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Effect of earplugs and eye masks on the sleep quality of intensive care unit patients: A systematic review and meta‐analysis

Chiu‐Shu Fang, , , , Shih‐Lun Chang, Ching‐Ju Fang
Published: 7 June 2021
Journal of Advanced Nursing ; doi:10.1111/jan.14914

Abstract: Aims To evaluate the effect of earplugs and eye masks on the sleep quality of patients in intensive care unit (ICU). Design Systematic review and meta-analysis. Data Sources Randomized controlled trial studies conducted before May 5, 2020 were searched for in Embase, MEDLINE, Cochrane Library, CINAHL and Index to Taiwan Periodical Literature System databases. Review Methods Analyses in this study were according to the PRISMA statement. The heterogeneity of the data was investigated through sub-group analysis while a meta-analysis was performed using the Review Manager 5.3 software. Results A total of 797 patients from 13 studies were included in this study. Without considering alone or combined use of earplugs and eye masks, the meta-analysis supported that there was a significant effect on self-reported sleep quality. The overall standardized mean difference of the effect size was 1.44 (95% confidence interval [CI]: [0.80, 2.09]). Sub-group analysis indicated that the use of earplugs alone had no significant effect on sleep quality (effect size: 0.07, 95% [CI]: [−0.50, 0.64]). The use of eye masks alone had a significant effect on sleep quality (effect size: 1.56, 95% [CI]: [1.08, 2.05]). The use of both earplugs and eye masks proved to have the largest effect size on sleep quality (effect size: 2.08, 95% [CI]: [0.95, 3.21]). Conclusion The combined use of earplugs and eye masks or the standalone use of eye masks is a non-invasive, economical and effective way to promote sleep quality in adult ICU patients. Impact Clinical nurses could use this meta-analysis as it recommends that nurses provide adult ICU patients with either one or both earplugs and eye masks to improve the patients’ sleep quality. Study Registration The review protocol was registered a priori and published online in the PROSPERO database of systematic reviews ( with the registration number # CRD42021221185).
Keywords: earplugs / eye masks / intensive care / meta-analysis / nursing / sleep quality / systematic review

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