1. In this systematic review and meta-analysis, it was found that among critically ill patients in the intensive care unit, the combination of earplugs, eye masks, and music was the most effective for improving sleep quality.
2. Individually, the most to least effective interventions for better sleep quality were the following: eye masks, bedtime music, quiet time, and earplugs.
Evidence Rating Level: 1 (Excellent)
Sleep quality in the intensive care unit (ICU) is often poor due to high levels of noise and nighttime light. Poor sleep can cause delayed recovery, delirium, and sleep fragmentation for up to a year after discharge in patients with critical illness. While medications for better sleep are available, they have undesirable side effects and may increase the risk of delirium in vulnerable patients. Previous systematic reviews have found that non-pharmaceutical interventions such as earplugs, eye masks, quiet time, and music therapy can be effective in improving sleep quality in ICU patients. The purpose of the present study was to determine the most effective sound and light interventions for improving sleep quality in the ICU.
Of 967 identified records, 24 (n=1507 patients) randomized controlled trials were included from a variety of sources from database inception to August 2021. Studies were included if they evaluated at least one non-pharmaceutical sleep intervention in an adult critical care population and assessed subjective sleep quality as an outcome variable. Studies were excluded if they assessed the efficacy of drug interventions. This meta-analysis was conducted according to PRISMA guidelines and used the Cochrane risk-of-bias tool as well as the Confidence in Network Meta-Analysis application to evaluate risk of bias. A random-effects standard network meta-analysis was performed to determine the effects of sleep interventions. The primary outcome was sleep quality.
The results indicated that a combination of earplugs, eye masks, and music was the most effective intervention for improving sleep quality in the ICU population. When used alone, eye masks were the most effective intervention, followed by bedtime music, quiet time, and earplugs, which had the lowest effect. However, it should be noted that the study only included conscious patients, and therefore the findings may not be generalizable to all ICU populations. Nonetheless, the study highlighted the clinical implications of sound and darkness interventions, which are accessible, non-invasive, and cost-effective methods to improve sleep quality in the ICU.
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