Comparative efficacy of nonpharmacological interventions on sleep quality in people who are critically ill: A systematic review and network meta-analysis

Background: Disrupted sleep is a critical and highly prevalent concern among critically ill patients requiring intensive care. However, the question of which nonpharmacological intervention represents the best strategy for improving sleep quality remains unanswered. Objective: To compare the efficacy of nonpharmacological interventions in improving sleep quality in people who are critically ill. Methods: Databases, namely PubMed, Embase, CINAHL, and ProQuest Dissertations and Theses A&I, were searched from their inception up until January 15, 2021, for relevant randomised controlled trials. No language or time period restrictions were applied. Only randomised controlled trials examining the effects of nonpharmacological interventions on sleep among adults (aged ≥18 years) admitted to an intensive care unit were included. A random-effects model was used for data analyses. The study protocol was registered at PROSPERO (CRD42021232004). Results: Twenty randomised controlled trials involving 1,207 participants were included. Music combined with earplugs and eye masks (standardised mean difference =1.64), eye masks alone (0.98), aromatherapy (0.87), and earplugs combined with eye masks (0.61) significantly improved sleep quality compared with routine care (all p <0.05). Music combined with earplugs and eye masks significantly enhanced sleep quality in comparison with music (1.34), earplugs combined with eye masks (1.03), and nursing intervention (1.76, all p <0.05). Earplugs alone was less likely to have effects on sleep quality improvement compared with routine care. Conclusion: Eye masks alone and music combined with earplugs and eye masks appear to be the most effective interventions for improving sleep quality in people who are critically ill. Critical care nurses should incorporate the use of eye masks alone or music combined with eye masks into sleep care.