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

Abhilasha Chaudhary, Vinay Kumari, Neetu Neetu, Abhilasha Chaudhary, Vinay Kumari, Neetu Neetu

Abstract

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.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2020 Abhilasha Chaudhary et al.

Figures

Figure 1
Figure 1
Flowchart of the study.
Figure 2
Figure 2
Factors affecting sleep at home before hospitalization.
Figure 3
Figure 3
Factors affecting sleep in the ICU.

References

    1. Daneshmandi M., Neiseh F., SadeghiShermeh M., Ebadi A. Effect of eye mask on sleep quality in patients with acute coronary syndrome. Journal of Caring Sciences. 2012;1(3):p. 135. doi: 10.5681/jcs.2012.020.
    1. Patel M., Chipman J., Carlin B. W., Shade D. Sleep in the intensive care unit setting. Critical Care Nursing Quarterly. 2008;31(4):309–318. doi: 10.1097/01.cnq.0000336816.89300.41.
    1. Beltrami F. G., Nguyen X.-L., Pichereau C., Maury E., Fleury B., Fagondes S. Sleep in the intensive care unit. Jornal Brasileiro de Pneumologia. 2015;41(6):539–546. doi: 10.1590/s1806-37562015000000056.
    1. Pisani M. A., Friese R. S., Gehlbach B. K., Schwab R. J., Weinhouse G. L., Jones S. F. Sleep in the intensive care unit. American Journal of Respiratory and Critical Care Medicine. 2015;191(7):731–738. doi: 10.1164/rccm.201411-2099ci.
    1. Altman M. T., Knauert M. P., Pisani M. A. Sleep disturbance after hospitalization and critical illness: a systematic review. Annals of the American Thoracic Society. 2017;14(9):1457–1468. doi: 10.1513/annalsats.201702-148sr.
    1. Bihari S., Doug McEvoy R., Matheson E., Kim S., Woodman R. J., Bersten A. D. Factors affecting sleep quality of patients in intensive care unit. Journal of Clinical Sleep Medicine. 2012;8(3):301–307. doi: 10.5664/jcsm.1920.
    1. Matthews E. E. Sleep disturbances and fatigue in critically ill patients. AACN Advanced Critical Care. 2011;22(3):204–224. doi: 10.1097/nci.0b013e31822052cb.
    1. Lewandowska K., Medrzycka-Dabrowska W., Kwiecien-Jagus K. Czyz-Szypenbejl K. Factors determining sleep in patients hospitalised in ICUs in a hospital in Northern Poland. Sleep and Biological Rhythms. 2019;17(2):243–250. doi: 10.1007/s41105-019-00207-2.
    1. Delaney L. J., Van Haren F., Lopez V. Sleeping on a problem: the impact of sleep disturbance on intensive care patients-a clinical review. Annals of Intensive Care. 2015;5(1):1–10. doi: 10.1186/s13613-015-0043-2.
    1. Ding Q., Redeker N. S., Pisani M. A., Yaggi H. K., Knauert M. P. Factors influencing patients’ sleep in the intensive care unit: perceptions of patients and clinical staff. American Journal of Critical Care. 2017;26(4):278–286. doi: 10.4037/ajcc2017333.
    1. Gabor J. Y., Cooper A. B., Hanly P. J. Sleep disruption in the intensive care unit. Current Opinion in Critical Care. 2001;7(1):21–27. doi: 10.1097/00075198-200102000-00004.
    1. Berglund B., Lindvall T., Schwela D. H. Guidelines for Community Noise Geneva. Geneva, Switzerland: World Health Organization; 1999.
    1. Hu R. F., Jiang X. Y., Zeng Y. M., Chen X. Y., Zhang Y. H. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Critical Care. 2010;14(2):p. 18. doi: 10.1186/cc8965.
    1. Simons K. S., Verweij E., Lemmens P. M. C., et al. Noise in the intensive care unit and its influence on sleep quality: a multicenter observational study in Dutch intensive care units. Critical Care. 2018;22(1):018–2182. doi: 10.1186/s13054-018-2182-y.
    1. Huang H. W., Zheng B. L., Jiang L., et al. Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation? Critical Care. 2015;19(1):015–0842. doi: 10.1186/s13054-015-0842-8.
    1. Brown G. M. Light, melatonin and the sleep-wake cycle. Journal of Psychiatry and Neuroscience. 1994;19(5):p. 345.
    1. Spencer J. A., Moran D. J., Lee A., Talbert D. White noise and sleep induction. Archives of Disease in Childhood. 1990;65(1):135–137. doi: 10.1136/adc.65.1.135.
    1. Sandoval C. P. Nonpharmacological interventions for sleep promotion in the intensive care unit. Critical Care Nurse. 2017;37(2):100–102. doi: 10.4037/ccn2017855.
    1. Brito R. A., Viana S. M. R., Beltrao B. A., de Araujo Magalhaes C. B., de Bruin V. M. S., de Bruin P. F. C. Pharmacological and non-pharmacological interventions to promote sleep in intensive care units: a critical review. Sleep and Breathing. 2019:1–11.
    1. Mashayekhi F., Rafiei H., Arab M., Abazari F., Ranjbar H. The effect of sleep quality on patients in a coronary care unit. British Journal of Cardiac Nursing. 2013;8(9):443–447. doi: 10.12968/bjca.2013.8.9.443.
    1. Babaii A., Adib-Hajbaghery M., Hajibagheri A. Effect of using eye mask on sleep quality in cardiac patients: a randomized controlled trial. Nursing and Midwifery Studies. 2015;4(4) doi: 10.17795/nmsjournal28332.
