The Impact of Earplugs and Eye Masks on Sleep Quality in Surgical ICU Patients at Risk for Frequent Awakenings

Abstract

OBJECTIVES: Sleep disturbances may contribute to the development of delirium, prolonged ICU stay, and increased mortality. There is conflicting data on the effectiveness of earplugs and eye masks for sleep promotion in the ICU. This study evaluates the impact of earplugs and eye masks on sleep quality in postoperative surgical ICU patients at risk for frequent awakenings. DESIGN: Prospective randomized controlled trial. SETTING: Surgical ICU within the University of Texas Southwestern Medical Center. PATIENTS: Adult, female patients admitted to the surgical ICU requiring hourly postoperative assessments following breast free flap surgery between February 2018 and October 2019. INTERVENTIONS: Patients were randomized into an intervention group or a control group. The intervention group received earplugs and eye masks in addition to standard postoperative care, whereas the control group received standard postoperative care. MEASUREMENTS AND MAIN RESULTS: The primary outcome was overall sleep quality assessed via the Richards-Campbell Sleep Questionnaire. Secondary outcomes of patient satisfaction and rates of ICU delirium were assessed with a modified version of the Family Satisfaction in the ICU survey and the Confusion Assessment Method for the ICU. After a planned interim analysis, the study was stopped early because prespecified criteria for significance were attained. Compared with the control group’s average Richards-Campbell Sleep Questionnaire total score of 47.3 (95% CI, 40.8–53.8), the intervention group’s average Richards-Campbell Sleep Questionnaire total score was significantly higher at 64.5 (95% CI, 58.3–70.7; p = 0.0007). There were no significant between-group differences for Confusion Assessment Method for the ICU scores or modified Family Satisfaction in the ICU survey scores. CONCLUSIONS: These results suggest that earplugs and eye masks are effective in improving sleep quality in ICU patients undergoing frequent assessments. The results strengthen the evidence for nonpharmacologic sleep-promoting adjuncts in the ICU.

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

“…The studies were conducted in USA ( 14 , 21 , 36 , 48 , 50 , 51 ), UK ( 13 , 22 , 43 ), Belgium ( 23 ), China ( 24 , 25 , 27 , 38 ), Iran ( 26 , 28 – 32 , 35 , 39 , 42 , 49 ), France ( 33 , 34 ), India ( 37 , 41 , 46 ), Australia ( 40 ), Jordan ( 44 ), Canada ( 45 ), Turkey ( 47 ), Egypt ( 52 ), and Singapore ( 53 ). Twenty eligible studies were RCTs ( 23 , 24 , 26 , 28 , 29 , 33 – 35 , 37 – 43 , 46 , 48 , 51 – 53 ), six were randomized quasi-experimental ( 3 , 21 , 25 , 27 , 30 ), four were pre-post studies ( 5 , 22 , 31 , 47 ), two were randomized cross-over studies ( 32 , 49 ), and three were non-randomized quasi-experimental ( 13 , 14 , 45 ). Twenty-four trials were conducted in ICU which including medical ICU ( 5 , 41 , 46 ), cardiac ICU ( 13 ), general ICU ( 22 , 33 ...…”

“…Twenty eligible studies were RCTs ( 23 , 24 , 26 , 28 , 29 , 33 – 35 , 37 – 43 , 46 , 48 , 51 – 53 ), six were randomized quasi-experimental ( 3 , 21 , 25 , 27 , 30 ), four were pre-post studies ( 5 , 22 , 31 , 47 ), two were randomized cross-over studies ( 32 , 49 ), and three were non-randomized quasi-experimental ( 13 , 14 , 45 ). Twenty-four trials were conducted in ICU which including medical ICU ( 5 , 41 , 46 ), cardiac ICU ( 13 ), general ICU ( 22 , 33 , 37 , 44 , 53 ), surgical ICU ( 32 , 40 , 48 , 51 ), mixed medical and surgical ICU ( 23 , 43 ), mixed medical and cardiac ICU ( 14 ), mixed medical and general ICU ( 42 , 45 , 50 ), neurology ICU ( 47 ), cardiac surgery intensive care unit (CSICU) ( 24 , 52 ), and post-anesthesia care units (PACUs) ( 34 ). Nine trials were conducted in coronary care unit (CCU) ( 26 – 31 , 35 , 39 , 49 ), and three trials were conducted in simulated ICU environment among healthy subjects ( 21 , 25 , 38 ).…”

“…Polysomnography (PSG) was the only form of objective method of assessment that used in these studies. Among the subjective tools for sleep evaluation, the Richards- Campbell Sleep Questionnaire (RCSQ) ( 5 , 24 , 44 , 46 – 48 , 51 – 54 ), and the Verran and Snyder-Halpern Sleep Scale (VSHSS) ( 14 , 27 , 31 , 32 , 37 , 42 , 45 , 49 ) were the most frequently used in 11 and eight studies, respectively. Five trials used Pittsburgh sleep quality index (PSQI) as sleep assessment tool ( 26 , 28 , 29 , 35 , 39 ).…”

“…Ten studies ( 3 , 5 , 24 , 40 , 46 – 48 , 51 – 53 ), with 1,078 participants (568 and 510 patients in the intervention and control group, respectively), reported data on sleep outcomes using the RCSQ scale. RCSQ responses were graded on a 0–100 mm visual analog scale, with higher scores indicating better sleep.…”

“…However, no significant difference was identified for sleep components based on PSQI score ( 26 , 28 , 29 ). Eleven studies reported the efficacy of eye masks and/or earplugs interventions on the overall sleep quality of critically ill patients using the RCSQ, and statistical significance in meta-analyses was observed, especially with respect to sleep depth, sleep latency, number of awakenings, sleep efficiency, and sleep quality ( 3 , 5 , 24 , 40 , 46 – 48 , 51 – 53 ). Based on three studies, a positive effect of using eye masks and/or earplugs on domains of sleep disturbance via VSHSS was observed ( 31 , 32 , 49 ).…”