***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Environmental stimulus , especially noise and light , is thought to disrupt sleep in patients in the intensive care unit ( ICU ) . This study aim ed to determine the physiological and psychological effects of ICU noise and light , and of earplugs and eye masks , used in these conditions in healthy subjects . Methods Fourteen subjects underwent polysomnography under four conditions : adaptation , baseline , exposure to recorded ICU noise and light ( NL ) , and NL plus use of earplugs and eye masks ( NLEE ) . Urine was analyzed for melatonin and cortisol levels . Subjects rated their perceived sleep quality , anxiety levels and perception of environmental stimuli . Results Subjects had poorer perceived sleep quality , more light sleep , longer rapid eye movement ( REM ) latency , less REM sleep when exposed to simulated ICU noise and light ( P < 0.05 ) . Nocturnal melatonin ( P = 0.007 ) and cortisol secretion levels ( P = 0.004 ) differed significantly by condition but anxiety levels did not ( P = 0.06 ) . Use of earplugs and eye masks result ed in more REM time , shorter REM latency , less arousal ( P < 0.05 ) and elevated melatonin levels ( P = 0.002 ) . Conclusions Earplugs and eye masks promote sleep and hormone balance in healthy subjects exposed to simulated ICU noise and light , making their promotion in ICU patients reasonable BACKGROUND Post-anaesthesia care units ( PACUs ) with 24/7 activity and consequently artificial light and noise may disturb the sleep of patients who require prolonged medical supervision . After one postoperative night , we compared sleep quality in patients with and without noise ( earplug ) and light ( eye mask ) protection . METHODS After ethical board approval , 46 patients without any neurological or respiratory failure undergoing major non-cardiac surgery were prospect ively included . They were r and omized to sleep with or without protective devices during the first postoperative night in the PACU . Sleep quality was simultaneously measured by sleep- quality scales ( Spiegel score and Medical Outcomes Study Sleep ) ,  nurses ' assessment , and through a wrist actigraph ( Actiwatch ) . Secondary outcomes such as pain control and nocturnal activity were recorded . Comparisons between groups were made by Student 's t-test or non-parametric test for repeated measures as appropriate ( SPSS 10.0 ) . A P-value < 0.05 was considered significant . RESULTS Data from 41 patients were analysed . Protective devices during the first postoperative night prevented a decrease in sleep quality compared with st and ard care , as evaluated by the Spiegel scale : 20 ( 4 ) vs 15 ( 5 ) , P=0.006 . These devices significantly decreased the need for a nap [ 50 % 95 % confidence interval ( CI ) ( 20 - 80 ) vs 95 % 95 % CI ( 85 - 100 ) , P<0.001 ] , but had no effect on sleep length evaluated by Actiwatch . The total consumption of morphine was significantly reduced in the first 24 h [ respectively , 15(12 ) mg and 27(17 ) mg , P=0.02 ] . CONCLUSIONS Earplugs and eye masks applied in the PACU during the first postoperative night significantly preserve sleep quality . Such non-invasive and cheap devices may be generalized in the PACU or in intensive care units Abstract Background : Poor sleep quality ( SQ ) is common among patients after coronary artery bypass graft surgery ( CABG ) . This study attempted to determine the status of SQ following an intervention based on the PRECEDE-PROCEED model in patients with poor SQ after CABG . Methods : This study was a r and omized clinical trial . The study sample , including 100 patients referred to the Cardiac Rehabilitation Clinic of Tehran Heart Center , was assigned either to the intervention ( recipient of exercise and lifestyle training plus design ed intervention based on the PRECEDE-PROCEED model ) or to the control group ( recipient of exercise and lifestyle training ) . Eight training sessions over 8 weeks were conducted for the intervention group . Predisposing , enabling , and reinforcing factors as well as social support and SQ were measured in the intervention group before and one month after the intervention and compared to those in the control group at the same time points . Results : The mean age of the patients in the intervention ( 24 % women ) and control ( 24 % women ) groups was 59.3 ± 7.3 and 59.5 ± 9.3 years , respectively . The results showed that the mean scores of SQ ( p value < 0.001 ) , knowledge ( p value < 0.001 ) , beliefs ( p value < 0.001 ) , sleep self-efficacy ( p value < 0.001 ) , enabling factors ( p value < 0.001 ) , reinforcing factors ( p value < 0.001 ) , and social support ( p value < 0.001 ) were significantly different between the intervention and control groups after the intervention . Conclusion : Adding an intervention based on the PRECEDE-PROCEED model to the cardiac rehabilitation program may further improve the SQ of patients INTRODUCTION : Poor sleep quality is common among patients following cardiopulmonary artery bypass graft surgery .  