The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis

Litton, E; Carnegie, V; Elliott, R; Webb, SAR

The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis

Litton, E Carnegie, V Elliott, R

Webb, SAR

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Publication Type:: Journal Article
Citation:: Critical Care Medicine, 2016, 44 (5), pp. 992 - 999
Issue Date:: 2016-05-01

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Field	Value	Language
dc.contributor.author	Litton, E	en_US
dc.contributor.author	Carnegie, V	en_US
dc.contributor.author	Elliott, R https://orcid.org/0000-0002-9239-7126	en_US
dc.contributor.author	Webb, SAR	en_US
dc.date.issued	2016-05-01	en_US
dc.identifier.citation	Critical Care Medicine, 2016, 44 (5), pp. 992 - 999	en_US
dc.identifier.issn	0090-3493	en_US
dc.identifier.uri	http://hdl.handle.net/10453/125432
dc.description.abstract	Objective: A systematic review and meta-analysis to assess the efficacy of earplugs as an ICU strategy for reducing delirium. Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of controlled trials were searched using the terms "intensive care," "critical care," "earplugs," "sleep," "sleep disorders," and "delirium." Study Selection: Intervention studies (randomized or nonrandomized) assessing the efficacy of earplugs as a sleep hygiene strategy in patients admitted to a critical care environment were included. Studies were excluded if they included only healthy volunteers, did not report any outcomes of interest, did not contain an intervention group of interest, were crossover studies, or were only published in abstract form. Data Extraction: Nine studies published between 2009 and 2015, including 1,455 participants, fulfilled the eligibility criteria and were included in the systematic review. Studies included earplugs as an isolated intervention (n = 3), or as part of a bundle with eye shades (n = 2), or earplugs, eye shades, and additional sleep noise abatement strategies (n = 4). The risk of bias was high for all studies. Data Synthesis: Five studies comprising 832 participants reported incident delirium. Earplug placement was associated with a relative risk of delirium of 0.59 (95% CI, 0.44-0.78) and no significant heterogeneity between the studies (I2, 39%; p = 0.16). Hospital mortality was reported in four studies (n = 481) and was associated with a relative risk of 0.77 (95% CI, 0.54-1.11; I2, 0%; p < 0.001). Compliance with the placement of earplugs was reported in six studies (n = 681). The mean per-patient noncompliance was 13.1% (95% CI, 7.8-25.4) of those assigned to receive earplugs. Conclusions: Placement of earplugs in patients admitted to the ICU, either in isolation or as part of a bundle of sleep hygiene improvement, is associated with a significant reduction in risk of delirium. The potential effect of cointerventions and the optimal strategy for improving sleep hygiene and associated effect on patient-centered outcomes remains uncertain.	en_US
dc.relation.ispartof	Critical Care Medicine	en_US
dc.relation.isbasedon	10.1097/CCM.0000000000001557	en_US
dc.subject.classification	Emergency & Critical Care Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Delirium	en_US
dc.subject.mesh	Dyssomnias	en_US
dc.subject.mesh	Hospital Mortality	en_US
dc.subject.mesh	Ear Protective Devices	en_US
dc.subject.mesh	Patient Compliance	en_US
dc.subject.mesh	Sleep	en_US
dc.subject.mesh	Intensive Care Units	en_US
dc.subject.mesh	Clinical Trials as Topic	en_US
dc.title	The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis	en_US
dc.type	Journal Article
utslib.citation.volume	5	en_US
utslib.citation.volume	44	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1117 Public Health and Health Services	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
utslib.copyright.status	closed_access
pubs.issue	5	en_US
pubs.publication-status	Published	en_US
pubs.volume	44	en_US

Abstract:

Objective: A systematic review and meta-analysis to assess the efficacy of earplugs as an ICU strategy for reducing delirium. Data Sources: MEDLINE, EMBASE, and the Cochrane Central Register of controlled trials were searched using the terms "intensive care," "critical care," "earplugs," "sleep," "sleep disorders," and "delirium." Study Selection: Intervention studies (randomized or nonrandomized) assessing the efficacy of earplugs as a sleep hygiene strategy in patients admitted to a critical care environment were included. Studies were excluded if they included only healthy volunteers, did not report any outcomes of interest, did not contain an intervention group of interest, were crossover studies, or were only published in abstract form. Data Extraction: Nine studies published between 2009 and 2015, including 1,455 participants, fulfilled the eligibility criteria and were included in the systematic review. Studies included earplugs as an isolated intervention (n = 3), or as part of a bundle with eye shades (n = 2), or earplugs, eye shades, and additional sleep noise abatement strategies (n = 4). The risk of bias was high for all studies. Data Synthesis: Five studies comprising 832 participants reported incident delirium. Earplug placement was associated with a relative risk of delirium of 0.59 (95% CI, 0.44-0.78) and no significant heterogeneity between the studies (I2, 39%; p = 0.16). Hospital mortality was reported in four studies (n = 481) and was associated with a relative risk of 0.77 (95% CI, 0.54-1.11; I2, 0%; p < 0.001). Compliance with the placement of earplugs was reported in six studies (n = 681). The mean per-patient noncompliance was 13.1% (95% CI, 7.8-25.4) of those assigned to receive earplugs. Conclusions: Placement of earplugs in patients admitted to the ICU, either in isolation or as part of a bundle of sleep hygiene improvement, is associated with a significant reduction in risk of delirium. The potential effect of cointerventions and the optimal strategy for improving sleep hygiene and associated effect on patient-centered outcomes remains uncertain.

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http://hdl.handle.net/10453/125432