Effectiveness of sound and darkness interventions for critically ill patients' sleep quality: A systematic review and component network meta‐analysis

Abstract

BackgroundNoise and lighting are prime factors of poor sleep quality in critically ill patients, which impair recovery and increase the risk of delirium or complications.AimsTo identify and rank the effectiveness of sound and darkness interventions on the sleep quality of critically ill patients.MethodsThis systematic review and component network meta‐analysis was based on the Preferred Reporting Items for Systematic Reviews incorporating the Network Meta‐Analyses (PRISMA‐NMA) Statement. The Embase, MEDLINE, Cochrane CENTRAL, CINAHL, Airiti Library, and Google Scholar databases were searched from inception to August 10, 2021, for randomized controlled trials (RCTs) on sound and darkness interventions targeting critically ill patients' sleep quality. We applied standard and component NMA to determine the effects of interventions. The certainty of evidence was evaluated using the Cochrane risk‐of‐bias tool (V.2.0) and the online Confidence in Network Meta‐Analysis (CINeMA) application.ResultsTwenty‐four RCTs with 1507 participants who used combined interventions constituting seven competing interventions were included in the standard NMA. The combination of earplugs, eye masks, and music; eye masks alone; earplugs combined with eye masks; and music alone had beneficial intervention effects. The combination of earplugs, eye masks, and music was the best intervention, and these components had no interaction effect. An eye mask had the best relative effect, followed by music, quiet time, and earplugs.ConclusionsThis study provides clinical evidence of the effectiveness of using eye masks, music, and earplugs to improve sleep quality in critically ill patients. We also recommend future research using bedtime music, nocturnal eye masks, and quiet time, which had the best relative effects on sleep quality.Relevance to clinical practiceThis study provides recommendations for interventions that nurses can use to improve critically ill patients' sleep quality.

Introduction to the issue and goodbye as co‐editor in chief

“…As the number of our submissions and accepted papers has increased, so too must the number of papers published in our issues, with this issue featuring around 25 papers around a number of themes, such as sleep promotion, 1,2 the impact of COVID-19 on both patients' experiences and nurses, [3][4][5][6][7][8][9] technology use in the intensive care unit (ICU) 10,11 and quantitative research, involving statistics. 1,2,[12][13][14] Our statistical advisor Dr. Chao Huang, in collaboration with the editors, has written an informative guest editorial 15 around why it is so important that nurses can understand basic statistics to be able to read and interpret papers such as these. Many of the papers in this issue are primarily quantitative in nature and use some form of statistical analysis in their results.…”

“…Many of the papers in this issue are primarily quantitative in nature and use some form of statistical analysis in their results. Whether a cross‐sectional survey, 13,16 a randomized clinical trial, 14 a systematic review with meta‐analysis, 1,2,17 a scoping review, 18 a short evidence‐based review 19 or the development and validation of a scale 20,21 all require some basic statistical analysis to analyse their results and draw conclusions. Florence Nightingale was the first nurse to use statistics to show the effects of poor hygiene on mortality during the Crimean War 22 which positively altered the way that care was delivered and saved lives.…”