Effectiveness of complementary and alternative medicine interventions for sleep quality in adult intensive care patients: A systematic review

Nurse-led evidence-based quality improvement programme to improve intensive care unit patient sleep quality

BACKGROUND

Patients in the intensive care unit (ICU) suffer from significant sleep disturbances, which can negatively impact their healing and overall health. Nurses, as the primary caregivers, need to have expertise in sleep management to ensure better patient outcomes. Implementing nurse-led, evidence-based sleep protocols in ICUs is crucial.

AIM

This study aimed to improve ICU patients' sleep quality by developing and implementing a nurse-led, evidence-based SLEEP Bundle, including Sleep initiative, Light control, Eye mask and earplugs usage, Environment noise cancellation and Provision of non-pharmacological (aromatherapy and music therapy) and pharmacological (dexmedetomidine and painkillers) support.

METHODS

The Framework of Evidence-based Continuous Quality Improvement and the Ottawa Model of Research Use framework were used to guide the development, implementation and assessment of the SLEEP Bundle. A quasi-experimental study was conducted in a 12-bed surgical intensive care unit (SICU), assessing patient-perceived sleep quality, nurses' self-report knowledge, attitudes and actions regarding patient sleep conditions and nurses' adherence to the interventions.

INTERVENTIONS

In order to successfully translate evidence into clinical practice, the protocol was crafted with significant nurse involvement, input in sleep promotion materials and a flexible continuing education component, which provided credits to encourage nurse participation. A sleep-aid kit, complete with non-pharmacological tools, and a system of regular quality control and feedback were integral to the clinical application of the protocol.

RESULTS

The intervention significantly enhanced ICU patients' sleep quality, as evidenced by a significant increase in Richards-Campbell Sleep Questionnaire scores from 62 (IQR = 48-72) to 70 (IQR = 62-76) (95% CI [-10.000, -6.000], Z = -6.100, p < .001). Nurses demonstrated a 100% agreement in knowledge items and a significant upsurge in action items following the intervention. Concurrently, adherence to practice standards showed notable improvements in sleep management practices, including enhanced sleep quality assessment, daytime functional exercise support and compliance with environmental regulations, along with increased use of earplugs, eye masks and aromatherapy/music therapy.

CONCLUSIONS

The study highlights the effectiveness and feasibility of a nurse-led sleep management strategy, as demonstrated by improved patient outcomes and increased nurse adherence to sleep promotion interventions.

RELEVANCE TO CLINICAL PRACTICE

The significant improvements in sleep quality as well as the increased adherence to evidence-based interventions by nurses suggest that this SLEEP Bundle could be effectively translated to other clinical settings.

Aromatherapy for Sleep Promotion in the ICU: Insights and Future Directions

BACKGROUND

The effects of inhaled aromatherapy on sleep quality in critically ill patients in the intensive care unit (ICU) have been widely studied. Specific essential oil combinations have been highlighted for their potential to promote sleep in these patients.

AIM

To offer additional insights and future directions for the application of aromatherapy in improving sleep quality among critically ill patients, considering the current evidence and addressing gaps in research.

DISCUSSION

While certain blends of essential oils, such as lavender, Matricaria recutita, and neroli, have shown promise, other studies have produced mixed results regarding the optimal aromatherapy interventions. Integrating aromatherapy with other non-pharmacological approaches, such as earplugs, eye masks, or music, may offer enhanced sleep benefits. Further research is needed to evaluate aromatherapy's effects on specific populations, such as intubated patients, and to assess feasibility, cost-effectiveness, and potential adverse effects.

CONCLUSION

Aromatherapy shows promise for improving sleep quality in critically ill patients but should be integrated with other evidence-based, non-pharmacological interventions. Addressing research gaps is crucial for developing comprehensive strategies to enhance sleep quality in ICU settings.

Summary of the Best Evidence for Non-Pharmacological Management of Sleep Disturbances in Intensive Care Unit Patients

AIM

To retrieve, evaluate and summarise the best evidence for non-pharmacological management of sleep disturbances in ICU patients, and to provide basis for clinical nursing practice.

DESIGN

This study was an evidence summary followed by the evidence summary reporting standard of Fudan University Center for Evidence-based Nursing.

