Murottal Qur'an on Anxiety and Sleep Quality of Patients Undergoing Dialysis: Scoping Review

Chronic kidney disease is a non-communicable disease problem that causes global problems. Patients with chronic kidney disease require dialysis therapy, including hemodialysis. Chronic kidney disease patients undergoing hemodialysis may experience anxiety, depression, and decreased sleep quality. This study aims to determine the effects of Murottal Qur’an therapy on anxiety and sleep quality in patients with chronic kidney disease undergoing hemodialysis. The method used is scoping review with the Google Scholar database and Springer Link. The keywords used are Chronic Kidney Disease Patients" AND "Murottal Qur'an Therapy" OR "Holy Qur'an Therapy" AND "anxiety and sleep quality while undergoing hemodialysis. Inclusion criteria include full text articles from 2019-2023 in Indonesian or English published from national and international journals. The types of articles are Randomized Controlled Trial (RCT), Quasi Experimental, and Case Study. Twelve articles meet the inclusion criteria. Qur’an murottal therapy with Surah Ar-Rahman and Al-Fatihah can reduce anxiety and improve sleep quality because there are chemical elements in the body. The conclusion is that there is an effect of murottal Qur’an on reducing anxiety and improving sleep quality in chronic kidney disease patients undergoing hemodialysis


INTRODUCTION
Chronic kidney disease is a noncommunicable disease that causes global health problems (Kampmann et al., 2023).Chronic kidney disease is defined as an abnormality in the structure or function of the kidneys, which occurs for more than 3 months.Chronic kideny disease is diagnosed by a persistent increase in urinary albumin excretion (albuminuria), a low glomerular filtration rate, or other manifestations of kidney damage (Elsayed et al., 2023).Decreased kidney function means that urine cannot be produced and excreted, toxins in the body accumulate, fluid balance is disturbed, shortness of breath, and anemia (Purba, 2021).Renal replacement therapy is a step to reduce the risk of damage to chronic kidney disease (Sinurat et al., 2022).Kidney replacement therapy includes hemodialysis therapy, peritoneal dialysis and kidney transplantation (Halimah et al., 2022).
Chronic kidney disease patients often choose hemodialysis because of the low cost of this therapy compared to other kidney replacement therapies (Ezdha et al., 2023).Data from the 2018 IRR stated that 99% of chronic kidney disease patients chose hemodialysis therapy (Perkumpulan Nefrologi Indonesia, 2018).
Hemodialysis is one of the dialysis therapies when the GFR is less than 15 ml/minute/1.73m2 .Hemodialysis will remove excess salt, water and dregs from the body (Priandini, Handayani and Rosyidah, 2023).Patients who experience chronic kidney disease will depend on hemodialysis for life on a regular basis and will no longer be able to carry out their usual activities (Darsini and Cahyono, 2023).
Anxiety in patients arises due to fluid restrictions, physical limitations, and dependence on hemodialysis therapy (Dahlan, Budi and Widiyanto, 2023).The level of anxiety greatly affects the quality of sleep in patients undergoing hemodialysis because they cannot think calmly about their future (Damanik, 2020).
Hemodialysis undertaken by chronic kidney disease patients also has an impact on poor sleep quality (Diawati, Dewi and Inayati, 2023).Poor sleep quality is caused by the kidneys not being able to filter properly, so that toxins remain in the blood and leave the body through urine (Muchammad and Waliyanti, 2023).
Patients who experience anxiety, if it cannot be handled properly, will cause stress and depression for themselves (Taha, Firmawati and Harismayanti, 2023) concentration.This will worsen the disease condition (Nurhayati et al., 2021).
An effective and efficient strategy for reducing anxiety levels and improving sleep quality is relaxation techniques (Kurniasih, Kurnia and Istiqomah, 2021).
There is a need for nursing intervention to keep noise levels to a minimum to disguise noisy sounds through Qur'an murottal therapy (Diawati, Dewi and Inayati, 2023).
Someone who listens to murottal Qur'an experiences a decrease in the hormones epinephrine, dopamine and cortisol.This decrease occurs because the sound of the murottal Qur'an stimulates the brain, thereby stimulating the hypothalamus to produce neuropeptides.This is what makes murottal Qur'an have a calming effect on the body (Yudha, Ludiana Ludiana and Sari, 2021).
The aim of this study was to determine the effect of murottal Qur'an on reducing anxiety and improving sleep quality in chronic kidney disease patients undergoing hemodialysis.Finally 12 articles were selected for analysis (table 1) and divided into 2 themes as follows:

