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Effectiveness of Sensory Stimulation for Improving Sleep Quality in Preterm Infants in the Neonatal Intensive Care
Insights
Sensory stimulation improves sleep duration and quiet sleep in preterm infants. While evidence quality varies, multi-sensory and auditory interventions show promise for enhancing infant sleep in the NICU.
Area of Science:
- Neonatal Intensive Care Unit (NICU) care
- Infant sleep science
- Developmental pediatrics
Background:
- Preterm infants often experience poor sleep quality due to immaturity and hospital environments.
- Sensory stimulation is a potential intervention to improve sleep, but evidence is limited.
Purpose of the Study:
- To systematically review and meta-analyze the effectiveness of sensory stimulation interventions on preterm infant sleep quality in the NICU.
- To evaluate different types of sensory stimulation and their impact on sleep parameters.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs).
- Searched multiple databases and grey literature up to March 2024.
- Assessed risk of bias using Cochrane ROB 2.0 and evidence certainty with GRADE.
Main Results:
- Twenty RCTs involving 1297 infants were included.
- Sensory stimulation improved sleep duration and quiet sleep efficiency (QS%).
- Auditory and multi-sensory stimulation extended sleep duration; tactile stimulation affected active sleep (AS%).
Conclusions:
- Sensory stimulation is beneficial for preterm infant sleep quality, though evidence quality ranges from moderate to very low.
- Specific intervention types, like multi-sensory stimulation, show particular benefits.
- High-quality trials are needed to explore specificity and inform clinical practice.
Background:
Sleep is crucial for preterm infants; however, their immaturity and hospital-related disturbances can lead to poor sleep quality. Recently, sensory stimulation has been used to promote sleep quality; however, comprehensive evidence regarding its effectiveness is lacking.
Aim:
The review aimed to evaluate sensory stimulation's effectiveness and different interventions on the sleep quality of preterm infants in the neonatal intensive care unit (NICU).
Study Design:
A systematic review and meta-analysis of randomized controlled trials. Different databases and grey literature were searched from inception to March 2024. Randomized controlled trials examining the effects of sensory stimulation on sleep quality among preterm infants. The Cochrane risk of bias tool (ROB 2.0) evaluated bias risk. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach evaluated evidence certainty for each meta-analysis outcome. RevMan version 5.3 was used to perform meta-analysis. The study was registered with the Prospective Register of Systematic Reviews.
Results:
Twenty studies involving 1297 premature infants met the inclusion criteria. Sensory stimulation could improve sleep duration and quiet sleep efficiency (QS%), but it had no significant effect on the active sleep efficiency (AS%). In the subgroup analysis based on sensory type and number, auditory and multi-sensory stimulation significantly extended sleep duration. Auditory and tactile stimulation did not significantly affect QS%, but tactile stimulation had favourable effects on AS%. Multi-sensory stimulation also had beneficial effects on QS%.
Conclusions:
Sensory stimulation is beneficial for improving the sleep quality of preterm infants, but the evidence quality is moderate to very low. Intervention types may have affected their effects. Future research should explore the specificity of sensory stimulation and multidisciplinary collaboration strategies, and high-quality, low-heterogeneity clinical trials are needed.
Relevance To Clinical Practice:
Evidence from this study suggests integrating sensory stimulation protocols into standard care regimens for preterm infants. Furthermore, NICU nurses should implement systematic sleep assessments to identify sleep disturbances and administer targeted sensory stimulation.
Trial Registration:
This review was registered on the Prospective Register of Systematic Reviews (PROSPERO protocol number: CRD42024520762).
