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Sleepless in the hospital: A systematic review of non-pharmacological sleep interventions.

General hospital psychiatry
January 1, 2019
Megan A Miller et al. (4 authors)
Journal ArticleResearch Support, N.I.H., ExtramuralSystematic ReviewHuman Study
Study Details

Study Goal

The researchers aimed to evaluate the effectiveness of nonpharmacological sleep interventions, including melatonin, for improving sleep in hospitalized patients.

Results Summary

The review found melatonin to be one of the most promising interventions for improving sleep in inpatient settings, though the overall literature was limited in quality and unable to recommend specific interventions. Environmental modifications like quiet time and ear plugs/eye masks were also noted as potentially beneficial.

Population

Hospitalized psychiatric and older adult patients from 18 countries.

Effective Dosage

Not available

Duration

Not specified

Interactions

None mentioned

Extracted Claims (3)
InterventionDirectionEndpointPopulationDosageImpactClaim #
melatonin
increase
sleep
inpatient medical settings
-
likely have the most promise to improve
#1
CBT-I
increase
sleep
inpatient medical settings
-
likely have the most promise to improve
#2
environmental modifications, including designated quiet time and ear plugs/eye masks
increase
sleep
inpatient medical settings
-
could be easily adopted and may support improvement
#3
Abstract

OBJECTIVE: Poor sleep is highly prevalent in inpatient medical settings and has been associated with attenuated healing and worsened outcomes following hospitalization. Although nonpharmacological interventions are preferred, little is known about the best way to intervene in hospital settings. METHOD: A systematic review of published literature examining nonpharmacological sleep interventions among inpatients in Embase, PsycINFO and PubMed in accordance with PRISMA guidelines. RESULTS: Forty-three of the 1529 originally identified manuscripts met inclusion criteria, encompassing 2713 hospitalized participants from 18 countries comprised of psychiatric and older adult patients living in hospital settings. Main outcomes were subjective and objective measures of sleep duration, quality, and insomnia. CONCLUSIONS: Overall, the review was unable to recommend any specific intervention due to the current state of the literature. The majority of included research was limited in quality due to lack of controls, lack of blinding, and reliance on self-reported outcomes. However, the literature suggests melatonin and CBT-I likely have the most promise to improve sleep in inpatient medical settings. Additionally, environmental modifications, including designated quiet time and ear plugs/eye masks, could be easily adopted in the care environment and may support sleep improvement. More rigorous research in nonpharmacological sleep interventions for hospitalized individuals is required to inform clinical recommendations.

Medical Subject Headings (MeSH)
HospitalizationHumansInpatientsSleep Initiation and Maintenance Disorders
Study Links
Quality Scores
SafetyNot Assessed
Efficacy70/10
Quality65/10
Citation Metrics
Total Citations41
Citations/Year6.8
Relative Citation Ratio3.62
NIH Percentile88.6%
Research Impact Scores
APT Score0.95
Weight Score2.12
Normalized Score0.61
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