162 A.Hajibagheri et al Complementary Therapies in Clinical Practice 20(2014)159-163 Table 2 Acknowledgment Sleep quality in experimental and control groups. PSQI domains Groups Before After P value" This article is the report of a Master's thesis funded by Kashan Subjective sleep quality University of Medical Sciences with the number 9276.The recorded Experimental 093±0.69 0.66±0.800.135 Control 120±0.71 1.13±0.620480 code in the registration center of clinical trials is IRCT201 P value 0114 0.012 3052013403N1.We would like to gratefully thank the Research Sleep latency Experimental 2.03±1.15 1.03±1.240.000 Administration of the funding university as well as the adminis- Control 2.50±097 260±0.67 0.546 P valueb 0.068 0.000 trators and the staffs of the study setting who helped and sup- Sleep duration Experimental1.66±1.341.03±1.400.009 ported us during the study.We also are thankful of the patients for Control 1.60±1.00 1.73±1.14 0355 their participation in this study. P valueb 0.679 0.042 Habitual sleep efficiency Experimental 1.40+1.42 080±1290023 Control 1.76±1.30 1.83±134 0.804 References P value 0208 0.002 Sleep disturbances Experimental 1.00±0.37 0.66±0.600.004 [1]Elliott R.McKinley S.Cistulli P.The quality and duration of sleep in the Control 0.96±0.31 0.93±0360.564 intensive care setting:an integrative review. Int J Nurs Stud 2011:48:384- P value 400. 0710 0.031 Use of sleep medications Experimental 1.00±0.26 1.00±0.37 1.000 [2]Wenham T.Pittard A.Intensive care unit environment.Contin Educ Anaesth Control 096士0.18 1.00±0.000317 Crit Care Pain 2009:9:178-83. P valueb [3]Moeini M.Khadibi M.Bekhradi R.Mahmoudian SA.Nazari F.Effect of 0.570 1.000 Daytime dysfunction Experimental0.66±0.800.43±0.850.143 aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University Control 0.16士037 0.10±030 0317 of Medical Sciences.Iran J Nurs Midwifery Ress 2010:15:234-9. P value 0.004 0.081 [4]Chokroverty S.Sahota P.Acute and emergent events in sleep disorders.New Total PSQI score Experimental 8.70+3.96 5.63±5.130001 York Oxford University Press:2010 Control 9.16±3.27 926±3.00 0.408 [5]Glass J.Lanctot KL,Herrmann N.Sproule BA,Busto UE.Sedative hypnotics in P value 0.929 0.031 older people with insomnia:meta-analysis of risks and benefits.BMJ 2005:331:1169-75 a The results of the Mann-Whitney U test for between-groups comparison [6]Saeedi M,Ashk Torab T.Saatchi K.Zayeri F.Amir Ali Akbari S.The effect of b The results of the Wilcoxon signed-rank test for within-groups comparison. progressive muscle relaxation on sleep quality of patients undergoing he- modialysis.IJCCN 2012:5:23-8. [7]Jones C.Dawson D.Eye masks and earplugs improve patient's perception of probably due to the discrepancies in the interventions of these sleep.Nurs Crit Care 2012:17:247-54. studies.For example,Lee administered aromatherapy between [8]Redeker N.McEnany GP.Sleep disorders and sleep promotion in nursing practice.New York:Spri ringer Publishing Company:2011 14:00 and 20:00,while we administered it during night-from [9]Chen JH,Chao YH,Lu SF.Shiung TF.Chao YF.The effectiveness of valerian 22:00 to 06:00.On the other hand,while we investigated the effect acupressure on the sleep of ICU patients:a randomized clinical trial.Int J Nurs of aromatherapy on patients'nighttime sleep,Chang et al.focused Sud2012:49:913-20. [10]Fismer KL,Pilkington K.Lavender and sleep:a systematic review of the evi- on the effects of aromatherapy on nurses'daytime sleep. dence.EuM2012:4:436-47. The study findings showed that Rosa damascene aromatherapy [11]Williams TL Evaluating effects of aromatherapy massage on sleep in children had no significant effect on patients'use of sleep medications. with autism:a pilot study.Evid Based Complement Altern Med 2006:3:373- Saeedi et al.noted that complementary therapies had no significant [12]Boskabady MH,Shafei MN.Saberi Z.Amini S.Pharmacological