METHODS

All evidence on non-pharmacological management of sleep disturbances in ICU patients from both domestic and international databases and relevant websites was systematically searched, including guidelines, expert consensuses, best practice, clinical decision-making, evidence summaries and systematic review.

DATA SOURCES

UpToDate, BMJ Best Practice, Joanna Briggs Institute, Scottish Intercollegiate Guidelines Network, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence, Yi Maitong Guidelines Network, Registered Nurses Association of Ontario, Canadian Medical Association: Clinical Practice Guideline, Guidelines International Network, WHO, the Cochrane Library, CINAHL, Embase, PubMed, Web of Science, CNKI, WanFang database, VIP database, SinoMed, The American Psychological Association, European Sleep Research Society, American Academy of Sleep Medicine and National Sleep Foundation were searched from the establishment of the databases to June 1, 2024.

RESULTS

A total of 18 pieces of literature were included, involving 4 guidelines, 2 expert consensuses, 1 best practice and 11 systematic reviews. 25 pieces of evidence covering 4 categories of risk factors, sleep monitoring, non-pharmaceutical intervention, education and training were summarised.

CONCLUSION

This study summarises the best evidence for non-pharmacological management of sleep disturbances in ICU patients. In clinical application, medical staff should make professional judgements and fully combine clinical situations and patient preferences to select evidence, laying a theoretical foundation for later empirical research to reduce the incidence of sleep disturbances in ICU patients and improve the sleep quality of critically ill patients.

IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE

Medical staff can refer to the best evidence to provide reasonable non-pharmacological management plans for sleep disturbances in ICU patients, improving their sleep quality and life satisfaction.

IMPACT

The management of sleep disturbances in critically ill patients has not received sufficient attention and standardisation. This study summarises 25 pieces of the best evidence for non-pharmacological management of sleep disturbances in critically ill patients. Accurate and standardised evaluation and monitoring are the foundation of sleep management for ICU patients. This summary of evidence can help ICU nurses enhance their clinical practice.

REPORTING METHOD

This evidence summary followed the evidence summary reporting specifications of Fudan University Center for Evidence-based Nursing, which were based on the methodological process for the summary of the evidence produced by the Joanna Briggs Institute. This study was based on the evidence summary reporting specifications of the Fudan University Center for the Evidence-based Nursing; the registration number is 'ES20231708'.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

Pharmacologic Sleep Aids in the Intensive Care Unit: A Systematic Review

Background: Patients in the intensive care unit (ICU) often experience poor sleep quality. Pharmacologic sleep aids are frequently used as primary or adjunctive therapy to improve sleep, although their benefits in the ICU remain uncertain. This review aims to provide a comprehensive assessment of the objective and subjective effects of medications used for sleep in the ICU, as well as their adverse effects. Methods: PubMed, Web of Science, Scopus, Embase, and Cochrane Central Register of Controlled Trials were systematically searched from their inception until June 2023 for comparative studies assessing the effects of pharmacologic sleep aids on objective and subjective metrics of sleep. Results: Thirty-four studies with 3498 participants were included. Medications evaluated were melatonin, ramelteon, suvorexant, propofol, and dexmedetomidine. The majority of studies were randomized controlled trials. Melatonin and dexmedetomidine were the best studied agents. Objective sleep metrics included polysomnography (PSG), electroencephalography (EEG), bispectral index, and actigraphy. Subjective outcome measures included patient questionnaires and nursing observations. Evidence for melatonin as a sleep aid in the ICU was mixed but largely not supportive for improving sleep. Evidence for ramelteon, suvorexant, and propofol was too limited to offer definitive recommendations. Both objective and subjective data supported dexmedetomidine as an effective sleep aid in the ICU, with PSG/EEG in 303 ICU patients demonstrating increased sleep duration and efficiency, decreased arousal index, decreased percentage of stage N1 sleep, and increased absolute and percentage of stage N2 sleep. Mild bradycardia and hypotension were reported as side effects of dexmedetomidine, whereas the other medications were reported to be safe. Several ongoing studies have not yet been published, mostly on melatonin and dexmedetomidine. Conclusions: While definitive conclusions cannot be made for most medications, dexmedetomidine improved sleep quantity and quality in the ICU. These benefits need to be balanced with possible hemodynamic side effects.

Non-Pharmacological Sleep Interventions after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

AIM

To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients.

