Sleep & Stress in Healthcare Providers After Defined Music Intervention Measure by 7-Tesla fMRI & Actigraphy
Condition: Stress, Psychological; Burnout, Professional; Sleep Deprivation; Music Therapy
MeSH terms: Sleep Deprivation; Burnout, Professional; Burnout, Psychological; Stress, Psychological
Study type: Interventional

Summary: 
      This study plans to explore whether specially chosen relaxing music can help improve sleep,
      reduce stress, and prevent burnout in healthcare workers, many of whom are often
      sleep-deprived. The researchers will measure changes in brain activity, sleep patterns, and
      self-reported stress levels before, during, and after participants listen to this music. The
      novel approach includes using advanced brain scanning technology, sleep monitoring devices,
      and carefully selected music. Ultimately, the aim is to create a scientifically backed music
      intervention that can be used widely to help healthcare providers get better sleep and manage
      stress, potentially reducing burnout rates.
    

Detailed description: 
      Study Summary Sleep deprivation is a serious safety hazard in acute-stress, high-autonomy,
      high-immediacy, and high-risk work environments, where small errors in judgment or motor
      performance can deleteriously impact clinical performance and patient outcomes. A reported
      65% of acute-care physicians suffer from acute and chronic sleep deprivation, and 50-70% of
      emergency-care physicians have reported symptoms of burnout. Sleep-deprived surgeons
      performed surgical tasks less competently and more slowly than intoxicated surgeons. Prior
      functional magnetic resonance imaging (fMRI) studies have linked sleep deprivation to an
      impaired ability to down-regulate negative emotions. Music serves as an effective and
      powerful modulator of human stress responses, effectively alleviating psychophysiological
      stress, enhancing functional connectivity in the emotional centers in the brain, and
      improving sleep by dynamically modulating the hypothalamic-pituitary-adrenal (HPA) axis,
      autonomic nervous system (ANS) and heart rate variability (HRV).

      Our central hypothesis is that listening to validated stress-reducing music containing
      defined compositional elements of relaxation will enhance sleep quality and/or quantity,
      reduce self-reported psychological stress, and mitigate burnout in health care providers. We
      aim to test this hypothesis by measuring pre-, intra-, and post- intervention changes in
      brain activation, functional connectivity, and neurotransmitter releases using 7-Tesla fMRI;
      in qualitative and quantitative sleep patterns using clinically validated actigraphy straps;
      and in self-reported psychological stress and burnout using validated surveys. We seek to
      gather data essential for a formal intervention to improve bedtime routines among healthcare
      providers prone to acute and chronic stress, sleep deprivation, depression and burnout.

      The novelty of our proposed study is threefold: (1) we will use high-resolution 7-Tesla fMRI
      technology to visualize neurological changes in the brain during and after the defined music
      intervention; (2) we will use state-of-the-art actigraphy to qualitatively and quantitatively
      measure music-induced changes in slow wave and rapid eye movement (REM) sleep; and (3) we
      will use sophisticated and precise repertoire-selection methodology developed by expert
      musicians on our team and aimed at increasing the reproducibility and scientific rigor in
      future music intervention studies. Gathering our team's interdisciplinary expertise of
      concert musicians, a Grammy-nominated composer, acute-care physicians, surgeons, and sleep
      experts at Houston Methodist, we seek to measure the impact of defined musical intervention
      on sleep, stress and burnout using repertoire ranging from the Baroque period to 21st Century
      and containing a combination of 16 universal Compositional Elements of Relaxation previously
      extracted and evaluated by our team.

      Our long-term goal is to implement and disseminate defined and scientifically reproducible
      stress-reducing and sleep-enhancing music interventions at the clinic and policy level that
      may alleviate psychophysiological stress and reduce the severity and prevalence of sleep
      deprivation and burnout in health care providers.

      Purpose of the Study / Objectives

      Objective 1 To measure the impact of defined music intervention on quality and quantity of
      sleep in acute care surgeons using WHOOP-a clinically validated actigraphy device Our
      research objective is to evaluate both pre- and self-selected music interventions prior to
      bedtime as a low-cost, zero-risk, noninvasive, easy-to-implement, and non-pharmacological
      technique to enhance sleep qualitatively and quantitatively in acute care attendings,
      fellows, and residents as measured by clinically validated actigraphy strap (WHOOP).

      Objective 2 To validate music-induced stress-reduction and emotion-regulating improvement via
      increased frontal-amygdala connection and using 7-Tesla fMRI We seek to investigate neural
      mechanisms underlying impaired emotional regulation as a result of sleep deprivation, and to
      develop a better understanding of the effects of music intervention on the human stress
      response. An algorithm for the graph-theoretical analysis of functional magnetic resonance
      imaging (fMRI) data will be developed. Emotional centers including the amygdala and bilateral
      insula activation patterns will be visualized. The impact of music on the frontal
      lobe-amygdala connection will be examined. Network clustering analysis will be performed to
      evaluate functional subunits with highest interactions induced by music exposure. 7-Tesla
      fMRI in connection with graph theoretical network analysis will be used to identify and
      differentiate functional subunits in the human brain when under prescribed and self-selected
      music intervention.

      Objective 3 To evaluate the impact of defined music intervention on self-reported
      psychological stress, quality of sleep and burnout in acute-care surgeons using validated
      surveys

      Our objective is to measure the impact of defined music intervention on self-reported
      psychological stress using the State-Trait Anxiety Inventory (STAI), on quality and quantity
      of sleep using the Pittsburg Sleep Quality Index (PSQI), and on self-reported burnout
      syndrome using the Maslach Burnout Inventory (MBI). We also aim to examine potential
      differences between the self-selected music and pre-selected music groups, and test the
      hypothesis that pre-selected music repertoire containing defined compositional elements of
      relaxation will achieve comparable or superior results at enhancing sleep and reducing
      self-reported stress. Additionally, a Brief Musical Experience Questionnaire (BMEQ) will be
      collected as information for the participants' musical background to investigate potential
      link between susceptibility to music intervention and prior musical training, preference and
      exposure.
    

Intervention name(s): Music Therapy
Intervention type(s): Other
Intervention description(s): All music pieces selected for the prescribed intervention contain compositional elements of relaxation analyzed, prepared, and recorded by professional concert artists and a Grammy-nominated composer. The compositional elements included Accentuation, Articulation, Dynamic Range, Familiarity, Interpretive Expertise, Melodic Shape, Meter, Recording Quality, Repetition, Register, Rubato, Tempo, Texture, Timbre, Transition, and Tonality. These 15 repertoire-selecting parameters were used to choose the prescribed music playlist for this study. Music used for the study was downloaded from a password-protected Google Drive accessible to the study participants assigned to the "prescribed music" intervention group.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants were enrolled from the surgery staff at a quaternary care hospital after signing informed consent and were randomized using block randomization (1:1:1) to one of 3 groups: (1) 30 minutes of prescribed musical intervention at bedtime (PM), (2) 30 minutes of self-selected music listening at bedtime (PS), or (3) unaltered, normal bedtime routine, as a control (C).
Masking: None (Open Label)
Primary purpose: Other
Keywords: Sleep Deprivation; Music Therapy; Stress; Burnout; fMRI