturnal urine cortisol concentration during baseline, NL and NLEE nights were 2.0 ± 1.6, 4.0 ± 2.4, and 3.2 ± 2.1 μg/kg, respectively. NL, recorded ICU noise and light exposure; NLEE, recorded ICU noise and light, subjects wore earplugs and eye masks.

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