Abstract
INTRODUCTION: Nurses often suffer from poor sleep due to shift work and stress, affecting their performance and patient safety. Sleep issues like insomnia and sleepiness are common, leading to burnout and cognitive impairment. This study aimed to determine the prevalence of poor sleep quality (primary outcome) and, as secondary outcomes, the prevalence of sleepiness and insomnia severity among nurses in critical care units. METHOD: A comprehensive search was conducted across the following databases: Web of Science, PubMed, Scopus, Embase, Cochrane Library, and CINAHL. Each database was searched from its inception to February 24, 2025. The keywords "Sleep Quality", "Insomnia", Sleepiness", "Prevalence", "Nurses", "Critical care unit", and their alternatives were searched using MeSH, EMTREE, free-text methods, and expert opinion. A pooled prevalence estimate with a 95% confidence interval (CI) was calculated, and the random-effects model was used to represent the data. The quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, and the studies were categorized as having a low, moderate, or high risk of bias. Analysis was performed using STATA version 17 statistical software. RESULTS: This review included 25 studies with a total sample size of 3,710 nurses. According to the results of the risk of bias assessments, 24% of studies were rated as having a low risk of bias, and 76% were rated as having a moderate risk. The overall prevalence of poor sleep quality was 69.2% (95% CI: 62.4%-76.1%). Heterogeneity was significantly high (I² = 94.49%), and the Q Cochrane test for heterogeneity was significant (p-value < 0.001), indicating substantial variability between studies. Subgroup analyses by country, continent, risk of bias assessment results, year of publication, and mean age of participants contributed to a reduction in heterogeneity. The mean score for sleep quality was 8.14 (95% CI: 6.51-9.77). Additionally, the pooled prevalence of sleepiness and mild to severe insomnia was 64.5% (95% CI: 56.4%-72.6%) and 63.1% (95% CI: 36.4%-89.7%), respectively. CONCLUSIONS: Given the high prevalence of poor sleep quality, sleepiness, and insomnia among critical care nurses, healthcare managers should implement practical measures such as evidence-based interventions, including behavioral, educational, and policy strategies, to enhance sleep outcomes among critical care nurses and ensure patient safety. IMPLICATIONS FOR CLINICAL PRACTICE: Our study's findings provide policymakers with a more comprehensive understanding of sleep disorders among critical care nurses. PROTOCOL REGISTRATION: PROSPERO registration number (International Prospective Register of Systematic Reviews) CRD420251009448 corresponds to the registered protocol for this systematic review. CLINICAL TRIAL NUMBER: Not applicable.