METHOD
Table 1.Article search results

Research design, sample, instruments, and analysis Intervention Results
Theme 1: The influence of Murottal Qur'an therapy on anxiety in chronic kidney disease patients undergoing hemodialysis 1. (Taha, Firmawati and Harismayanti, 2023) Research

Murottal
Qur'an therapy with Surah Ar-Rahman can be done improve sleep quality with p-value = 0.000

Qur'an on reducing anxiety
Anxiety is an unpleasant feeling of tension and an apprehensive feeling that something bad will happen (Cholis, Rumpiati and Sureni, 2020).Anxiety in patients undergoing hemodialysis will usually be seen when undergoing hemodialysis for ≤6 months , patients usually feel very anxious about what they are doing, respondents are often angry, sad, shaking, weak, nervous, often repeat questions, worried that they will not work as usual, There was a look of despair on the patient's face, as well as confusion and anxiety thinking about how long he would undergo hemodialysis therapy (Sinay and Lilipory, 2019).
Anxiety will increase the hormone norepinephrine in the blood, which will stimulate the parasympathetic nerves, then cause changes in biochemistry.The action of the hormone epinephrine is vasoconstriction in the arteries and stimulates the heart rate and heart contractions, so that blood pressure will increase, blood sugar levels will increase.
increasing, rate metabolism increase And need oxygen increases.Hormone epinephrine generated in amount big moment somebody currently angry, indication Which will seen are difficulty sleeping and anxiety (Astuti, Lestari and Simbolon, 2021).Unresolved anxiety can result in negative thoughts about one's life, decreased quality of life, depression and psychological disorders (Puspanegara, 2019).
Murottal Qur'an can be used as therapy to reduce anxiety (Alivian, Purnawan and Setiyono, 2019).The reduction in anxiety levels in hemodialysis patients is due to the Qur'an surah Ar-Rahman murottal therapy intervention which provides calm so that it can reduce anxiety and can be used as an alternative therapy because it does not cause side effects and is affordable (Hapsari, Endah and Kusuma Putri, 2022).
Positive responses emerged from providing murottal Qur'an therapy (Yudha, Ludiana Ludiana and Sari, 2021).Positive responses were seen in respondents who experienced chronic kidney disease who underwent hemodialysis, such as looking calm while closing their eyes and enjoying the sound of surah Ar -Rahman.This shows that the respondent is in a pleasant condition and has good hearing and anxiety that was previously very severe can be reduced (Suhita, Arini and Kardjati, 2019).
Murottal Qur'an has beautiful chants that make the body relax, reduce stress hormones, can divert attention from fear, anxiety and tension, get closer to God, and can improve the body's chemical system so that it lowers blood pressure, slows down breathing, heart rate, pulse and brain wave activation (Taha, Firmawati and Harismayanti, 2023).Murottal Qur'an is also able to break the cycle of negative thinking for someone who experiences anxiety (Agusmita and Efffendy, 2019).
Another benefit of listening to murottal Al-Quran is that it can increase a person's immunity (Dahlan, Budi and Widiyanto, 2023).
Surah Al-Fatihah is believed to be a cure for various diseases as another name it bears is Asy-Syifa which means healer.Apart from that, Al-Fatihah can overcome all anxiety, protect from all evil in facing difficulties (Twistiandayani and Prabowo, 2021).
Surah Ar-Rahman has many verses that are read repeatedly so that they can divert attention and function as a decrease in the patient's brain waves.In this condition, the brain will produce the hormones serotonin and endorphins which make a person feel comfortable, calm and happy (Hapsari, Endah and Kusuma Putri, 2022).
This anxiety can be reduced when the patient is not nervous, does not feel tense and restless, the patient feels comfortable, the patient does not ask any more questions about the hemodialysis process and the patient does not feel cold sweat (Suhita, Arini and Kardjati, 2019) .Reducing anxiety with stimulation can increase the natural release of endorphins and balance brain waves so that listeners get a positive response in the form of relaxation or calm and comfort and have an effect on reducing perceived anxiety (Yudha, Ludiana Ludiana and Sari, 2021).
Theme 2: The influence of Murottal

