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

J Adv Nurs. 2021 Nov;77(11):4321-4331. doi: 10.1111/jan.14914. Epub 2021 Jun 7.


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 (www.crd.York.ac.uk/Prospero with the registration number # CRD42021221185).

Keywords: earplugs; eye masks; intensive care; meta-analysis; nursing; sleep quality; systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Ear Protective Devices*
  • Humans
  • Intensive Care Units*
  • Sleep
  • Taiwan