Delirium, Earplugs, Eye masks, Intensive care unit, Light and noise control, Sleep quality
Citation Information :
Arttawejkul P, Reutrakul S, Muntham D, Chirakalwasan N. Effect of Nighttime Earplugs and Eye Masks on Sleep Quality in Intensive Care Unit Patients. Indian J Crit Care Med 2020; 24 (1):6-10.
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.
Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med 2001;163(2):451–457. DOI: 10.1164/ajrccm.163.2.9912128.
Bihari S, Doug McEvoy R, Matheson E, Kim S, Woodman RJ, Bersten AD. Factors affecting sleep quality of patients in intensive care unit. J Clin Sleep Med 2012;8(3):301–307. DOI: 10.5664/jcsm.1920.
Gabor JY, Cooper AB, Crombach SA, Lee B, Kadikar N, Bettger HE, et al. Contribution of the intensive care unit environment to sleep disruption in mechanically ventilated patients and healthy subjects. Am J Respir Crit Care Med 2003;167(5):708–715. DOI: 10.1164/rccm.2201090.
Chen HI, Tang YR. Sleep loss impairs inspiratory muscle endurance. Am Rev Respir Dis 1989;140(4):907–909. DOI: 10.1164/ajrccm/140.4.907.
Weinhouse GL, Schwab RJ, Watson PL, Patil N, Vaccaro B, Pandharipande P, et al. Bench-to-bedside review: delirium in ICU patients - importance of sleep deprivation. Crit Care 2009;13(6):234. DOI: 10.1186/cc8131.
Spiegel K, Sheridan JF, Van Cauter E. Effect of sleep deprivation on response to immunization. JAMA 2002;288(12):1471–1472. DOI: 10.1001/jama.288.12.1469.
Kamdar BB, King LM, Collop NA, Sakamuri S, Colantuoni E, Neufeld KJ, et al. The effect of a quality improvement intervention on perceived sleep quality and cognition in a medical ICU. Crit Care Med 2013;41(3):800–809. DOI: 10.1097/CCM.0b013e3182746442.
Kollef MH, Levy NT, Ahrens TS, Schaiff R, Prentice D, Sherman G. The use of continuous i.v. sedation is associated with prolongation of mechanical ventilation. Chest 1998;114(2):541–548. DOI: 10.1378/chest.114.2.541.
Hu RF, Jiang XY, Chen J, Zeng Z, Chen XY, Li Y, et al. Non-pharmacological interventions for sleep promotion in the intensive care unit. Cochrane Database Syst Rev 2015;10:CD008808. DOI: 10.1002/14651858.CD008808.pub2.
DuBose JR, Hadi K. Improving inpatient environments to support patient sleep. Int J Qual Health Care 2016;28(5):540–553. DOI: 10.1093/intqhc/mzw079.
Le Guen M, Nicolas-Robin A, Lebard C, Arnulf I, Langeron O. Earplugs and eye masks vs routine care prevent sleep impairment in post-anaesthesia care unit: a randomized study. Br J Anaesth 2014;112(1):89–95. DOI: 10.1093/bja/aet304.
Miranda DR, de Rijk A, Schaufeli W. Simplified therapeutic intervention scoring system: the TISS-28 items–results from a multicenter study. Crit Care Med 1996;24(1):64–73. DOI: 10.1097/00003246-199601000-00012.
Berry BB, Brooks R, Gamaldo CE, Harding SM, Lloyd RM, Marcus CL, et al. For the American Academy of Sleep Medicine. In: The ASSM Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Version 2.3. Darien, Illinois: American Academy of Sleep Medicine; 2016.
Sitasuwan T, Bussaratid S, Ruttanaumpawan P, Chotinaiwattarakul W. Reliability and validity of the Thai version of the Pittsburgh Sleep Quality Index. J Med Assoc Thai 2014;97(Suppl 3):S57–S67.
Richards KC, O’Sullivan PS, Phillips RL. Measurement of sleep in critically ill patients. J Nurs Meas 2000;8(2):131–144. DOI: 10.1891/1061-37220.127.116.11.
Snyder-Halpern R, Verran JA. Instrumentation to describe subjective sleep characteristics in healthy subjects. Res Nurs Health 1987;10(3):155–163. DOI: 10.1002/nur.4770100307.
Huang HW, Zheng BL, Jiang L, Lin ZT, Zhang GB, Shen 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? Crit Care 2015;19:124. DOI: 10.1186/s13054-015-0842-8.
