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

Ed Litton, V. Carnegie, R. Elliott, Steve A.R. Webb

    Research output: Contribution to journalReview article

    43 Citations (Scopus)

    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.
    Original languageEnglish
    Pages (from-to)992-999
    Number of pages8
    JournalCritical Care Medicine
    Volume44
    Issue number5
    DOIs
    Publication statusPublished - 2016

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    Ear Protective Devices
    Delirium
    Meta-Analysis
    Critical Care
    Sleep
    Sleep Hygiene
    Public Opinion
    Information Storage and Retrieval
    Risk Reduction Behavior
    Patient Compliance
    Hospital Mortality
    MEDLINE
    Cross-Over Studies
    Noise
    Healthy Volunteers

    Cite this

    @article{ae264477e44c47ebb343e8f2a8f3fd08,
    title = "The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis",
    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.",
    author = "Ed Litton and V. Carnegie and R. Elliott and Webb, {Steve A.R.}",
    year = "2016",
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    language = "English",
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    pages = "992--999",
    journal = "Critical Care Medicine",
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    The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis. / Litton, Ed; Carnegie, V.; Elliott, R.; Webb, Steve A.R.

    In: Critical Care Medicine, Vol. 44, No. 5, 2016, p. 992-999.

    Research output: Contribution to journalReview article

    TY - JOUR

    T1 - The efficacy of earplugs as a sleep hygiene strategy for reducing delirium in the ICU: A systematic review and meta-analysis

    AU - Litton, Ed

    AU - Carnegie, V.

    AU - Elliott, R.

    AU - Webb, Steve A.R.

    PY - 2016

    Y1 - 2016

    N2 - 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.

    AB - 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.

    U2 - 10.1097/CCM.0000000000001557

    DO - 10.1097/CCM.0000000000001557

    M3 - Review article

    VL - 44

    SP - 992

    EP - 999

    JO - Critical Care Medicine

    JF - Critical Care Medicine

    SN - 0090-3493

    IS - 5

    ER -