Effects of non-pharmacological interventions on sleep in patients with critical illness: a systematic review and network meta-analysis

Adequate sleep is vital for recovery in patients with critical illness, yet sleep in intensive care units (ICUs) is widely disrupted. Although various non-pharmacological strategies have been proposed, evidence remains inconsistent, and the most effective intervention for improving ICU sleep has not been clearly established. In this review, we evaluated the effectiveness of non-pharmacological interventions for sleep promotion and identified the most effective strategies for improving sleep quality among ICU patients. Studies implementing non-pharmacological sleep-promoting interventions and evaluating sleep quality in ICU patients were identified using MEDLINE and Cumulative Index to Nursing and Allied Health Literature. The protocol was registered in PROSPERO (CRD420251184156). Thirty-six studies encompassing 16 intervention types were included. A Bayesian network meta-analysis demonstrated significant improvements for aromatherapy, eye mask, eye mask and earplugs, music therapy, and multicomponent intervention compared with control groups. Surface under the cumulative ranking curves indicated that music therapy (94.9%) had the highest probability of being the most effective intervention, followed by aromatherapy (76.2%). These interventions may improve sleep by reducing environmental disturbances and stabilizing autonomic and neurotransmitter activity.