LAUSR

Patients who have undergone cardiac surgery experience decreased sleep quality, which is associated with patients’ quality of life and mortality. Various interventions were conducted to improve sleep after cardiac surgery; however, findings have been inconsistent. This systematic review was conducted to examine the effects of non-pharmacological sleep interventions in patients after cardiac surgery. The review was performed following PRISMA guidelines. CINAHL, PubMed, PsycINFO, Embase, Scopus, and Web of Science were searched. Studies were included if they were a randomized controlled trial that applied non-pharmacological sleep intervention in patients who underwent cardiac surgery and reported sleep as an outcome. Excluded studies conducted on non-open-heart surgery (e.g., percutaneous coronary intervention) or were theses, dissertations, reviews, or study protocols. Quality appraisal of included studies was assessed using the Cochrane Risk of Bias tool. Meta-analysis was conducted, and mean effect size was separately calculated for studies with reverse-scored scales, which means higher scores indicate poorer sleep quality. Twenty studies (n=1,460 participants) were included. The most common cardiac surgery was coronary artery bypass graft, and sleep was mostly measured using subjective questionnaires in the studies; only 1 study applied both subjective and objective measures (Actigraphy). Sleep interventions were conducted in a hospital intensive care unit, ward, or outpatient clinic between 1 month before and 2 months after the surgery. The interventions were categorized into educational strategies, complementary medicine relaxation methods, complementary medicine sensory therapies, and the use of a device (e.g., earplugs or eye masks). The meta-analysis results showed that non-pharmacological interventions resulted in better sleep quality as compared to control group. The mean effect size was 0.66 for studies with regular scoring scales (95% confidence interval [CI], 0.38 to 0.94) and -0.83 with reverse scoring scales (95% CI, -1.23 to -0.42), which indicated that the sleep interventions were overall effective for improving sleep quality with medium-to-large effect sizes. Non-pharmacological sleep interventions improved sleep quality in patients after cardiac surgery. More studies should be conducted to identify the most effective type of sleep intervention and examine the long-term effects of these interventions using objective measures of sleep.