Effects of Patient-Directed Interactive Music Therapy on Sleep Quality in Postoperative Elderly Patients: A Randomized-Controlled Trial

Abstract

Purpose

This study aimed to investigate the effects of patient-directed interactive music on saliva melatonin levels and sleep quality among postoperative elderly patients in the intensive care unit (ICU).

Patients and Methods

A total of 133 elderly patients were randomized into three groups: interactive music therapy (IMT), passive listening (PL), and the control group. The control group (n = 45) received routine medical care, while IMT and PL groups received music therapy on ICU day 1. The IMT group received up to 20 mins of interactive music sessions, including relaxation techniques. The PL group received only pre-selected relaxing music-listening for 30 mins. Saliva melatonin and cortisol levels were measured three times at 11 p.m. (preoperative, operation day, and postoperative day [POD] 1). The Richards-Campbell Sleep Questionnaire (RCSQ) and Quality of Recovery-40 questionnaire (QoR40) were administered on the preoperative day, as well as PODs 1 and 2.

Results

The RCSQ showed a significant improvement in the IMT group compared to the control group on POD2 (71.50 vs 56.89, p=0.012), but the QoR40 did not show any difference between groups. The quality control of the saliva sample was not available due to the immediate postoperative patient’s condition, resulting in a higher dropout rate. Saliva melatonin levels on POD 1 were elevated in the IMT group compared to the control group (1.45 vs 0.04, p=0.0068). The cortisol level did not show a significant difference between groups.

Conclusion

Single IMT intervention improved subjectively assessed short-term sleep quality in postoperative elderly patients. It is difficult to conclude whether music therapy intervention affects the level of melatonin and cortisol.

Trial Registration

The study was registered at ClinicalTrials.Gov (number NCT03156205).

Keywords:

• critical care
• delirium
• music therapy
• melatonin
• sleep

Abbreviations

CAM-ICU, Confusion Assessment Method for the intensive care unit; CV, coefficients of variation; ICU, intensive care unit; IQR, interquartile range; PDIMT, patient-directed interactive music therapy; NRS, numeric rating scale; PL, passive listening; QOR40, Quality of Recovery-40 questionnaire; RCSQ, Richards-Campbell Sleep Questionnaire; SD, standard deviation.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

This study was conducted in accordance with the principles of Good Clinical Practice and was approved by the Institutional Research Board of Severance Hospital (reference number 4-2016-0873). All patients provided written informed consent.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This work was supported by a grant from the National Research Foundation of Korea (2016R1A2B1012708).