Pain , stress , anxiety and poor sleep quality may be improved by massage therapy . OBJECTIVE : This study evaluated whether massage therapy is an effective technique for improving sleep quality in patients following cardiopulmonary artery bypass graft surgery .  METHOD : Participants included cardiopulmonary artery bypass graft surgery patients who were r and omized into a control group and a massage therapy group following discharge from the intensive care unit ( Day 0 ) , during the postoperative period . The control group and the massage therapy group comprised participants who were subjected to three nights without massage and three nights with massage therapy , respectively . The patients were evaluated on the following mornings ( i.e. , Day 1 to Day 3 ) using a visual analogue scale for pain in the chest , back and shoulders , in addition to fatigue and sleep . Participants kept a sleep diary during the study period . RESULTS : Fifty-seven cardiopulmonary artery bypass graft surgery patients were enrolled in the study during the preoperative period , 17 of whom were excluded due to postoperative complications . The remaining 40 participants ( male : 67.5 % , age : 61.9 years ± 8.9 years , body mass index : 27.2 kg/m2 ± 3.7 kg/m2 ) were r and omized into control ( n = 20 ) and massage therapy ( n = 20 ) groups . Pain in the chest , shoulders , and back decreased significantly in both groups from Day 1 to Day 3 . The participants in the massage therapy group had fewer complaints of fatigue on Day 1 ( p = 0.006 ) and Day 2 ( p = 0.028 ) in addition , they reported a more effective sleep during all three days ( p = 0.019 ) when compared with the participants in the control group . CONCLUSION : Massage therapy is an effective technique for improving patient recovery from cardiopulmonary artery bypass graft surgery because it reduces fatigue and improves sleep Introduction Intensive care unit ( ICU ) environmental factors such as noise and light have been cited as important causes of sleep deprivation in critically ill patients . Previous studies indicated that using earplugs and eye masks can improve REM sleep in healthy subjects in simulated ICU environment , and improve sleep quality in ICU patients . This study aim ed to determine the effects of using earplugs and eye masks with relaxing background music on sleep , melatonin and cortisol levels in ICU patients . Methods Fifty patients who underwent a scheduled cardiac surgery and were expected to stay at least 2 nights in Cardiac Surgical ICU ( CSICU ) were included . They were r and omized to sleep with or without earplugs and eye masks combined with 30-minute relaxing music during the postoperative nights in CSICU . Urine was analyzed for nocturnal melatonin and cortisol levels . Subjective sleep quality was evaluated using the Chinese version of Richards-Campbell Sleep Question naire ( a visual analog scale , ranging 0–100 ) . Results Data from 45 patients ( 20 in intervention group , 25 in control group ) were analyzed . Significant differences were found between groups in depth of sleep , falling asleep , awakenings , falling asleep again after awakening and overall sleep quality ( P < 0.05 ) . Perceived sleep quality was better in the intervention group . No group differences were found in urinary melatonin levels and cortisol levels for the night before surgery , and the first and second nights post-surgery ( P > 0.05 ) . The urinary melatonin levels of the first and second postoperative nights were significantly lower than those of the night before surgery ( P = 0.01 ) . The opposite pattern was seen with urinary cortisol levels ( P = 0.00 ) . Conclusion This combination of non-pharmacological interventions is useful for promoting sleep in ICU adult patients ; however , any influence on nocturnal melatonin levels and cortisol level may have been masked by several factors such as the timing of surgery , medication use and individual differences . Larger scale studies would be needed to examine the potential influences of these factors on biological markers and intervention efficacy on sleep . Trial registration Chinese Clinical Trial Registry : ChiCTR-IOR-14005511 . Registered 21 November 2014 Background : Coronary artery bypass grafting ( CABG ) in high-risk patients is associated with significant perioperative complications and anxiety . Prevention of these postoperative complications and anxiety is important in the improvement of clinical outcomes following CABG . Objective : The objective of the study was to evaluate the effect of nurse-initiated