The Efficacy of Eye Masks and Earplugs Interventions for Sleep Promotion in Critically Ill Patients: A Systematic Review and Meta-Analysis

Abstract

Using physical devices such as eye masks and earplugs to improve to the quality of sleep in intensive care units (ICUs) is a very important issue. This study was conducted to assess the efficacy of eye masks and earplugs for sleep promotion in critically ill adult patients in the ICU based on various sleep quality assessment tools. PubMed, Scopus, Web of Science, and ProQuest were systematically retrieved until May 2021. Both randomized and non-randomized experimental and quasi-experimental studies were included if they evaluated the efficacy of eye masks and earplugs interventions on sleep outcomes in critically ill patients. The methodological quality was assessed by the Joanna Briggs Institute (JBI) critical appraisal tool. For the main outcome (sleep quality), a mean difference (MD) and confidence intervals (CIs) of 95% were determined. A total of 2,687 participants from 35 studies met the inclusion criteria. Twenty one studies were included in meta-analysis and 14 studies were included in the qualitative analysis. According to the results based on sleep quality assessment tools; overall scores of Pittsburgh Sleep Quality Index (PSQI) and Richards-Campbell Sleep Questionnaire (RCSQ), eye mask and/or earplug interventions have a positive effect on sleep quality. Based on Verran-Snyder-Halpern Sleep Scale (VSHSS), sleep disturbance was significantly lower in the intervention groups. In terms of polysomnography, the use of eye masks and/or earplugs resulted in a significant increase in total sleep time, sleep efficiency, rapid eye movement (REM) time, significant reduction of awaking, and sleep arousals index. The results of the present study suggest that the use of earplugs or eye masks, separately or combined affects sleep improvement in critically ill patients.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=145830, PROSPERO: CRD42020145830.

The effects of eye masks and earplugs on sleep quality, anxiety, fear, and vital signs in patients in an intensive care unit: A randomised controlled study

“…In a different meta-analysis, it was reported that eye masks and earplugs provided a significant increase in total sleep time, sleep efficiency, REM time, and a significant decrease in awakening (Karimi et al, 2021). Different studies support the results of the study, reporting a positive effect of eye masks and earplugs on sleep quality (Dave et al, 2015;Hu et al, 2010;Koçak & Arslan, 2021).…”

“…It has been reported that in reducing noise and controlling light, eye mask and earplug use may be better than other interventions (Karimi et al, 2021). In order to increase sleep quality, nurses should determine and implement the appropriate nursing intervention for the patient who has sleep problems.…”

Society of Anesthesia and Sleep Medicine Position Paper on Patient Sleep During Hospitalization

“…107,108 Apart from care to reduce noise and lighting levels when practicable, earplugs and eye masks can be used to reduce the impact of these factors. 109 Aligning lighting levels, noise levels, mealtimes, and designated sleep times with the biological clock may also act to preserve and reinforce the natural circadian day-night/wake-sleep cycle.…”

Sleep disruption in older surgical patients and its important implications

“…As mentioned above, external factors such as those driven by overnight hospitalization can severely impact a patient’s sleep. One approach to improving sleep is aimed at modulating environmental factors such as light and noise using eye masks and ear plugs or minimizing overnight disruptions 101,102…”

“…One approach to improving sleep is aimed at modulating environmental factors such as light and noise using eye masks and ear plugs or minimizing overnight disruptions. 101,102 Sleep hygiene education is targeted to address habitual behaviors that may be an impediment to sleep initiation and maintenance. It has been shown to improve sleep quality in hospitalized patients.…”