BACKGROUND

Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed.

DESIGN

A systematic review and meta-analysis guided by the PRISMA protocol.

METHODS

CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales.

RESULTS

Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes.

CONCLUSION

Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings.

IMPLICATIONS

Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy.

REPORTING METHOD

This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.

NO PATIENT OR PUBLIC CONTRIBUTION

Patient and public contributions were not required for this review.

Factors influencing sleep quality among nurses in tertiary hospitals in Kelantan, Malaysia: a cross-sectional study

BACKGROUND

Poor sleep quality among nurses can negatively impact their performance, leading to increased risks of errors in nursing practice, which directly affect patient safety. However, there is limited research on the factors influencing sleep quality and its subsequent consequences on patient safety, particularly in tertiary hospitals in Kelantan, Malaysia. This study aimed to determine the factors influencing sleep quality and the prevalence of poor sleep quality among nurses at tertiary hospitals in Kelantan.

METHODOLOGY

A cross-sectional study was conducted in two tertiary care hospitals in Kelantan between December 2023 and February 2024. A proportionate stratified random sampling method was employed to recruit a sample of 470 registered nurses. Data were collected using a validated self-administered questionnaire comprising 19 items across seven component scores.

RESULTS

The prevalence of poor sleep quality among nurses was found to be 69.8%. The study identified several significant factors associated with poor sleep quality, including sleep duration (aOR 0.291; 95% CI: 0.215-0.393; p < 0.001), years of work experience (aOR 0.953; 95% CI: 0.924-0.984; p = 0.003), history of involvement in medication errors (aOR 2.669; 95% CI: 1.413-5.041; p = 0.002), and experiences of commuting injury (aOR 1.869; 95% CI: 1.119-3.121; p = 0.017).

CONCLUSION

The high prevalence of poor sleep quality among nurses highlights the need for targeted interventions to address this issue. In addition to ongoing education, implementing sleep hygiene programs, offering stress management workshops, and introducing flexible work schedules could significantly improve sleep quality. Creating a supportive work environment that prioritizes nurse well-being is crucial for enhancing patient safety and overall healthcare outcomes.

Night-time sleep of intensive care patients: A qualitative study

BACKGROUND

The quality of the sleep in the intensive care unit (ICU) is generally poor. It is known that several factors contribute to this situation.

AIM

To describe the experiences of adult patients during night-time sleep in the ICU.

DESIGN

A qualitative study using a phenomenological approach was conducted from May to October 2021. Patients were intensive care patients (n = 10) who were treated for at least 24 h in tertiary ICUs.

METHODS

The data were obtained through semi-structured interviews based on an interview guide. A qualitative content analysis using an inductive approach was performed.

RESULTS

The analysis resulted in three main themes: (a) inadequate sleep at night; (b) factors negatively affecting night-time sleep; and (c) patient expectations for improved night-time sleep. Night-time sleep of patients treated in intensive care were determined to generally have inadequate and be interrupted. Patients associated the cause of this situation with the physical environment conditions in the ICU, loud noises made by health employees and emotional reactions. It was stated that some physical environment changes that can be made in ICUs and psychological support will positively affect sleep.

CONCLUSIONS

Intensive care patients may not have quality night-time sleep because of multifactorial reasons. Noise in the ICU is a significant factor preventing patients from sleeping. In addition to reorganization of the physical environment to ensure adequate sleep, there is a need for an integrated approach dealing with patients' feelings and concerns.

RELEVANCE TO CLINICAL PRACTICE

Each patient has their own unique sleep pattern. To ensure effective management of sleep problems, health professionals should organize care and physical conditions in line with guidelines and create patient-specific night-time sleep management programmes.

