Non-pharmacologic interventions to improve the sleep of hospitalized patients: a systematic review.

OBJECTIVES: Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among acutely ill inpatients. Behavioral interventions are recommended as first-line therapy prior to using pharmacologic therapy due to the side effects of sedative hypnotics. The objective of this systematic review was to identify non-pharmacologic interventions that have been used to improve sleep quality and quantity of non-intensive care unit (ICU) inpatients.

DATA SOURCES: PubMed, Embase, Web of Science, CINAHL, and Cochrane Library through January 2013; manual searches of reference lists.

STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, INTERVENTIONS: Any study in which a non-pharmacologic intervention was conducted in a general inpatient setting, and nighttime sleep quantity or quality was assessed.

STUDY APPRAISAL AND SYNTHESIS METHODS: Information on study design, populations, interventions, comparators, outcomes, time frame, and risk of bias were independently abstracted by two investigators.

RESULTS: 13 intervention studies with 1,154 participants were included. Four studies were randomized controlled trials. Seven studies had a low to medium risk of bias, and there was significant heterogeneity in the interventions. Relaxation techniques improved sleep quality 0-38%, interventions to improve sleep hygiene or reduce sleep interruptions improved sleep quantity 5%, and daytime bright light exposure improved sleep quantity 7-18%.

LIMITATIONS: The heterogeneity in the types and dose of interventions, outcome measures, length of follow-up, differences in patient populations, and dearth of randomized trials may dilute effects seen or make it more difficult to draw conclusions.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: There is insufficient to low strength of evidence that any non-pharmacologic intervention improves sleep quality or quantity of general inpatients. Further studies are needed in this area to guide clinicians.