effects of Rosa effect on patients'use of sleep medications61.Most patients in the damascena.Iran J Basic Med Sci 2011:14:295 intensive care unit of doctor's orders requiring medication are [13]Setayeshvali Pour N.Kheirkhah M.Neisani L Haghani H.Comparison of the effects of aromatherapy with essential oils of damask rose and hot footbath on sleeping at night.In Iran most patients have confidence in their the first stage of labor anxiety in Nulliparous women.Complement Med J Fac physician's instructions such as sleep medications and execute Nurs Midwifery 2012:2:1-9. them 28.Therefore do not start or discontinue drugs with their [14]Hongratanaworakit T.Relaxing effect of rose oil on humans.Nat Prod Com- mun2009:4291-6. authorization. [15]Sahebalzamin M.Khanavi M.Alvi majd H,Mirkarimi SM,Karimi M.Effects of This study has several limitations.Different people have inhalation aromatherapy on female students'anxiety and depression settling different levels of psychological development and hence,have in dormitory of Tehran University of medical saences med sai lislamic Azad Univ Tehran Med Branch 2010:20:175-81 different abilities for coping with strains and pressures that disturb [16]Afkham Ebrahimi A.Ghale Bandi MF.Salehi M.Kafian Tafti AR,Vakili Y. sleep.Moreover,different people have different sleeping habits. Akhlaghi Farsi E.Sleep parameters and the factors affecting the quality of These two factors might have affected our findings. sleep in patients attending selected clinics of Rasoul-e-Akram Hospital.RJMS 2008:15:31-8. [17]Farrahi Moghaddam J.Nakhaee N,Sheibani V.Garrusi B.Amirkafi A.Reliability 5.Conclusion and validity of the Persian version of the Pittsburgh Sleep Quality Index(PSQI- P).Sleep Breath 2012:16:79-82. The findings of this study indicate that Rosa damascene [18]Rener-Sitar K,John MT,Bandyopadhyay D.Howell MJ.Schiffman EL Explo- ration of dimensionality and psychometric properties of the Pittsburgh Sleep aromatherapy can significantly improve the sleep quality of cardiac Quality Index in cases with temporomandibular disorders.Health Qual Life patients hospitalized in CCU.Accordingly,healthcare providers can 0 utcomes2014:12:10. use Rosa damascene aroma-either in combination with current [19]Spira AP.Beaudreau SA,Stone KL Kezirian EJ.Lui LY.Redline S,et al.Reli- ability and validity of the Pittsburgh Sleep Quality Index and the Epworth treatments or alternatively-for promoting patients'sleep without Sleepiness Scale in older men.J Gerontol A Biol Sci Med Sci 2012:67:433-9. causing them the adverse side-effects of routine sleep medications. [20]Izadi Avanji FS.Adib Hajbaghery M,Afazel MR.Quality of sleep and it's related However,conducting further long-term,large-scale studies on factors in the hospitalized elderly patients of Kashan hospitals in 2007.Feyz 2009:12:52-60. cardiac patients as well as other patient populations is necessary [21]Buysse DI.Reynolds 3rd CF.Monk TH.Berman SR,Kupfer DJ.The Pittsburgh for providing ample evidence regarding the effectiveness of Rosa Sleep Quality Index:a new instrument for psychiatric practice and research damascene aromatherapy in promoting sleep.Moreover, Psychiatry Res 1989:28:193-213. [22]Chien LW.Cheng SL Liu CF.The effect of lavender aromatherapy on autonomic comparing the effects of Rosa damascene aromatherapy with sleep nervous system in midlife women with insomnia.eCAM 2012:2012:1-8 medications on patients'sleep quality is also recommended. [23]Soden K.Vincent K.Craske S.Lucas C,Ashley S.A randomized controlled trial of aromatherapy massage in a hospice setting.Palliat Med 2004:18:87-92. Conflict of interest statement [24]Lewith GT.Godfrey AD.Prescott P.A single-blinded,randomized pilot study evaluating the aroma of Lavandula augustifolia as a treatment for mild The authors have no conflict of interest to declare. insomnia.J Altern Complement Med 2005:11:631-7.probably