Original Article

Effects of red light on sleep quality in cardiac intensive care unit patients: A randomized controlled trial

Abstract

Background & Aim: Sleep disturbances are prevalent in cardiac intensive care units. Due to the side effects of sleep medications, complementary methods are recommended. This study aimed to assess the impact of red light on the sleep quality of patients in cardiac intensive care units.
Methods & Materials: In a randomized clinical trial, 80 patients at the CCU at Shahid Beheshti Hospital in Kashan, Iran, in 2024. The participants were allocated to two groups using block randomization. In the intervention group, red light replaced the white light in the room for two consecutive nights from 10 pm to 6 am. In the control group, no changes were made to lighting. The sleep quality, insomnia severity, and frequency of insomnia causes of the patients in both groups were assessed before the intervention and on the first and second days after the intervention using the St. Mary's Hospital Sleep Quality Questionnaire. Data were analyzed using chi-square tests, independent t-tests, repeated measures ANOVA, Friedman tests, and Cochran test (SPSS V: 19).
Results: There was no statistically significant difference between the two groups before the intervention in terms of demographic information and sleep quality score (P>0.05). The sleep quality score of patients in the intervention group was higher after the intervention than in the control group (p=0.001). A statistically significant difference was observed between the two groups in the first and second days after that for sleep quality score and frequency of insomnia, and insomnia severity (P= 0.001). Comparing the scores of the dimensions of Sleep Latency, Awake onset latency, the duration of the entire sleep process, and napping before and after the intervention in the two groups showed that the two groups did not have a statistically significant difference in these dimensions before and the first and second days after that (p>0.017).
Conclusion: Red light led to an improvement in sleep quality scores and a reduction in the severity and frequency of insomnia in patients admitted to the cardiac intensive care units. Its simplicity and low cost make it a recommended approach for improving their sleep.

