Sleep Quality Assessment in Trauma Patients Requiring Intensive Care: A Prospective Observational Study

Background Sleep is vital for healing, cognitive function, immunity regulation, hormonal balance, and waste clearance. Sleep deprivation is common among intensive care unit (ICU) patients, particularly those receiving mechanical ventilation. Fragmented sleep, pain, noise, and other factors adversely affect recovery and outcomes. Trauma patients often experience increased pain from their injuries. As most sleep studies have been conducted in general and surgical ICUs, but not in trauma patients, a sleep quality assessment study was planned for trauma patients requiring intensive care. The primary objective was to evaluate sleep quality in trauma patients admitted to the ICU. The secondary objectives were to assess sleep quality changes during ICU stay, identify factors affecting sleep, measure environmental noise levels, and determine the incidence of delirium. Methodology A single-center, prospective observational study was conducted at a level I trauma ICU of a tertiary care hospital involving 80 trauma patients from July 2022 to June 2024. Patients were assessed using the Richmond Agitation and Sedation Scale (RASS) to evaluate sedation and agitation levels. Those with a RASS score of -1 to +1 were screened for delirium using the Confusion Assessment Method (CAM-ICU). Delirium-free patients (CAM-ICU score of 0-2) were recruited, and their sleep quality was assessed using the Richards-Campbell Sleep Questionnaire (RCSQ) over three days. Poor sleep was defined as RCSQ <50, and the poor sleep and good sleep groups were analyzed. Data were expressed as mean ± SD or median (IQR) or percentage as appropriate. Sleep groups were compared using Student's t-test for normally distributed continuous variables, Mann-Whitney U test for non-parametric variables, and ANOVA test for repeated measures, while categorical data were compared using Fisher's exact test. Results The mean RCSQ score was 49.87± 5.35 on day one, and the overall mean RCSQ score of the study population was 49.57 ± 4.95, indicating generally poor sleep quality among trauma ICU patients. Poor sleep (RCSQ <50) was found in 52.5% of patients on the first day, 45% on the second day, and 43.75% on the third day. The mean RCSQ score was significantly lower in the poor sleep group (45.87 ± 2.60) compared with the good sleep group (54.29 ± 3.90) (p = 0.001). Overall, the mean age was 41.42 ± 17.04 years and was comparable between the groups, with a male predominance (82.5%, 66). Noise was the most common factor (n = 52), followed by pain (n = 37) and light (n = 18), which kept the patients awake. Mean noise level in the ICU over three days was 48.7 ± 2.04 dB, which was above the WHO recommendations. Delirium cumulative incidence was 20%, and overall mortality was 11.25%. This was not significant between the poor and good sleep groups, though higher mortality was reported in the poor sleep group. Conclusions Trauma patients requiring ICU care reported poor sleep quality, with only minimal improvement during their ICU stay. Noise was identified as the most significant sleep disruptor, followed by light exposure and pain. Noise levels in the ICU exceeded the recommended limits, with significantly higher noise levels reported during the daytime compared with nighttime. Sleep quality did not significantly influence mortality in trauma patients. Better sleep management is required with targeted interventions, though larger trials are needed to confirm its impact on clinical outcomes.