Non-pharmacological therapies for sleep and occupational stress regulation among nightshift nurses: a systematic review and Bayesian network meta-analysis based on randomized controlled trials

Guangrong Deng, Li Zeng, Fang Wang, Hailong Hou, Lu Liu, Yu An, Yifan Lv, Xiuying Hu

Purpose Nightshift nurses commonly suffer from sleep disturbances and occupational stress due to irregular work-sleep rhythms. This Bayesian network meta-analysis (NMA) compared the efficacy of non-pharmacological therapies to identify optimal interventions for improving sleep and reducing occupational stress in night/rotating-shift nurses. Methods Cochrane, Embase, PubMed, Web of Science, and CNKI were searched up to October 24, 2025. Studies were assessed for bias via ROB2. Primary outcomes were total sleep score and sleep duration; secondary outcomes included anxiety, depression, and fatigue scores. Bayesian NMA (R 4.5.2) calculated SMD (95% CrI) and SUCRA for intervention ranking. Results Eighteen studies involving 1,572 nurses were included. Sleep intervention program (SIP) appeared to be effective for optimizing total sleep score (SMD −0.80, 95% CrI [−1.2, −0.41]; SUCRA = 80.71%). Mindfulness training intervention (MTI) showed relatively good effectiveness in regulating sleep duration (SMD −1.0, 95% CrI [−1.4, −0.57]; SUCRA = 95.97%). Auricular plaster therapy (APT) appeared to be effective in alleviating depression (SMD −0.60, 95% CrI [−1.0, −0.17]; SUCRA = 84.60%). Rational emotive behavior therapy (REBT) showed superior efficacy for alleviating anxiety (SMD −3.0, 95% CrI [−3.6, −2.4]; SUCRA = 100%). Pure pelargonium essential oil (PPEO) demonstrated relatively good efficacy in relieving fatigue (SMD −0.70, 95% CrI [−1.2, −0.25]; SUCRA = 94.92%). Conclusion SIP, MTI, APT, REBT, and PPEO appeared to be effective non-pharmacological interventions for optimizing nightshift nurses' total sleep score, regulating their sleep duration, and alleviating their depression, anxiety, and fatigue, respectively. Future well-designed studies are warranted to further validate the role of non-pharmacological therapies, particularly SIP and MTI, in regulating sleep among nightshift nurses. However, all findings were based on indirect evidence, which formed a star-shaped network with no closed loops. Therefore, the findings should be considered exploratory and hypothesis-generating, which are intended to provide preliminary guidance for future head-to-head comparative trials rather than establishing definitive clinical evidence. Clinical decisions should be made based on a comprehensive assessment that takes into account local resources, cultural context, and individual preferences of nurses. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251180760