1. Pisani MA, Friese RS, Gehlbach BK, Schwab RJ, Weinhouse GL, Jones SF. Sleep in the intensive care unit. American Journal of Respiratory and Critical Care Medicine. 2015;191(7):731-8. https://doi.org/10.1164/rccm.201411-2099CI
2. Druce KL, Cordingley L, Short V, Moore S, Hellman B, James B, et al. Quality of life, sleep and rheumatoid arthritis (QUASAR): a protocol for a prospective UK mHealth study to investigate the relationship between sleep and quality of life in adults with rheumatoid arthritis. BMJ Open. 2018;8(1):e018752. https://doi.org/10.1136/bmjopen-2017-018752
3. Kwak A, Jacobs J, Haggett D, Jimenez R, Peppercorn J. Evaluation and management of insomnia in women with breast cancer. Breast Cancer Research and Treatment. 2020;181(2):269-77. https://doi.org/10.1007/s10549-020-05635-0
4. Petrosino F, Bartoli D, Trotta F, Di Nome S, Di Sarli MG, Frammartino R, Giancane F. Nurses quality of life, sleep disturbance, and intention to leave critical care units: a cross-sectional moderated mediation analysis. Intensive and Critical Care Nursing. 2024;81:103602. https://doi.org/10.1016/j.iccn.2023.103602
5. Buysse DJ, Rush AJ, Reynolds CF. Clinical management of insomnia disorder. Journal of the American Medical Association. 2017;318(20):1973-4. https://doi.org/10.1001/jama.2017.15683
6. Al Mutair A, Shamsan A, Salih S, Al-Omari A. Sleep deprivation etiologies among patients in the intensive care unit: literature review. Dimensions of Critical Care Nursing. 2020;39(4):203-10. https://doi.org/10.1097/DCC.0000000000000422
7. Madsen MT, Huang C, Zangger G, Zwisler ADO, Gögenur I. Sleep disturbances in patients with coronary heart disease: a systematic review. Journal of Clinical Sleep Medicine. 2019;15(3):489-504. https://doi.org/10.5664/jcsm.7684
8. Bagheri Nesami M, Heydari Gorji MA, Rezaie S, Pouresmail Z, Yazdani Chorati J. The effect of acupressure on the quality of sleep in patients with acute coronary syndrome in cardiac care unit. Iranian Journal of Critical Care Nursing. 2014;7(1):7-14.
9. Zhao J, Tian Y, Nie J, Xu J, Liu D. Red light and the sleep quality and endurance performance of Chinese female basketball players. Journal of Athletic Training. 2012;47(6):673-8. https://doi.org/10.4085/1062-6050-47.6.08
10. Marshall JC, Bosco L, Adhikari NK, Connolly B, Diaz JV, Dorman T, et al. What is an intensive care unit? A report of the task force of the World Federation of Societies of Intensive and Critical Care Medicine. Journal of Critical Care. 2017;37:270-6. https://doi.org/10.1016/j.jcrc.2016.07.015
11. Pan R, Zhang G, Deng F, Lin W, Pan J. Effects of red light on sleep and mood in healthy subjects and individuals with insomnia disorder. Frontiers in Psychiatry. 2023;14:1200350. https://doi.org/10.3389/fpsyt.2023.1200350
12. Martin D, Hurlbert A, Cousins DA. Sleep disturbance and the change from white to red lighting at night on old age psychiatry wards: a quality improvement project. Archives of Psychiatric Nursing. 2018;32(3):379-83. https://doi.org/10.1016/j.apnu.2017.12.001
13. Aulsebrook AE, Jones TM, Mulder RA, Lesku JA. Impacts of artificial light at night on sleep: a review and prospectus. Journal of Experimental Zoology Part A: Ecological and Integrative Physiology. 2018;329(8-9):409-18. https://doi.org/10.1002/jez.2189
14. Wright HR, Lack LC. Effect of light wavelength on suppression and phase delay of the melatonin rhythm. Chronobiology International. 2001;18(5):801-8. https://doi.org/10.1081/CBI-100107515
15. Ho Mien I, Chua EC, Lau P, Tan LC, Lee IT, Yeo SC, et al. Effects of exposure to intermittent versus continuous red light on human circadian rhythms, melatonin suppression, and pupillary constriction. PLoS One. 2014;9(5):e96532. https://doi.org/10.1371/journal.pone.0096532
16. Wu HS, Gao F, Davis JE, Given CW. Effects of chronotype-tailored bright light intervention on post-treatment symptoms and quality of life in breast cancer survivors. Supportive Care in Cancer. 2023;31(12):705. https://doi.org/10.1007/s00520-023-08157-9
17. Zhang Z, Wang HJ, Wang DR, Qu WM, Huang ZL. Red light at intensities above 10 lx alters sleep-wake behavior in mice. Light: Science & Applications. 2017;6(5):e16231. https://doi.org/10.1038/lsa.2016.231
18. Figueiro MG, Pedler D. Red light: a novel, non-pharmacological intervention to promote alertness in shift workers. Journal of Safety Research. 2020;74:169-77. https://doi.org/10.1016/j.jsr.2020.06.003
19. Xie B, Zhang Y, Qi H, Yao H, Shang Y, Yuan S, Zhang J. Red light exaggerated sepsis-induced learning impairments and anxiety-like behaviors. Aging. 2020;12(23):23739-60. https://doi.org/10.18632/aging.103940
20. Askaripoor T, Motamedzade M, Golmohammadi R, Farhadian M, Babamiri M, Samavati M. Effects of light intervention on alertness and mental performance during the post-lunch dip: a multi-measure study. Industrial Health. 2019;57(4):511-24. https://doi.org/10.2486/indhealth.2018-0030
21. Li A, Wei X, Xie Y, Ren Y, Zhu X, Liu M, Liu S. Light exposure and its applications in human health. Journal of Biophotonics. 2024;17(5):e202400023. https://doi.org/10.1002/jbio.202400023
22. Atiaa Tolba A, Mohamed Mehany M, Aly Mohammed M. Association between sleep disturbance and physiological parameters of critically ill patients. Egyptian Journal of Health Care. 2021;12(3):38-47. https://doi.org/10.21608/ejhc.2021.183802
23. Chamanzari H, Hesari-Moghadam M, Malekzadeh J, Shakeri MT, Hojjat SK, Hosseini SM, Kianian T. Effect of implementation of quiet time protocol on sleep quality of patients in intensive care unit. Medical-Surgical Nursing Journal. 2016;5(1):49-56.
24. Oshvandi K, Hadad Samani M, Manafi B, Molavi Vardanjani M. The effect of the white noise on sleep quality and comfort of patients after open heart surgery. Journal of Critical Care Nursing. 2020;13(4):63-9.
25. Cheraghi M, Akbari Kh, Baharamnezhad F, Haghani H. The effect of instrumental music on sleep in patient admitted to coronary care unit. Cardiovascular Nursing Journal. 2015;3(4):24-33.
26. van der Meijden WP, Te Lindert BHW, Ramautar JR, Wei Y, Coppens JE, Kamermans M, et al. Sustained effects of prior red light on pupil diameter and vigilance during subsequent darkness. Proceedings of the Royal Society B: Biological Sciences. 2018;285(1883):20180989. https://doi.org/10.1098/rspb.2018.0989
27. Figueiro MG, Sahin L, Roohan C, Kalsher M, Plitnick B, Rea MS. Effects of red light on sleep inertia. Nature and Science of Sleep. 2019;11:45-57. https://doi.org/10.2147/NSS.S195563
28. Mirmohammadsadeghi A, Jahannama N, Mirmohammadsadeghi M. Sleep quality after coronary artery bypass graft surgery: comparing pulsatile and nonpulsatile pump flow. Journal of Extra-Corporeal Technology. 2020;52(4):314-8. https://doi.org/10.1051/ject/202052314
IssueArticles in Press QRcode
SectionOriginal Article(s)
Keywords
red light; sleep quality; cardiac intensive care unit
Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Motahary SM, Barati AM, Mirbagher Ajorpaz N. Effects of red light on sleep quality in cardiac intensive care unit patients: A randomized controlled trial. NPT. 2025;:X-X.