Although music as a supportive treatment has been suggested for promoting sleep quality, its effectiveness and implementation remain inconsistent and controversial. This systematic review synthesizes the evidence and analyses influencing factors on the effectiveness of music to arrive at a set of recommendations of music in clinical practice. We searched different to identify potential literature, settling upon 29 randomized controlled trials of music-based interventions added to usual care, with a total population of 2,013. We performed meta-analyses, meta-regression, subgroup analyses, and GRADE guidelines. The results indicated that subjective sleep quality was improved in patients with poor sleep due to specified (e.g. cancer, chronic pain) and unspecified conditions (e.g. ageing, pregnancy). Heterogeneity showed low to moderate. Objective sleep quality was slight changed in N1 sleep time and N3 sleep time. Patient clinical conditions was found to be the important influencing factor. The whole quality of evidence should be improved. Clinicians should conduct different treatment durations responding to patient clinical conditions.