Effects of a combination of Poria Cocos, Ziziphus spinose, and gamma-aminobutyric acid (GABA) on sleep quality and skin health: A randomized double-blind placebo-controlled clinical trial

Sleep is crucial for preserving both physical and mental health, including skin health. Presently, there is a burgeoning interest in the use of herbal and natural ingredients to mitigate the adverse effects of sleep disorders. In this 4-week, randomized, double-blind, controlled trial, 70 subjects with sleep disorders were randomly assigned to receive either a placebo or a Poria cocos, Ziziphus spinose, and GABA (PZG) supplement (10 mL per day). Total sleep duration was detected by wrist actigraphy, and sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Skin conditions were evaluated based on assessments of skin hydration, glossiness elasticity, color, severity of wrinkles, and skin roughness. After 4 weeks, the total sleep duration significantly increased by 12.96% (p = .006) and the PSQI score notably decreased by 59.94% (p = .000) compared to the baseline. Notably, compared to the baseline conditions, skin hydration, radiance, elasticity, firmness, wrinkle severity, and roughness were significantly improved in the PZG group. In addition, the PZG group demonstrated significantly greater improvements than the placebo group in terms of changes from baseline in total sleep duration, PSQI score, skin hydration, wrinkle severity, and skin roughness. The present results demonstrated that the combined intake of herbs and GABA can improve sleep quality and enhance skin health without adverse effects.

Sleep in the intensive and intermediate care units: Exploring related factors of delirium, benzodiazepine use and mortality

AIM OF THE STUDY

The primary purpose was to examine sleep difficulties and delirium in the Intensive and Intermediate Care Unit. Secondarily, factors impacting night-time sleep duration and quality, mortality, and the impact of benzodiazepine use on sleep outcomes were investigated.

MATERIALS AND METHODS

This retrospective study encompassed data from 323 intensive and intermediate care unit admissions collected in the Netherlands, spanning from November 2018 to May 2020. Sleep quality was measured using the Richards-Campbell Sleep Questionnaire. Night-time sleep duration was nurse-reported. We investigated associations of these sleep outcomes with age, sex, length-of-stay, natural daylight, disease severity, mechanical ventilation, benzodiazepine use, and delirium using Generalized Estimating Equations models. Associations with one-year post-discharge mortality were analyzed using Cox regression.

RESULTS

Night-time sleep duration was short (median 4.5 hours) and sleep quality poor (mean score 4.9/10). Benzodiazepine use was common (24 % of included nights) and was negatively associated with night-time sleep duration and quality (B = -0.558 and -0.533, p <.001). Delirium and overnight transfers were negatively associated with sleep quality (B = -0.716 and -1.831, p <.05). The day-to-night sleep ratio was higher in the three days before delirium onset than in non-delirious individuals (p <.05). Age, disease severity and female sex were associated with increased one-year mortality. Sleep quality was negatively, but not-significantly, associated with mortality (p =.070).

CONCLUSIONS

Night-time sleep in the critical care environment has a short duration and poor quality. Benzodiazepine use was not associated with improved sleep. Sleep patterns change ahead of delirium onset.

IMPLICATIONS FOR CLINICAL PRACTICE

Consistent sleep monitoring should be part of routine nursing practice, using a validated instrument like the Richards-Campbell Sleep Questionnaire. Given the lack of proven efficacy of benzodiazepines in promoting sleep in critical care settings, it is vital to develop more effective sleep treatments that include non-benzodiazepine medication and sleep hygiene strategies.

The effect of breathing relaxation to improve poor sleep quality in adults using a huggable human-shaped device: a randomized controlled trial

PURPOSE

To examine whether or not breathing relaxation, using a huggable human-shaped device, improves poor sleep quality in adults.

METHODS

We conducted a randomized controlled trial using outpatients with sleep problems from two clinics in Japan. The intervention group conducted three minutes of breathing relaxation using a huggable human-shaped device before going to bed every night for four weeks. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), at pre-intervention, mid-intervention (2 weeks after pre-intervention), and post-intervention (4 weeks after pre-intervention). We employed intention-to-treat analysis.

RESULTS

A total of 68 participants (mean [SD] age, 41.7 [11.4] years; 64 female [95%]) were randomly assigned to the intervention group (n = 29, mean [SD] age, 43.6 [9.5] years; 28 female [97%]) and the control group (n = 36, mean [SD] age, 40.3 [12.7] years; 36 female [95%]). The intervention group showed a significant decrease in the PSQI score compared to the control group (F = 3.81, p = 0.025, effect size (η2) = 0.057). Furthermore, we found the intervention to be more effective in participants without suicide risk and with a lower number of adverse childhood experiences (effect size (η2) = 0.080 and 0.160, respectively).

CONCLUSIONS

A novel psychological intervention, breathing relaxation using a huggable human-shaped device, may be effective to improve sleep quality among people with sleep problems, especially those without severe psychological symptoms.