preoperative education and counseling on postoperative complications and anxiety symptoms following CABG . Methods : In this prospect i ve and r and omized trial , 40 patients were divided into the study and control groups . All patients received st and ard preoperative and postoperative care , but the study group patients also completed a structured education and counseling course supervised by design ated nurses 3 days before the surgery . Anxiety symptoms were assessed by Zung ’s self-rating anxiety scale ( SAS ) on the day of admission and at 3 days after the surgery . Results : There was no statistically significant difference in the baseline characteristics or operational data between the 2 groups ( P > .05 ) . Following the surgery , the rate of complications such as lower extremity edema , urinary retention , constipation , respiratory infection , and deep venous thrombosis in the study group was lower than in the control group ( P < .05 ) . The mean postoperative SAS scores in the study group was lower than in the control group ( 40.1 [ SD , 6.5 ] vs 48.9 [ SD , 7.3 ] ; P = .01 ) , and the proportion of patients with a SAS score greater than 40 in the study group was also lower than in the control group ( 15 % vs 45 % , P = .041 ) . Conclusions : Nurse-initiated preoperational education and counseling were associated with a reduced rate of perioperative complications and a reduced level of anxiety following CABG AIMS AND OBJECTIVES To evaluate the effectiveness of an individualised programme to promote self-care in sleep-activity in patients with coronary artery disease . BACKGROUND Recent scientific findings have shown that low physical exercise and stress interfere with coronary artery disease patients ' sleep quality and sleep efficiency independent of gender , age and co-morbidity . DESIGN A r and omised pretest-post-test control design . METHODS Forty-seven patients who had undergone a coronary revascularisation procedure and /or pharmacological treatment three to seven weeks earlier at a general hospital were r and omised to either an intervention group or a control group . Data collection was carried out by question naires , a study -specific sleep diary and actigraphy registration for 10 consecutive 24-hour periods , with a follow-up after three to four months . The intervention group underwent a nurse-led individualised education programme to promote self-care of sleep-activity .  Sleep habits and sleep-related lifestyle together formed the basis for setting up individual goals together with the nurse . Individual advice on physical training , relaxation exercise and a CD-based relaxation programme was provided by a physiotherapist . Both groups received a brochure about sleep and stress . RESULTS At a three- to four-month follow-up , the main improvements were seen in the intervention group regarding sleep quality , sleep duration and sleep efficiency in the sleep diary and sleep efficiency in actigraphy . Statistical improvements in health-related quality of life were revealed . This was not so obvious in the control group . CONCLUSIONS An individualised intervention programme to promote self-care of sleep-activity including relaxation in patients with coronary artery disease led by a nurse may improve sleep quality . However , a longitudinal study to promote self-care in sleep-activity should be performed using a larger sample and multiple sites with continuous follow-ups to determine whether any positive effects remain stable over time . RELEVANCE TO CLINICAL PRACTICE Implementation of a multiprofessional individualised programme to promote self-care of sleep-activity including relaxation based on patients ' needs , supported by a healthcare team and led by nurses , is important in clinical practice Disturbed sleep and sleep deprivation is common in patients in critical care setting s. Noise and inappropriate use of light/dark cycles are two of the causes of sleep interruptions . The purpose of the study was to evaluate eye masks and earplugs to help control patients ' exposure to noise and light within the critical care environment . An intervention study using a two group post-test quasi-experimental design of high dependency patients within a cardiothoracic critical care unit was undertaken by a group of critical care n 
    Output:
    
Significant improvement was found in the scores assessing sleep quality among studies testing interventions such as earplugs , sleeping masks , muscle relaxation , posture and relaxation training , white noise , and educational strategies .
Conclusion : significant improvement was found among the scores assessing sleep in the studies testing interventions such as earplugs , sleeping masks , muscle relaxation , posture and relaxation training , white noise and music , and educational strategies