Influence of Ward Nighttime Noise Management on Sleep Quality and Negative Emotions in Postoperative Patients with Osteonecrosis of the Femoral Head within an Enhanced Recovery After Surgery Context.
Zhang L, Liang H, et al. • Noise & health • 2026
Incorporating ward nighttime noise management into ERAS protocols improves sleep quality, reduces negative emotions, and effectively lowers noise levels in ONFH patients after THA.
Key Findings
Results
Ward nighttime noise intensity was significantly lower in the noise-reduction group compared with the conventional group.
The noise-reduction group implemented an ERAS-based ward nighttime noise management protocol starting July 2023
The conventional group had no noise management protocol (January 2022 to June 2023)
Difference in noise levels between groups was statistically significant (P < 0.05)
Study conducted at Luoyang Orthopedic-Traumatological Hospital of Henan Province (Henan Provincial Orthopedic Hospital)
Results
Both groups showed improved sleep quality after 1 week of hospitalization compared to baseline at admission.
Improvements were measured using both the Richards-Campbell Sleep Questionnaire (RCSQ) and polysomnography (PSG)
Both groups showed improved RCSQ scores after 1 week (P < 0.05)
Both groups showed prolonged deep sleep and total sleep time measured by PSG (P < 0.05)
Both groups showed reduced frequency of nighttime awakenings after 1 week (P < 0.05)
Total sample included 140 ONFH patients who underwent total hip arthroplasty (THA)
Results
The noise-reduction group demonstrated significantly better outcomes in all sleep parameters compared with the conventional group.
Noise-reduction group: n = 68; conventional group: n = 72
Superior outcomes observed across all PSG-measured sleep parameters including deep sleep time, total sleep time, and nighttime awakening frequency
Superior outcomes also observed in subjective sleep quality measured by RCSQ
All between-group differences in sleep parameters were statistically significant (P < 0.05)
Results
Negative emotions decreased and positive emotions increased in both groups after 1 week of hospitalization, with greater improvements in the noise-reduction group.
Emotional outcomes were measured using the short-form Depression, Anxiety, and Stress Scales (DASS-C21) and the Positive and Negative Affect Schedule (PANAS)
DASS-C21 scores decreased in both groups after 1 week relative to admission (P < 0.05)
PANAS negative affect scores decreased in both groups after 1 week (P < 0.05)
PANAS positive affect scores increased in both groups after 1 week (P < 0.05)
The noise-reduction group demonstrated significantly better emotional outcomes compared to the conventional group (P < 0.05)
Methods
The study design was a single-center retrospective controlled study comparing outcomes before and after implementation of an ERAS-based nighttime noise management protocol.
Clinical data from 140 ONFH patients who underwent THA between January 2022 and March 2025 were analyzed
Group assignment was based on the implementation timeline of the noise management protocol, not randomization
Assessments were conducted at two time points: at admission and 1 week after hospitalization
Both subjective (RCSQ, DASS-C21, PANAS) and objective (PSG, noise intensity measurement) outcome measures were used
What This Means
This research suggests that actively managing nighttime noise levels in hospital wards can meaningfully improve sleep quality and emotional well-being in patients recovering from hip replacement surgery for a condition called osteonecrosis of the femoral head (where bone tissue in the hip joint dies due to reduced blood supply). The study compared 140 patients treated at a Chinese orthopedic hospital — 72 who received standard care without a noise management program and 68 who received care that included a structured nighttime noise reduction protocol as part of a broader 'Enhanced Recovery After Surgery' (ERAS) approach. After one week in the hospital, patients in the noise-reduction group slept longer, spent more time in deep sleep, woke up less during the night, and reported better sleep quality than those in the standard care group. They also showed lower levels of depression, anxiety, and stress, and reported more positive emotional states.
Both groups showed some improvement over their baseline status at admission, suggesting that hospitalization and treatment itself helps recovery, but the noise-reduction protocol produced measurably greater benefits. The researchers used both self-reported questionnaires and objective sleep monitoring (polysomnography) to measure sleep, which strengthens the reliability of the findings. This research suggests that simple environmental interventions — like controlling noise in hospital wards at night — may be a low-cost way to support patient recovery after surgery. It also highlights that poor sleep and negative emotions during hospital stays are addressable problems, not just unavoidable aspects of being hospitalized.
Zhang L, Liang H, Zhu C, Zhu Y, Liu Y. (2026). Influence of Ward Nighttime Noise Management on Sleep Quality and Negative Emotions in Postoperative Patients with Osteonecrosis of the Femoral Head within an Enhanced Recovery After Surgery Context.. Noise & health. https://doi.org/10.4103/nah.nah_180_25