Improving Sleep Quality in Stroke and Chronic Kidney Disease Patients: A Systematic Review of Non-Pharmacological Interventions
Keywords:
Sleep Disorders, Non-Pharmacological Interventions, Stroke, Chronic Kidney DiseaseAbstract
Sleep disturbances are common in patients with stroke and chronic kidney disease, potentially worsening health conditions and reducing quality of life. Non-pharmacological interventions have received less research attention, despite the potential for non-pharmacological approaches to improve sleep quality without causing side effects. This systematic review aimed to evaluate the effectiveness of non-pharmacological interventions in this population. Randomized controlled trials involving patients with stroke and chronic kidney disease aged >18 years were searched in seven English-language databases. Methodological quality was assessed using the JBI critical appraisal tool, and data were synthesized. 9 RCTs met inclusion criteria and demonstrated significant benefits. Cognitive Behavioral Therapy (4 studies) consistently improved sleep quality and reduced fatigue, anxiety, and depression (p < 0.001). Reflexology (2 studies) decreased anxiety and improved sleep quality (p < 0.001). Acupuncture significantly improved ISI, PSQI, and HADS scores (p < 0.001–0.003). Lavender aromatherapy reduced depression and improved sleep quality (p < 0.001), while spiritual care improved sleep quality and spiritual well-being (p < 0.001). These findings highlight the role of nurses in implementing non-pharmacological interventions to address sleep disturbances and related psychological symptoms in patients with stroke and chronic kidney disease. Cognitive Behavioral Therapy is recommended for patients with insomnia and psychological comorbidities, reflexology and massage may be beneficial for those undergoing hemodialysis, while acupuncture, aromatherapy, and spiritual care can be tailored to individual needs. Further research is needed to assess their long-term effectiveness and their integration into broader clinical practice.
References
Ahn, E., Baek, Y., Park, J. E., Lee, S., & Jin, H. J. (2024). Elevated prevalence and treatment of sleep disorders from 2011 to 2020: a nationwide population-based retrospective cohort study in Korea. BMJ Open, 14(2). https://doi.org/10.1136/bmjopen-2023-075809
Alsolami, M., Almohammadi, N., Alrashdi, H., Alasmari, M., & Aljadaani, H. (2024). Classified diagnosis of sleep disorders and treatment: a review. International Journal of Medicine in Developing Countries, 2836–2841. https://doi.org/10.24911/ijmdc.51-1606756076
Barker, T. H., Stone, J. C., Sears, K., Klugar, M., Tufanaru, C., Leonardi-Bee, J., Aromataris, E., & Munn, Z. (2023). The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis, 21(3), 494–506
Cai, H., Wang, X. P., & Yang, G. Y. (2021). Sleep disorders in stroke: An update on management. In Aging and Disease (Vol. 12, Issue 2, pp. 570–585). International Society on Aging and Disease. https://doi.org/10.14336/AD.2020.0707
Cao, Y., Yan, Y. J., Xu, J. Y., Liwayiding, A., Liu, Y. P., Yin, X., Lao, L. X., Zhang, Z. J., & Xu, S. F. (2022). Acupuncture for insomnia after ischemic stroke: an assessor-participant blinded, randomized controlled trial. Acupuncture in Medicine, 40(5), 443–452. https://doi.org/10.1177/09645284221077106
Chen, P., Wang, W., Ban, W., Zhang, K., Dai, Y., Yang, Z., & You, Y. (2024). Deciphering Post-Stroke Sleep Disorders: Unveiling Neurological Mechanisms In The Realm Of Brain Science. In Brain Sciences (Vol. 14, Issue 4). Multidisciplinary Digital Publishing Institute (Mdpi). Https://Doi.Org/10.3390/Brainsci14040307
Chen, W. Y., Li, J., & Xia, D. (2025). Efficacy of Cognitive Behavioral Therapy Combined with Jacobson Progressive Muscle Relaxation in Improving Sleep Quality and Overall Well-Being in Hemodialysis Patients with Insomnia: A Randomized Controlled Trial. Tohoku Journal of Experimental Medicine, 267(2), 141–150. https://doi.org/10.1620/tjem.2025.J005
