Multi-Intervention Protocol to Improve Sleep Quality in a CCU

Quick Takes

  • Reducing noise from medical equipment, TVs, and staff discussions, as well as unnecessary light sources can enhance sleep quality.
  • Providing adequate pain control can enhance patients’ ability to fall asleep and sleep quality.
  • Performing procedures (vital sign measurements, diagnostic tests, blood samples, medication administration) together to avoid waking patients can enhance sleep quality.

Study Questions:

What is the effect of an intervention protocol aimed at improving sleep quality among patients in the coronary care unit (CCU)?


A two-phased, quasi-experimental study was employed in Brazil to examine the effect of a sleep-promoting intervention among patients who spent one or more consecutive nights in an open (six-bed room divided by retractable curtains) CCU who had acute coronary syndrome (ACS) or acute decompensated heart failure (ADHF). During the first phase of the study, patients received usual care (n = 58), and in the second phase, patients (n = 55) received the sleep-promoting intervention. Baseline data on sleep quality and sleep aid use were collected in both groups. Two self-reported questionnaires (Richards-Campbell Sleep Questionnaire [RCSQ] and a modified version of the Sleep in the Intensive Care Unit Questionnaire [SICUQ]) were used to assess sleep quality. Training of staff and care providers focused on the importance of promoting sleep, and bi-monthly meetings were held to ensure intervention fidelity. The intervention was designed to reduce stimuli and optimize nocturnal circadian rhythm.


The usual care and intervention groups were equivalent on demographic and clinical characteristics, as well as length of stay and mortality. The main barriers to sleep identified by both groups were pain, light, and noise (cardiac monitor alarm, intravenous pump, and mechanical ventilator). The intervention protocol was completed for 78% of patient nights. The intervention group had higher overall sleep depth scores (p = 0.046), less fragmented sleep (p = 0.011), greater return to sleep (p = 0.007), and higher sleep quality scores (p = 0.026) compared to the usual care group. Mean RCSQ scores were lower in the intervention group than the comparison group (83 [66-94] vs. 66.5 [45.7-87.2], p = 0.002).


Compared to the usual care group, the intervention group had lower (i.e., better) scores on the sleep protocol measures. The intervention protocol effectively enhanced sleep quality parameters and reduced barriers to sleep in patients in the CCU, similar to findings in previous research.


Sleep quality is an important aspect of care among critically ill patients with ACS and ADHF. In this study, investigators aimed to determine the impact of implementing a sleep protocol among patients with ACS and ADHF in the CCU. A major strength of this study is the use of the RCSQ, which has been validated against polysomnography. For future research, the sleep-promoting protocol is needed in a variety of hospital settings.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Sleep Apnea

Keywords: Acute Coronary Syndrome, Circadian Rhythm, Coronary Care Units, Critical Illness, Heart Failure, Length of Stay, Pain, Patient Care Team, Polysomnography, Secondary Prevention, Sleep, Sleep Deprivation, Ventilators, Mechanical

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