TRIAL REGISTRATION

UMIN000045262. (Registration Date: September 28th, 2021).

An aromatherapy massage intervention on sleep in the ICU: A randomized controlled feasibility study

We conducted a feasibility randomized controlled trial exploring the effect of aromatherapy massage on sleep in critically ill patients. Patients were randomized to receive aromatherapy massage or usual care, and feasibility of recruitment and outcome data completion was captured. Sleep (depth) was assessed through Bispectral Index monitoring and self/nurse-reported Richards-Campbell Sleep Questionnaires, and the Sleep in the ICU Questionnaire. Thirty-four patients participated: 17 were randomized to aromatherapy massage and 17 to control. Five participants who received the intervention completed outcomes for analysis (alongside eight controls). A larger study was deemed unfeasible in this population, highlighting the value of testing feasibility of complex interventions, such as massage for sleep in ICU.

The effect of lavender on mothers sleep quality in the postpartum period: a systematic review and meta-analysis

Poor sleep quality in the postpartum period can have various negative effects on the health of mothers and infants such as anxiety, depression, low breastfeeding self-efficacy and disrupted child-mother attachment. Accordingly, intervention seems necessary to improve sleep quality. Given the probable effect of lavender on sleep problems, the present research intended to determine its effects on mothers' sleep quality during postpartum period. The PubMed, Embase, Cochrane Library, Scopus databases and the Persian language databases (Magiran and SID) were searched for all the articles they included at the end of February 2021. The risk of bias of the included studies was assessed using the Cochrane tool. The results of the meta-analysis were reported as the standardized mean difference (SMD). Heterogeneity of the studies was investigated using the I-squared test (I2). Three out of the 292 obtained studies entered the meta-analysis. The results indicated that sleep quality in the group receiving lavender improved compared to the control group, (SMD = -0.61; 95% CI: -1.07 to -015 p = 0.01) whereas the heterogeneity was higher. (I2 = 75%; Tau2 = 012; Chi2 = 7.905, p = 0.02). According to the results of this systematic review, use of lavender can improve postpartum maternal sleep quality. However, further randomized controlled trials using identical methodology, larger sample sizes and longer follow-up periods are needed.

Visual and auditory stimulation for patients in the intensive care unit: A mixed-method study

OBJECTIVES

To determine what type (e.g., television, photographs, music, etc), content (e.g., nature scenes, family members, etc), and duration of visual and auditory stimuli should be provided to intensive care unit patients during their hospitalisation.

RESEARCH METHODOLOGY AND DESIGN

This mixed-methods study followed an exploratory-descriptive design. In total, 31 participants were interviewed: 19 were former critically ill patients in the intensive care unit and 12 were nursing experts, all from a university hospital in Switzerland. Based on current practice, patients and nurses were familiar with receiving and providing television, photographs, radio, and musical stimuli, with no specific exposure to virtual reality, aside from that in their personal lives. Data were collected from the former patients using structured interviews, whereas semi-structured interviews were used for the nursing experts.

FINDINGS

Overall, patient and expert opinions aligned well; both groups agreed that receiving visual and/or auditory stimuli would benefit patients. Photographs, television, and virtual reality were the visual stimuli most chosen by the patients, with an emphasis on nature-focused content. When appropriate, audio matching the content should be provided alongside the visual stimuli to act as a distraction from the hospital environment. Visual stimuli should not exceed 10-15 min, while auditory stimuli should not exceed one hour.

CONCLUSION

Sensory overload and deprivation are common problems in the intensive care unit with negative effects on patient outcomes. Based on patient and expert opinions, visual and auditory stimuli are desired by patients and could help address these issues.

Probiotics in Critically Ill Patients: An Umbrella Review

Objectives

Data sources

Study selection

Data extraction

Data synthesis

Conclusion

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Non-pharmacological sleep interventions for adult patients in intensive care Units: A systematic review

OBJECTIVES

To synthesize and evaluate current non-pharmacological sleep interventions for critically ill adult patients in intensive care units and provide recommendations for future studies of non-pharmacological means of improving this population's sleep quality.