Van Rompaey B, Elseviers MM, Van Drom W, Fromont V, Jorens PG. The effect of earplugs during the night on the onset of delirium and sleep perception: a randomized controlled trial in intensive care patients. Crit Care 2012;16(3):R73. DOI: 10.1186/cc11330.
Daneshmandi M, Neiseh F, SadeghiShermeh M, Ebadi A. Effect of eye mask on sleep quality in patients with acute coronary syndrome. J Caring Sci 2012;1(3):135–143. DOI: 10.5681/jcs.2012.020.
Babaii A, Adib-Hajbaghery M, Hajibagheri A. Effect of using eye mask on sleep quality in cardiac patients: a randomized controlled trial. Nurs Midwifery Stud 2015;4(4):e28332. DOI: 10.17795/nmsjournal28332.
Wallace CJ, Robins J, Alvord LS, Walker JM. The effect of earplugs on sleep measures during exposure to simulated intensive care unit noise. Am J Crit Care 1999;8(4):210–219. DOI: 10.4037/ajcc1918.104.22.168.
Hu RF, Jiang XY, Zeng YM, Chen XY, Zhang YH. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care 2010;14(2):R66. DOI: 10.1186/cc8965.
Taylor KS, Murai H, Millar PJ, Haruki N, Kimmerly DS, Morris BL, et al. Arousal from sleep and sympathetic excitation during wakefulness. Hypertension 2016;68(6):1467–1474. DOI: 10.1161/HYPERTENSIONAHA.116.08212.
Suzuki M, Shimamoto K, Sekiguchi H, Harada T, Satoya N, Inoue Y, et al. Arousal index as a marker of carotid artery atherosclerosis in patients with obstructive sleep apnea syndrome. Sleep Breath 2019;23(1):87–94. DOI: 10.1007/s11325-018-1664-0.
Zinchuk AV, Jeon S, Koo BB, Yan X, Bravata DM, Qin L, et al. Polysomnographic phenotypes and their cardiovascular implications in obstructive sleep apnoea. Thorax 2018;73(5):472–480. DOI: 10.1136/thoraxjnl-2017-210431.
Winkelman C, Higgins PA, Chen YJ, Levine AD. Cytokines in chronically critically ill patients after activity and rest. Biol Res Nurs 2007;8(4):261–271. DOI: 10.1177/1099800406298168.
Winkelman C. Investigating activity in hospitalized patients with chronic obstructive pulmonary disease: a pilot study. Heart Lung 2010;39(4):319–330. DOI: 10.1016/j.hrtlng.2009.09.004.
Morris PE, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early intensive care unit mobility therapy in the treatment of acute respiratory failure. Crit Care Med 2008;36(8):2238–2243. DOI: 10.1097/CCM.0b013e318180b90e.
Routsi C, Gerovasili V, Vasileiadis I, Karatzanos E, Pitsolis T, Tripodaki E, et al. Electrical muscle stimulation prevents critical illness polyneuromyopathy: a randomized parallel intervention trial. Crit Care 2010;14(2):R74. DOI: 10.1186/cc8987.
Patel BK, Pohlman AS, Hall JB, Kress JP. Impact of early mobilization on glycemic control and ICU-acquired weakness in critically ill patients who are mechanically ventilated. Chest 2014;146(3):583–589. DOI: 10.1378/chest.13-2046.
Schweickert WD, Pohlman MC, Pohlman AS, Nigos C, Pawlik AJ, Esbrook CL, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet 2009;373(9678):1874–1882. DOI: 10.1016/S0140-6736(09)60658-9.
Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep 2003;26(3):342–392. DOI: 10.1093/sleep/26.3.342.
Kamdar BB, Kadden DJ, Vangala S, Elashoff DA, Ong MK, Martin JL, et al. Feasibility of continuous actigraphy in patients in a medical intensive care unit. Am J Crit Care 2017;26(4):329–335. DOI: 10.4037/ajcc2017660.
Schwab KE, Ronish B, Needham DM, To AQ, Martin JL, Kamdar BB. Actigraphy to evaluate sleep in the intensive care unit. A systematic review. Ann Am Thorac Soc 2018;15(9):1075–1082. DOI: 10.1513/AnnalsATS.201801-004OC.
Knauert MP, Yaggi HK, Redeker NS, Murphy TE, Araujo KL, Pisani MA. Feasibility study of unattended polysomnography in medical intensive care unit patients. Heart Lung 2014;43(5):445–452. DOI: 10.1016/j.hrtlng.2014.06.049.