Qur'an on improving sleep quality
Sleep quality is someone who feels satisfied with their sleep, so they don't feel tired, restless, headaches and drowsiness (Damanik, 2020).Good sleep quality is characterized by the ease with which a person can start sleeping at bedtime, maintain sleep, initiate sleep again after waking up night and the easy transition from sleeping to waking up in the morning (Pius and Herlina, 2019).
Poor sleep quality in chronic kidney disease patients undergoing hemodialysis is caused by worries about the economy, quality of life, and reduced life expectancy (Dewi and Hendrati, 2022) .Poor quality in chronic kidney disease patients undergoing hemodialysis will have a negative impact on their health status and quality of life (Saraswati, Lestari and Putri, 2022).
One thing that must be adhered to by patients undergoing hemodialysis is good sleep quality (Sinay and Lilipory, 2019).
Treatment that can be done to improve sleep quality is murottal Qur'an therapy (Siregar et al. , 2023).person feel comfortable and calm so that the quality of sleep which was initially poor becomes good (Nurani, Rochmawati and Nurchayati, 2019).

CONCLUSION
The results of twelve articles that have carried out a scoping review can be concluded that Qur'an murottal therapy has an influence on reducing anxiety and improving sleep quality in chronic kidney disease patients undergoing hemodialysis.

ACKNOWLEDGMENT
DUHP would like to thank the Akademi Keperawatan Pelni for their support to make this research success.Author would like to thank all parties who have provided support throughout the process of preparing this scoping review until the end.
Data from the National Health and Nutrition Examination Survey (NHANES) shows the prevalence of chronic kidney disease in adults in the United States in 2015-2018 was 14.4% (National Kidney Foundation, 2022).Data from the Indonesian Renal Registry (IRR) in 2018 stated that the prevalence of chronic kidney disease in Indonesia had increased from 108,723 people in 2017 to 198,575 people in 2018 (Perkumpulan Nefrologi Indonesia, 2018).

Figure 1 .
Figure 1.Article screening process Qur'an , the earlobe captures sound in the form of waves through the air to the cochlea so that it vibrates the tympanic membrane and is transmitted to the middle ear through the auditory ossicles.This process is a mechanical stimulus that releases neurotransmitters into the synapse which gives rise to an action potential in the auditory nerve which then goes to the auditory cortex which is transmitted to the limbic system and leads to the hypothalamus.Stimulation of the sense of hearing through sound waves originating from the murottal of the Koran can reduce cortisol and ACTH levels which causes relaxation and helps improve sleep quality (Diawati, Dewi and Inayati, 2023).One of the Quran surahs used in murotal therapy is Surah Ar-Rahman which consists of 78 verses.One of the verses of Surah Ar-Rahman is the repetition of the verse, namely: "Fa bi ayyi alairobbikuma tukadzidziban " which means " Which favors of God do you deny? ".The repetition of this verse is to emphasize a very strong belief , so that it can have a calming effect and ultimately lead to a positive emotional response which can sleep quality.(Muchammad and Waliyanti, 2023).Murottal Qur'an therapy which is carried out regularly before bedtime can improve a person's sleep quality and provide calm which can make a