RESEARCH METHODOLOGY/DESIGN

The literature search was conducted following PRISMA guidelines. Seven databases CINAHL, PsycINFO, Embase, Medline, Cochrane Library, Web of Science, and Scopus and three keywords, sleep, intervention and intensive care unit were employed. All possible combinations of the keywords and similar words were considered. Included studies were primary studies, involved adult intensive care unit patients, focused on non-pharmacological sleep interventions, measured subjective and/or objective sleep quality and were published in English between January 2010 and September 2020.

RESULTS

The 20 included studies examined different types of non-pharmacological sleep interventions involving use of earplugs, an eye mask, white noise, music, aromatherapy, massage, acupressure, light intensity, a sleep hygiene protocol, quiet time and minimization of nursing care. Of 18 studies employing an experimental design, most reported that non-pharmacological interventions improved sleep quality. All these interventions involved environmental factors or complementary relaxation strategies.

CONCLUSIONS

Non-pharmacological sleep interventions can have a positive influence on sleep quality in critically ill patients, but more research is needed to determine their effectiveness.

Sleep improvement intervention and its effect on patients' sleep on the ward

AIM AND OBJECTIVE

The aim of the study was to investigate how the sleep improvement interventions developed for the wards were associated with patients' sleep. The objective was to promote patients' sleep.

BACKGROUND

The quality of sleep is vital for patients' health and recovery from illness. However, patients generally sleep poorly during hospitalisation. Sleep-disturbing factors are connected to the hospital environment, patients' physical illness, emotional state and the activities of the staff. Many sleep-disturbing factors can be influenced by appropriate nursing interventions.

DESIGN

A two-group intervention study including the development of nursing interventions aimed at supporting patients' sleep. One group received a sleep promotion intervention and the other received standard care. Both groups evaluated their sleep in the morning.

METHODS

A survey of participants' sleep evaluations was collected with the five-item Richards-Campbell Sleep Questionnaire. The data were analysed statistically. The STROBE checklist was used to report the study.

RESULTS

From the participants' perspective, sleep was better in the intervention group, even though statistically significantly only among men. The pain intensity correlated with sleep quality. The number of patients in the room or whether participants had had an operation had no effect on their sleep evaluations.

CONCLUSIONS

Interventions targeted at supporting and promoting the sleep quality of hospital inpatients may be effective. They should be developed in collaboration with patients and nurses. Several nursing interventions can be proposed to promote better sleep among patients; however, more research is needed to confirm the results. Sleep promotion should include both standardised protocols and individualised sleep support.

RELEVANCE TO CLINICAL PRACTICE

Investing in nursing interventions to promote patients' sleep is important. Patients' individual sleep-related needs should be part of their care plan. Training programmes that support nurses' knowledge and skills of patients' sleep promotion should be part of nursing education in healthcare organisations.

The Effects of Valerian on Sleep Quality, Depression, and State Anxiety in Hemodialysis Patients: A Randomized, Double-blind, Crossover Clinical Trial

OBJECTIVES

Our study sought to determine the effects of valerian on sleep quality, depression, and state anxiety in hemodialysis (HD) patients.

METHODS

This randomized, double-blind, placebo-controlled, crossover clinical trial was conducted on 39 patients undergoing HD allocated into a valerian and placebo group. In the first phase of the study, group A (n = 19) received valerian and group B (n = 20) received a placebo one hour before sleep every night for a total of one month. Sleep quality, state anxiety, and depression were assessed in the patients at the beginning and end of the intervention using the Pittsburgh Sleep Quality Index, the Spielberger State-Trait Anxiety Inventory, and Beck Depression Inventory. In the second phase, the two groups' treatment regimen was swapped. After a one-month washout period, the same process was repeated on the crossover groups (i.e., group A received placebo and group B received valerian).

RESULTS

In the first phase, the mean sleep quality, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly higher in group A compared to group B (7.6 vs. 3.2, p< 0.001; 6.5 vs. 2.3, p =0.013; 14.6 vs. 7.3, p =0.003, respectively). In the second phase, the mean sleep disorder, depression, and state anxiety scores showed significant reductions in both groups, but the reduction was significantly lower in group A compared to group B (1.4 vs. 4.6, p< 0.001; 1.2 vs. 3.8, p =0.002; 1.5 vs. 6.2, p< 0.001, respectively).

CONCLUSIONS

Valerian significantly improved sleep quality, the symptoms of state anxiety, and depression in HD patients.

