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Meta-Analysis
. 2021 May 10;11(5):e042510.
doi: 10.1136/bmjopen-2020-042510.

Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis

Ellaha Kakar  1 , Esmée Venema  2 , Johannes Jeekel  3 , Markus Klimek  4 , Mathieu van der Jagt  5
Affiliations
Meta-Analysis

Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis

Ellaha Kakar et al. BMJ Open. .

Abstract

Objective: Sleep disruption occurs frequently in hospitalised patients. Given the potential of music intervention as a non-pharmacological measure to improve sleep quality, we aimed to assess and quantify current literature on the effect of recorded music interventions on sleep quality and quantity in the adult critical care and surgical populations.

Design: Systematic review and meta-analysis.

Data sources: Embase, MEDLINE Ovid, Cochrane Central, Web of Science and Google Scholar.

Eligibility criteria for studies: Randomised controlled trials assessing the effect of music on sleep quality in critically ill and surgical patients.

Methods: The electronic databases were systematically searched from 1 January 1981 to 27 January 2020. Data were screened, extracted and appraised by two independent reviewers. Primary outcomes were sleep quality and quantity, assessed with validated tools. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Random effects meta-analysis was performed, and pooled standardised mean differences (SMDs) with 95% CIs were reported.

Results: Five studies (259 patients) were included in qualitative (risk of bias) and quantitative analysis (meta-analysis). Pooled data showed a significant effect of recorded music on subjective sleep quality in the critical care and surgical population (SMD=1.21 (95% CI 0.50 to 1.91), p<0.01, excluding one non-English study; SMD=0.87 (95% CI 0.45 to 1.29), p<0.01). The SMD of 1.21 corresponded to a 27.1% (95% CI 11.2 to 42.8) increase in subjective sleep quality using validated questionnaires. A significant increase in subjective sleep quantity of 36 min was found in one study. Objective measurements of sleep assessed in one study using polysomnography showed significant increase in deeper sleep stage in the music group.

Conclusions: Recorded music showed a significant improvement in subjective sleep quality in some critical care and surgical populations. Therefore, its use may be relevant to improve sleep, but given the moderate potential for bias, further research is needed.

Prospero registration number: CRD42020167783.

Keywords: intensive & critical care; sleep medicine; surgery.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
PRISMA flor diagram. N indicates the number of articles. GI, Guided Imaging; PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
(A) Forest plot assessing the effect of music on subjective sleep quality. (B) Funnel plot assessing the effect of music on subjective sleep quality. (C) Forest plot assessing the effect of music on subjective sleep, excluding the paper of Cheraghi et al. SMD, standardised mean difference.
Figure 3
Figure 3
Risk of bias assessment.
Figure 4
Figure 4
Summary of risk of bias.
See this image and copyright information in PMC

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