Effect of a Nurse-Led Cognitive-Behavioral Therapy on Sleep Quality in Patients Undergoing Open Heart Surgery: A Prospective Randomized Clinical Trial

Background: Sleep disorders are one of the most common complications in patients undergoing open-heart surgery. Cognitive-behavioral therapy (CBT-I) is used as a way to improve sleep quality. Objectives: This study aimed to determine the effect of a nurse-led CBT-I on sleep quality among patients undergoing open-heart surgery. Methods: This prospective randomized clinical trial was conducted on 90 patients undergoing open-heart surgery in both intervention and control groups (N = 45). The control group received routine care. The intervention group received 10-12 sessions of nurse-led CBT-I. The demographic questionnaire and the Pittsburgh Sleep Quality Index (PSQI) were used to collect data. The data was analyzed in SPSS v. 22 software using X2, independent sample t-test, analysis of covariance (ANCOVA), and paired t-test. Results: The majority of samples were in the age range of 31 - 40 years (33.33%) and male (53.33%). The results of the independent t-test showed that the mean total PSQI score in the 2 groups before the intervention was not significantly different (P = 0.245). Also, the results of ANCOVA showed that the mean total PSQI score after the intervention has a significant difference in the 2 groups (P = 0.0001). Conclusions: Nurse-led CBT-I intervention helps to improve the sleep quality of patients after open-heart surgery by reducing their automatic thoughts that affect behavior. Thus, it is recommended that training in nurse-led CBT-I be included in the nurses academic training program, as well as in continuing education programs for nurses working in heart surgery wards.