Chu, G., Matricciani, L., Russo, S., Viecelli, A. K., Jesudason, S., Bennett, P., & Fernandez, R. (2025). Sleep disturbances in adults with chronic kidney disease: an umbrella review. In Journal of Nephrology (Vol. 38, Issue 2, pp. 353–369). Springer Science and Business Media Deutschland GmbH. https://doi.org/10.1007/s40620-025-02214-8
Crowe, K., & Spiro-Levitt, C. (2024). Sleep-Related Problems and Pediatric Anxiety Disorders. In Psychiatric Clinics of North America (Vol. 47, Issue 1, pp. 213–228). W.B. Saunders. https://doi.org/10.1016/j.psc.2023.06.014
Fatma, S. (2023). Investigasi Masalah Gangguan Tidur Terhadap Penyakit Kronik. Jurnal Klinik Dan Riset Kesehatan, 2(2), 260–261. https://doi.org/10.11594/jk-risk.02.2.1
Fleming, M. K., Smejka, T., Macey, E., Luengo-Fernandez, R., Henry, A. L., Robinson, B., Kyle, S. D., Espie, C. A., & Johansen-Berg, H. (2024). Improving sleep after stroke: A randomised controlled trial of digital cognitive behavioural therapy for insomnia. Journal of Sleep Research, 33(2). https://doi.org/10.1111/jsr.13971
Ghanbari, A., Shahrbabaki, P. M., Dehghan, M., Mardanparvar, H., Abadi, E. K. D., Emami, A., & Sarikhani-Khorrami, E. (2022). Comparison of the Effect of Reflexology and Swedish Massage on Restless Legs Syndrome and Sleep Quality in Patients Undergoing Hemodialysis: a Randomized Clinical Trial. International Journal of Therapeutic Massage and Bodywork: Research, Education, and Practice, 15(2), 1–13. https://doi.org/10.3822/ijtmb.v15i2.705
Göktuna, G., & Arslan, G. G. (2024). Effect of foot reflexology massage on sleep, anxiety and quality of life in hemodialysis patients: A single-blind, randomized, placebo-controlled trial. Explore, 20(6). https://doi.org/10.1016/j.explore.2024.103061
Gopal, A., Farragher, J., Jassal, S. V., & Mucsi, I. (2025). Sleep Disorders in CKD: A Review. In American Journal of Kidney Diseases (Vol. 85, Issue 6, pp. 754–766). W.B. Saunders. https://doi.org/10.1053/j.ajkd.2024.12.010
Hasan, F., Gordon, C., Wu, D., Huang, H. C., Yuliana, L. T., Susatia, B., Marta, O. F. D., & Chiu, H. Y. (2021). Dynamic Prevalence of Sleep Disorders Following Stroke or Transient Ischemic Attack: Systematic Review and Meta-Analysis. Stroke, 52(2), 655–663. https://doi.org/10.1161/STROKEAHA.120.029847
Khazaei, S., Ayubi, E., Khazaei, M., Khazaei, M., & Afrookhteh, G. (2022). Sleep Quality and Related Determinants among Stroke Patients: A Cross-Sectional Study. Iranian journal of psychiatry, 17(1), 84–90. https://doi.org/10.18502/ijps.v17i1.8052.
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. In BMJ (Vol. 372). BMJ Publishing Group. https://doi.org/10.1136/bmj.n71
Pilon, L., Frankenmolen, N. F., van der Zijp, J., Kessels, R. P. C., & Bertens, D. (2023). A short add-on sleep intervention in the rehabilitation of individuals with acquired brain injury: A randomized controlled trial. NeuroRehabilitation, 53(3), 323–334. https://doi.org/10.3233/NRE-230139
Yang, J. (2021). Acupuncture treatment for post-stroke insomnia: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Clinical Practice, 44. https://doi.org/10.1016/j.ctcp.2021.101396
Yin, X. J., Lin, G. P., Wu, X. Y., Huang, R., Xu, C. J., & Yao, M. Y. (2024). Effects of lavender essential oil inhalation aromatherapy on depression and sleep quality in stroke patients: A single-blind randomized controlled trial. Complementary Therapies in Clinical Practice, 55. https://doi.org/10.1016/j.ctcp.2024.101828
Ymer, L., McKay, A., Wong, D., Frencham, K., Grima, N., Roper, M., Nguyen, S., Murray, J., Spitz, G., & Ponsford, J. (2025). Randomized controlled trial of cognitive behavioral therapy versus health education for sleep disturbance and fatigue following stroke and traumatic brain injury. Journal of Rehabilitation Medicine, 57, jrm41302. https://doi.org/10.2340/jrm.v57.41302
Yousofvand, V., Torabi, M., Oshvandi, K., Kazemi, S., Khazaei, S., Khazaei, M., & Azizi, A. (2023). Impact of a spiritual care program on the sleep quality and spiritual health of Muslim stroke patients: A randomized controlled trial. Complementary Therapies in Medicine, 77. https://doi.org/10.1016/j.ctim.2023.102981
