Non-pharmacological interventions for improving sleep outcomes among patients with a diagnosis of coronary artery disease: a systematic review and meta-analysis

Aims To determine the effectiveness of non-pharmacological interventions on sleep outcomes among patients with coronary artery disease and recognize pertinent characteristics that potentially affect the effectiveness of such interventions. Methods and results Relevant studies conducted before 27 April 2022 were identified through four core electronic databases using terms related to coronary artery disease, sleep outcomes, and randomized controlled trials. Two authors independently conducted study selection, data extraction, and risk-of-bias assessment. Meta-analysis, sub-group analysis, publication bias analysis, and sensitivity analysis were conducted using R version 4.2.2. Of the 4755 retrieved articles, 42 studies were selected for systematic review and 30 studies were included in the meta-analysis. The findings of this study revealed that non-pharmacological interventions significantly improved self-reported sleep quality (standardized mean difference = -0.85, 95% confidence interval -1.08, -0.63), but had no effects on objectively measured sleep efficiency and duration. Regarding the types of interventions involved, environmental control was the most effective in improving self-reported sleep quality, followed by relaxation, self-care behaviour management, and relaxation and cognitive/psychological complex interventions. Through subgroup analysis, we did not find any covariates that were significantly related to self-reported sleep quality. Conclusion Non-pharmacological interventions have been shown to play beneficial roles in improving self-reported sleep quality among patients with coronary artery disease. Additional studies are required to elucidate the effect of non-pharmacological interventions on objectively measured sleep outcomes and to characterize their optimal frequencies and durations. Registration PROSPERO CRD42022366851