Hu Rong-Fang, Jiang Xiao-Ying, Hegadoren Kathleen M, Zhang You-Hua
School of Nursing, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350108, China.
Faculty of Nursing, University of Alberta, 11405 87 Avenue, Edmonton, Alberta, T6G 1C9, Canada.
Crit Care. 2015 Mar 27;19(1):115. doi: 10.1186/s13054-015-0855-3.
Intensive care unit (ICU) environmental factors such as noise and light have been cited as important causes of sleep deprivation in critically ill patients. Previous studies indicated that using earplugs and eye masks can improve REM sleep in healthy subjects in simulated ICU environment, and improve sleep quality in ICU patients. This study aimed to determine the effects of using earplugs and eye masks with relaxing background music on sleep, melatonin and cortisol levels in ICU patients.
Fifty patients who underwent a scheduled cardiac surgery and were expected to stay at least 2 nights in Cardiac Surgical ICU (CSICU) were included. They were randomized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in CSICU. Urine was analyzed for nocturnal melatonin and cortisol levels. Subjective sleep quality was evaluated using the Chinese version of Richards-Campbell Sleep Questionnaire (a visual analog scale, ranging 0-100).
Data from 45 patients (20 in intervention group, 25 in control group) were analyzed. Significant differences were found between groups in depth of sleep, falling asleep, awakenings, falling asleep again after awakening and overall sleep quality (P < 0.05). Perceived sleep quality was better in the intervention group. No group differences were found in urinary melatonin levels and cortisol levels for the night before surgery, and the first and second nights post-surgery (P > 0.05). The urinary melatonin levels of the first and second postoperative nights were significantly lower than those of the night before surgery (P = 0.01). The opposite pattern was seen with urinary cortisol levels (P = 0.00).
This combination of non-pharmacological interventions is useful for promoting sleep in ICU adult patients; however, any influence on nocturnal melatonin levels and cortisol level may have been masked by several factors such as the timing of surgery, medication use and individual differences. Larger scale studies would be needed to examine the potential influences of these factors on biological markers and intervention efficacy on sleep.
Chinese Clinical Trial Registry: ChiCTR-IOR-14005511 . Registered 21 November 2014.
重症监护病房（ICU）的环境因素，如噪音和光线，已被认为是重症患者睡眠剥夺的重要原因。先前的研究表明，在模拟ICU环境中，使用耳塞和眼罩可改善健康受试者的快速眼动睡眠，并提高ICU患者的睡眠质量。本研究旨在确定使用耳塞、眼罩并搭配舒缓背景音乐对ICU患者的睡眠、褪黑素和皮质醇水平的影响。
纳入50例行择期心脏手术且预计在心脏外科重症监护病房（CSICU）至少停留2晚的患者。他们被随机分为两组，一组在CSICU术后夜间睡眠时使用耳塞和眼罩并搭配30分钟舒缓音乐，另一组则不使用。分析尿液中的夜间褪黑素和皮质醇水平。使用中文版理查兹 - 坎贝尔睡眠问卷（一种视觉模拟量表，范围为0 - 100）评估主观睡眠质量。
分析了45例患者的数据（干预组20例，对照组25例）。两组在睡眠深度、入睡情况、觉醒次数、觉醒后再次入睡情况及总体睡眠质量方面存在显著差异（P < 0.05）。干预组的睡眠质量感知更好。术前及术后第一晚和第二晚的尿褪黑素水平和皮质醇水平在两组间无差异（P > 0.05）。术后第一晚和第二晚的尿褪黑素水平显著低于术前一晚（P = 0.01）。尿皮质醇水平则呈现相反趋势（P = 0.00）。
这种非药物干预组合有助于促进ICU成年患者的睡眠；然而，手术时间、药物使用和个体差异等多种因素可能掩盖了其对夜间褪黑素水平和皮质醇水平的任何影响。需要开展更大规模的研究来考察这些因素对生物标志物的潜在影响以及对睡眠的干预效果。
中国临床试验注册中心：ChiCTR - IOR - 14005511。于2014年11月21日注册。
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