AIM: To synthesise up-to-date research evidence for non-pharmacological interventions to improve various sleep outcomes (e.g., sleep quality, duration) in postsurgical cardiac patients.
BACKGROUND: Sleep disturbances are common amongst postsurgical cardiac patients, yet the effectiveness of non-pharmacological interventions in improving various sleep outcomes has not been comprehensively reviewed.
DESIGN: A systematic review and meta-analysis guided by the PRISMA protocol.
METHODS: CINAHL, PubMed, PsycINFO, Embase, Web of Science, and Cochrane Library were searched for relevant research in May 2023. Included studies used a randomised controlled trial design that applied a non-pharmacological intervention for postsurgical cardiac patients and reported sleep as an outcome. For the meta-analysis, mean effect sizes were separately calculated for studies with regular and reverse-scored scales.
RESULTS: Of 37 studies included, the most common cardiac surgery was coronary artery bypass graft. Most interventions were performed within the first postoperative week and assessed sleep quality outcomes using the Pittsburgh Sleep Quality Index. The interventions are categorised into five types. Human resource-based strategies emerged as the most effective. The meta-analysis of 27 eligible studies showed a mean effect size of 0.76 for studies with regular scoring scales and - 1.04 for those with reverse-scored scales, indicating medium to large effect sizes.
CONCLUSION: Our findings provide strong evidence that non-pharmacological interventions, particularly human resource-based strategies, significantly improve sleep quality in postsurgical cardiac patients. The medium to large effect sizes underscore the clinical significance of these findings.
IMPLICATIONS: Healthcare professionals should consider incorporating non-pharmacological interventions, especially human resource-based strategies, in care plans for postsurgical cardiac patients to improve sleep outcomes and promote recovery. These interventions should be tailored to individual physical and cultural differences for maximum effectiveness. Future research should evaluate the long-term effects of these interventions on various sleep outcomes, using both objective and subjective measures to provide a comprehensive assessment of their efficacy.
REPORTING METHOD: This study adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol.
NO PATIENT OR PUBLIC CONTRIBUTION: Patient and public contributions were not required for this review.
| Specialty Area | Score |
|---|---|
| Hospital Doctor/Hospitalists | |
| Internal Medicine | |
| Cardiology |
This is a well-designed systematic review and meta-analysis dealing with the effect on non-pharmacological measures on sleep disturbances after cardiac surgery. The main result is the beneficial role of globally considered non-pharmacologic measures on sleep disturbances at the immediate post-surgery period among patients who undergo cardiac interventions. However, the main limitation is that most sleep measures are subjective and prone to bias. Furthermore, it would have been of interest to assess the effects of non-pharmacological interventions on objective hard endpoints such as length of hospital stay or avoidance of pharmacological measures and their potential adverse effects and associated costs. On the other hand, the heterogeneity of the non-pharmacological measures does not allow firm conclusions on the effect of any of the reported interventions.
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