due to the discrepancies in the interventions of these studies. For example, Lee administered aromatherapy between 14:00 and 20:00, while we administered it during nightdfrom 22:00 to 06:00. On the other hand, while we investigated the effect of aromatherapy on patients’ nighttime sleep, Chang et al. focused on the effects of aromatherapy on nurses’ daytime sleep. The study findings showed that Rosa damascene aromatherapy had no significant effect on patients’ use of sleep medications. Saeedi et al. noted that complementary therapies had no significant effect on patients’ use of sleep medications [6]. Most patients in the intensive care unit of doctor’s orders requiring medication are sleeping at night. In Iran most patients have confidence in their physician’s instructions such as sleep medications and execute them [28]. Therefore do not start or discontinue drugs with their authorization. This study has several limitations. Different people have different levels of psychological development and hence, have different abilities for coping with strains and pressures that disturb sleep. Moreover, different people have different sleeping habits. These two factors might have affected our findings. 5. Conclusion The findings of this study indicate that Rosa damascene aromatherapy can significantly improve the sleep quality of cardiac patients hospitalized in CCU. Accordingly, healthcare providers can use Rosa damascene aromadeither in combination with current treatments or alternativelydfor promoting patients’ sleep without causing them the adverse side-effects of routine sleep medications. However, conducting further long-term, large-scale studies on cardiac patients as well as other patient populations is necessary for providing ample evidence regarding the effectiveness of Rosa damascene aromatherapy in promoting sleep. Moreover, comparing the effects of Rosa damascene aromatherapy with sleep medications on patients’ sleep quality is also recommended. Conflict of interest statement The authors have no conflict of interest to declare. Acknowledgment This article is the report of a Master’s thesis funded by Kashan University of Medical Sciences with the number 9276. The recorded code in the registration center of clinical trials is IRCT201 3052013403N1. We would like to gratefully thank the Research Administration of the funding university as well as the adminis￾trators and the staffs of the study setting who helped and sup￾ported us during the study. We also are thankful of the patients for their participation in this study. References [1] Elliott R, McKinley S, Cistulli P. The quality and duration of sleep in the intensive care setting: an integrative review. Int J Nurs Stud 2011;48:384e 400. [2] Wenham T, Pittard A. Intensive care unit environment. Contin Educ Anaesth Crit Care Pain 2009;9:178e83. [3] Moeini M, Khadibi M, Bekhradi R, Mahmoudian SA, Nazari F. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences. Iran J Nurs Midwifery Ress 2010;15:234e9. [4] Chokroverty S, Sahota P. Acute and emergent events in sleep disorders. New York: Oxford University Press; 2010. [5] Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005;331:1169e75. [6] Saeedi M, Ashk Torab T, Saatchi K, Zayeri F, Amir Ali Akbari S. The effect of progressive muscle relaxation on sleep quality of patients undergoing he￾modialysis. IJCCN 2012;5:23e8. [7] Jones C, Dawson D. Eye masks and earplugs improve patient’s perception of sleep. Nurs Crit Care 2012;17:247e54. [8] Redeker N, McEnany GP. Sleep disorders and sleep promotion in nursing practice. New York: Springer Publishing Company; 2011. [9] Chen JH, Chao YH, Lu SF, Shiung TF, Chao YF. The effectiveness of valerian acupressure on the sleep of ICU patients: a randomized clinical trial. Int J Nurs Stud 2012;49:913e20. [10] Fismer KL, Pilkington K. Lavender and sleep: a systematic review of the