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

Authors: Cooke Marie, Ritmala-Castrén Marita, Dwan Toni, Mitchell MarionJournal: International journal of nursing studiesPublished: July 1, 2020DOI: 10.1016/j.ijnurstu.2020.103582

Q1 JournalSJR: 2.1h-index: 148SCImago

Strong EvidenceSystematic Review

Insomnia

In Plain Language: sleep, explained

Pharmacological interventions for sleep (analgesic, sedative and hypnotic agents) can both disrupt and induce sleep and have many negative side effects within the intensive care population. The use of complementary and alternative medicine therapies to assist with sleep has been studied but given the variety of modalities and methodological limitations no reliable conclusions have been drawn. To synthesise research findings regarding the effectiveness of using complementary and alternative medicine interventions within the domains of mind and body practices (relaxation techniques, acupuncture) and natural biologically based products (herbs, vitamins, minerals, probiotics) on sleep quality and quantity in adult intensive care patients. Systematic review. Five databases were searched in August 2018 and updated in February 2019 and 2020. Searches were limited to peer reviewed randomised controlled trials, published in English involving adult populations in intensive care units. Interventions were related to the complementary and alternative medicine domains of mind and body practices and natural products. Included studies were assessed using Cochrane's risk of bias tool. Seventeen studies were included. The interventions used varied: 4 investigated melatonin; 4 music +/- another therapy; 3 acupressure; 2 aromatherapy and 1 each for relaxation and imagery, reflexology, bright light exposure and inspiratory muscle training. Measurement of sleep quantity and quality was also varied: 5 studies used objective measures such as Polysomnography and Bispectral index with the remaining using subjective patient or clinician assessment (for example, Richards-Campbell Sleep Questionnaire, Pittsburgh Sleep Quality Index, observation). Given the different interventions, outcomes and measures used in the studies a meta-analysis was not possible. Generally, the results support the use of complementary and alternative medicine for assisting with sleep with 11 out of 17 trials repor

Key Findings: what this systematic review found about sleep

✓Pharmacological sleep interventions in intensive care units can both disrupt and induce sleep while causing multiple negative side effects in this patient population.
✓Complementary and alternative medicine therapies including mind-body practices (relaxation techniques, acupuncture) and natural products (herbs, vitamins, minerals, probiotics) have been studied for sleep improvement in intensive care patients but lack sufficient methodological rigor to draw reliable conclusions.
✓Current research evidence on complementary and alternative medicine interventions for sleep quality in adult intensive care patients is limited by methodological limitations across the variety of modalities studied.

What This Means for You

While reflexology and other complementary therapies are being studied for sleep in hospitalized patients, current evidence is not strong enough to recommend them as a reliable treatment on their own.

What This Means for Practitioners

This systematic review identifies reflexology as a potential complementary approach but highlights the need for more rigorous research and standardized outcome measures to establish its effectiveness for sleep in intensive care settings.

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Sleep: common questions

What does this study say about sleep?

While reflexology and other complementary therapies are being studied for sleep in hospitalized patients, current evidence is not strong enough to recommend them as a reliable treatment on their own.

What did this study find?

Pharmacological sleep interventions in intensive care units can both disrupt and induce sleep while causing multiple negative side effects in this patient population. Complementary and alternative medicine therapies including mind-body practices (relaxation techniques, acupuncture) and natural products (herbs, vitamins, minerals, probiotics) have been studied for sleep improvement in intensive care patients but lack sufficient methodological rigor to draw reliable conclusions. Current research evidence on complementary and alternative medicine interventions for sleep quality in adult intensive care patients is limited by methodological limitations across the variety of modalities studied.

How strong is this evidence?

This is a systematic review and we rate its evidence strong. It was published in International journal of nursing studies, a Q1 journal. This study is indexed here for context; it did not test reflexology itself.