    1. Dave K., Qureshi A., Gopichandran L. Effects of earplugs and eye masks on perceived quality of sleep during night among patients in intensive care units. Asian Journal of Nursing Education and Research. 2015;5(3):319–322. doi: 10.5958/2349-2996.2015.00065.8.
    1. Demoule A., Carreira S., Lavault S., et al. Impact of earplugs and eye mask on sleep in critically ill patients: a prospective randomized study. Critical Care. 2017;21(1):p. 284. doi: 10.1186/s13054-017-1865-0.
    1. Locihova H., Axmann K., Padysakova H., Fejfar J. Effect of the use of earplugs and eye mask on the quality of sleep in intensive care patients: a systematic review. Journal of Sleep Research. 2018;27(3):p. 12607. doi: 10.1111/jsr.12607.
    1. Sweity S., Finlay A., Lees C., Monk A., Sherpa T., Wade D. SleepSure: a pilot randomized-controlled trial to assess the effects of eye masks and earplugs on the quality of sleep for patients in hospital. Clinical Rehabilitation. 2019;33(2):253–261. doi: 10.1177/0269215518806041.
    1. Bani Younis M. K., Hayajneh F. A., Alduraidi H. Effectiveness of using eye mask and earplugs on sleep length and quality among intensive care patients: a quasi‐experimental study. International Journal of Nursing Practice. 2019;25(3):p. 12740. doi: 10.1111/ijn.12740.
    1. Afshar P. F., Bahramnezhad F., Asgari P., Shiri M. Effect of white noise on sleep in patients admitted to a coronary care. Journal of Caring Sciences. 2016;5(2):p. 103.
    1. Stanchina M. L., Abu-Hijleh M., Chaudhry B. K., Carlisle C. C., Millman R. P. The influence of white noise on sleep in subjects exposed to ICU noise. Sleep Medicine. 2005;6(5):423–428. doi: 10.1016/j.sleep.2004.12.004.
    1. Williamson J. The effects of ocean sounds on sleep after coronary artery bypass graft surgery. American Journal of Critical Care. 1992;1(1):91–97. doi: 10.4037/ajcc1992.1.1.91.
    1. Litton E., Elliott R., Thompson K. Earplugs in the ICU: to sleep, to dream. Critical Care. 2018;22(1):48. doi: 10.1186/s13054-018-1954-8.
    1. Buysse D. J., Reynolds C. F., Monk T. H., Berman S. R., Kupfer D. J. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research. 1989;28(2):193–213. doi: 10.1016/0165-1781(89)90047-4.
    1. Shahid A., Wilkinson K., Macsu S., Caprio C. M. STOP THAT and One Hundred Other Sleep Scales. NY, USA: Springer; 2012.
    1. Hu R.-F., Jiang X.-Y., Hegadoren K. M., Zhang Y.-H. Effects of earplugs and eye masks combined with relaxing music on sleep, melatonin and cortisol levels in ICU patients: a randomized controlled trial. Critical Care. 2015;19(1):115. doi: 10.1186/s13054-015-0855-3.
    1. Stewart J. A., Green C., Stewart J., Tiruvoipati R. Factors influencing quality of sleep among non-mechanically ventilated patients in the intensive care unit. Australian Critical Care. 2017;30(2):85–90. doi: 10.1016/j.aucc.2016.02.002.
    1. Freedman N. S., Kotzer N., Schwab R. J. Patient perception of sleep quality and etiology of sleep disruption in the intensive care unit. American Journal of Respiratory and Critical Care Medicine. 1999;159(4):1155–1162. doi: 10.1164/ajrccm.159.4.9806141.
    1. Hale L. Who has time to sleep? Journal of Public Health. 2005;27(2):205–211. doi: 10.1093/pubmed/fdi004.
    1. Grandner M. A., Patel N. P., Gehrman P. R., et al. Who gets the best sleep? Ethnic and socioeconomic factors related to sleep complaints. Sleep Medicine. 2010;11(5):470–478. doi: 10.1016/j.sleep.2009.10.006.
    1. Krause N., Ironson G. Is involvement in religion associated with better sleep quality? Pastoral Psychology. 2017;66(5):595–608. doi: 10.1007/s11089-017-0766-0.
    1. Dobing S., Frolova N., McAlister F., Ringrose J. Sleep quality and factors influencing self-reported sleep duration and quality in the general internal medicine inpatient population. PLoS One. 2016;11(6) doi: 10.1371/journal.pone.0156735.
    1. Yazdannik A. R., Zareie A., Hasanpour M., Kashefi P. The effect of earplugs and eye mask on patients’ perceived sleep quality in intensive care unit. Iranian Journal of Nursing and Midwifery Research. 2014;19(6):p. 673.
    1. Simons K. S., Van den Boogaard M., de Jager C. P. C. Impact of intensive care unit light and noise exposure on critically ill patients. Netherland Journal of Critical care. 2019;27(4):145–149.
    1. Krogh H. B., Storebø O. J., Faltinsen E., et al. Methodological advantages and disadvantages of parallel and crossover randomised clinical trials on methylphenidate for attention deficit hyperactivity disorder: a systematic review and meta-analyses. BMJ Open. 2019;9(3) doi: 10.1136/bmjopen-2018-026478.2018-026478
    1. Richardson A., Allsop M., Coghill E., Turnock C. Earplugs and eye masks: do they improve critical care patients’ sleep? Nursing in Critical Care. 2007;12(6):278–286. doi: 10.1111/j.1478-5153.2007.00243.x.

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