Effects of music therapy on delirium, clinical outcomes, and psychological and sleep outcomes in adult ICU patients: a systematic review and meta-analysis

Background Delirium and psychological stress are major clinical challenges for adult ICU patients, contributing to increased mortality and resource consumption. This study evaluated the efficacy of music therapy (MT) on delirium incidence, resource utilization, and psychological and sleep outcomes. Methods Seven electronic databases (Medline, Embase, Cochrane Library, CNKI, Wanfang, VIP, and CBM) were searched from inception to December 20, 2025. Following PRISMA guidelines, 15 randomized controlled trials (RCTs) involving 1,552 patients were included. Two researchers independently performed screening and data extraction. Risk of bias was assessed using RoB 2.0, and evidence certainty was graded using the GRADE system. Primary outcomes focused on delirium assessments; secondary outcomes included mortality and resource utilization; exploratory outcomes encompassed anxiety, depression, pain, and sleep. Results A total of 863 records were identified, and 15 RCTs involving 1,552 patients were finally included. Meta-analysis indicated that music therapy significantly reduced the incidence of delirium ( RR = 0.49; 95% CI : 0.40–0.60; p < 0.001). Regarding resource utilization, after excluding heterogeneous outliers through sensitivity analysis, the intervention group showed a significantly shorter duration of mechanical ventilation ( SMD = −0.25; p = 0.009) and ICU length of stay ( MD = −1.07 days; p = 0.004). However, there was no significant difference between the two groups in terms of hospital length of stay ( MD = −1.37 days; 95% CI , −4.06 to 1.33; p = 0.32). For exploratory outcomes, depression symptoms were significantly improved ( SMD = −1.30; p < 0.001); objective acute sleep quality (based on the RCSQ scale) was markedly enhanced ( SMD = −0.62; p < 0.001, I 2 = 0%); and anxiety was significantly relieved ( SMD = −0.79; p = 0.02), with subgroup analysis suggesting a more pronounced effect in Chinese cohorts. No significant differences were observed in short-term mortality or pain scores. GRADE grading indicated high-quality evidence for delirium incidence and ICU length of stay. Conclusion Music therapy is a safe, low-cost non-pharmacological intervention that significantly reduces delirium risk, restores sleep architecture, alleviates anxiety and depression, and accelerates weaning from mechanical ventilation in adult ICU patients. However, due to heterogeneity and lower certainty in some secondary outcomes, larger multicenter trials are needed before routinely integrating music therapy into standard ICU and ERAS protocols. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261329297 .