Which Non-pharmacological Sleep Interventions Are Most Effective After Cardiac Surgery?: A Network Meta-Analysis

Sleep disturbances are common after cardiac surgery. Although nonpharmacological interventions such as cognitive behavioral therapy (CBT), relaxation, and sleep hygiene practices have shown effectiveness for improving sleep, their relative impact remains unclear.

We applied network meta-analysis (NMA) to compare multiple nonpharmacological interventions and identify the most effective approach for improving sleep quality in patients after cardiac surgery.

Following PRISMA-NMA guidelines, comprehensive searches across 6 databases were conducted in February 2025. Randomized controlled trials examining nonpharmacological interventions to improve sleep quality in postsurgical cardiac patients were included. All trials used the Pittsburgh Sleep Quality Index as the outcome measure. We performed NMA using STATA to determine the most effective intervention.

Nineteen studies involving 1944 participants were examined. Interventions included education, relaxation, CBT, family-centered care, resistance exercise, aromatherapy, use of eye masks and earplugs, and combined therapies. Nonpharmacological interventions significantly improved sleep quality after cardiac surgery (standardized mean difference, 1.02; 95% confidence interval, -1.50 to -0.54). Among the interventions, CBT emerged as the most effective (surface under the cumulative ranking curve = 88.5%).

Our findings highlight the clinical value of CBT for postsurgical sleep management and support development of standardized guidelines for its implementation. Future research should explore a broader range of nonpharmacological interventions, assess their effectiveness across different types of cardiac surgeries, and investigate alternative CBT models such as online or shortened versions tailored to this population. Integrating CBT into routine postoperative care could enhance patient sleep, recovery, and well-being after cardiac surgery.