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

Abstract

Jeongmin Kim,1 Dain Choi,2 Myung Sun Yeo,2 Ga Eul Yoo,2 Soo Ji Kim,3 Sungwon Na1 1Department of Anesthesiology and Pain Medicine, Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; 2Department of Music Therapy, Graduate School, Ewha Womans University, Seoul, Republic of Korea; 3Music Therapy Education, Graduate School of Education, Ewha Womans University, Seoul, Republic of KoreaCorrespondence: Sungwon NaDepartment of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, 50 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, Republic of KoreaTel [phone]Fax [phone]Email [email protected] Ji KimMusic Therapy Education, Graduate School of Education, Ewha Womans University, 52 Ewhayeodae-Gil, Seodaemun-Gu, Seoul 03760, Republic of KoreaTel [phone]Fax [phone]Email [email protected]: 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

Keywords

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