Quality of sleep among social media users during the lockdown period due to COVID-19 in Spain

Aims

To analyse the quality of sleep of the Spanish population during the lockdown due to COVID-19.

Design

Cross-sectional descriptive study using a web based survey design.

Methods

Pittsburgh Sleep Quality Index questionnaire and sociodemographic, occupational, health and sleep quality variables were used to collect data during the first month of the lockdown period due to COVID-19 (March–April 2020). A snowball sampling was carried out, where participants were asked to disseminate and distribute the questionnaire among their own profiles in social networks.

Results

A representative sample of 5220 participants aged ≥18 years old took part in the study. The global PSQI score was 8.17 points (SD 4.43). A statistical association was found between the global PSQI score and several of the variables collected. Findings show that the quality of sleep was worse among women (p < 0.001), single participants (p 0.02), those working in rotating shifts (p < 0.001), on-site workers (p < 0.001), and people diagnosed with COVID-19 or who had someone in their environment diagnosed with the virus (p < 0.001).

Conclusion

Findings show that the Spanish population has experienced poor quality of sleep during the lockdown period. Being a woman, working in rotating shifts, having suffered from COVID-19 or having someone close suffering from COVID-19, being unemployed or being affected by a Temporary Redundancy Scheme, as well as spending long hours in bed were associated with poorer sleep quality. On the contrary, being older and sleeping longer hours were associated with a better sleep quality.

Updated Review of the Acoustic Modulation of Sleep: Current Perspectives and Emerging Concepts

With growing interest in the use of acoustic stimuli in sleep research and acoustic interventions used therapeutically for sleep enhancement, there is a need for an overview of the current lines of research. This paper summarizes the various ways to use acoustic input before sleep or stimulation during sleep. It thereby focuses on the respective methodological requirements, advantages, disadvantages, potentials and difficulties of acoustic sleep modulation. It highlights differences in subjective and objective outcome measures, immediate and whole night effects and short versus long term effects. This recognizes the fact that not all outcome parameters are relevant in every research field. The same applies to conclusions drawn from other outcome dimensions, consideration of mediating factors, levels of stimulation processing and the impact of inter-individual differences. In addition to the deliberate influences of acoustic input on sleep, one paragraph describes adverse environmental acoustic influences. Finally, the possibilities for clinical and basic research-related applications are discussed, and emerging opportunities are presented. This overview is not a systematic review but aims to present the current perspective and hence summarizes the most up-to-date research results and reviews. This is the first review providing a summary of the broad spectrum of possibilities to acoustically influence sleep.

Effect of rosa damascene aromatherapy on anxiety and sleep quality in cardiac patients: A randomized controlled trial

INTRODUCTION

Anxiety and sleep disorders are the most common disorders of patients admitted to the cardiac care units. The purpose of this study is to investigate the effect of Rosa damascene fragrance on anxiety and sleep quality of hospitalized patients in the cardiac care units.

METHODS

In this Randomized clinical trial, 60 patients who had the inclusion criteria were conveniently sampled and randomly allocated to the experimental and control groups. Patients were enrolled in the study 24 h after hospitalization. Those diagnosed with dysrhythmia, ACS, and CHF were included. Patient recruitment lasted from October 2018 to December 2019. In these groups, in addition to the routine care, the intervention was performed for three consecutive nights from 22:00 to 06:00. In the experimental group, patients inhaled five drops of Rosa damascene essence 40% in distilled water, while in the control group, patients inhaled five drops of distilled water as placebo. In both groups, anxiety and sleep quality were examined before and after three consecutive nights using the St. Mary's Hospital Sleep Quality Questionnaire (SMHSQ) and the Spiel Berger State-Trait Anxiety Inventory (STAI) questionnaire.

RESULTS

The results of this study showed that the use of Rosa damascene aroma in patients hospitalized in the cardiac care unit significantly reduces anxiety and increases the improvement of sleep quality in the experimental group compared to the control group (P < 0.05). The significance level for anxiety and sleep quality was (P = 0.001).

CONCLUSION

Aromatherapy with Rosa damascene reduces anxiety and increases the sleep quality of patients hospitalized in the cardiac care unit. Therefore, along with other treatment measures, Rosa damascene can be used as a complementary method to reduce anxiety and improve sleep quality.