evi￾dence. EuJIM 2012;4:436e47. [11] Williams TI. Evaluating effects of aromatherapy massage on sleep in children with autism: a pilot study. Evid Based Complement Altern Med 2006;3:373e 7. [12] Boskabady MH, Shafei MN, Saberi Z, Amini S. Pharmacological effects of Rosa damascena. Iran J Basic Med Sci 2011;14:295. [13] Setayeshvali Pour N, Kheirkhah M, Neisani L, Haghani H. Comparison of the effects of aromatherapy with essential oils of damask rose and hot footbath on the first stage of labor anxiety in Nulliparous women. Complement Med J Fac Nurs Midwifery 2012;2:1e9. [14] Hongratanaworakit T. Relaxing effect of rose oil on humans. Nat Prod Com￾mun 2009;4:291e6. [15] Sahebalzamin M, Khanavi M, Alvi majd H, Mirkarimi SM, Karimi M. Effects of inhalation aromatherapy on female students’ anxiety and depression settling in dormitory of Tehran University of Medical Sciences. Med Sci J Islamic Azad Univ Tehran Med Branch 2010;20:175e81. [16] Afkham Ebrahimi A, Ghale Bandi MF, Salehi M, Kafian Tafti AR, Vakili Y, Akhlaghi Farsi E. Sleep parameters and the factors affecting the quality of sleep in patients attending selected clinics of Rasoul-e-Akram Hospital. RJMS 2008;15:31e8. [17] Farrahi Moghaddam J, Nakhaee N, Sheibani V, Garrusi B, Amirkafi A. Reliability and validity of the Persian version of the Pittsburgh Sleep Quality Index (PSQI￾P). Sleep Breath 2012;16:79e82. [18] Rener-Sitar K, John MT, Bandyopadhyay D, Howell MJ, Schiffman EL. Explo￾ration of dimensionality and psychometric properties of the Pittsburgh Sleep Quality Index in cases with temporomandibular disorders. Health Qual Life Outcomes 2014;12:10. [19] Spira AP, Beaudreau SA, Stone KL, Kezirian EJ, Lui LY, Redline S, et al. Reli￾ability and validity of the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale in older men. J Gerontol A Biol Sci Med Sci 2012;67:433e9. [20] Izadi Avanji FS, Adib Hajbaghery M, Afazel MR. Quality of sleep and it’s related factors in the hospitalized elderly patients of Kashan hospitals in 2007. Feyz 2009;12:52e60. [21] Buysse DJ, Reynolds 3rd CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989;28:193e213. [22] Chien LW, Cheng SL, Liu CF. The effect of lavender aromatherapy on autonomic nervous system in midlife women with insomnia. eCAM 2012;2012:1e8. [23] Soden K, Vincent K, Craske S, Lucas C, Ashley S. A randomized controlled trial of aromatherapy massage in a hospice setting. Palliat Med 2004;18:87e92. [24] Lewith GT, Godfrey AD, Prescott P. A single-blinded, randomized pilot study evaluating the aroma of Lavandula augustifolia as a treatment for mild insomnia. J Altern Complement Med 2005;11:631e7. Table 2 Sleep quality in experimental and control groups. PSQI domains Groups Before After P valuea Subjective sleep quality Experimental 0.93 0.69 0.66 0.80 0.135 Control 1.20 0.71 1.13 0.62 0.480 P valueb 0.114 0.012 Sleep latency Experimental 2.03 1.15 1.03 1.24 0.000 Control 2.50 0.97 2.60 0.67 0.546 P valueb 0.068 0.000 Sleep duration Experimental 1.66 1.34 1.03 1.40 0.009 Control 1.60 1.00 1.73 1.14 0.355 P valueb 0.679 0.042 Habitual sleep efficiency Experimental 1.40 1.42 0.80 1.29 0.023 Control 1.76 1.30 1.83 1.34 0.804 P valueb 0.208 0.002 Sleep disturbances Experimental 1.00 0.37 0.66 0.60 0.004 Control 0.96 0.31 0.93 0.36 0.564 P valueb 0.710 0.031 Use of sleep medications Experimental 1.00 0.26 1.00 0.37 1.000 Control 0.96 0.18 1.00 0.00 0.317 P valueb 0.570 1.000 Daytime dysfunction Experimental 0.66 0.80 0.43 0.85 0.143 Control 0.16 0.37 0.10 0.30 0.317 P valueb 0.004 0.081 Total PSQI score Experimental 8.70 3.96 5.63 5.13 0.001 Control 9.16 3.27 9.26 3.00 0.408 P valueb 0.929 0.031 a The results of the ManneWhitney U test for between-groups comparison. b The results of the Wilcoxon signed-rank test for within-groups comparison. 162 A. Hajibagheri et al. / Complementary Therapies in Clinical Practice 20 (2014) 159e163