Author: Sathiya G. Priya, et al.
Cureus, July 1, 2026
Sleep is essential for healing, immune function, cognition, hormonal regulation, and recovery after serious injury. However, patients in intensive care frequently experience fragmented and poor-quality sleep because of pain, noise, light, monitoring, nursing interventions, and the unfamiliar ICU environment.
This prospective observational study evaluated sleep quality among trauma patients admitted to a level I trauma ICU and examined the factors most responsible for sleep disruption.
Methods
The study included 80 adult trauma patients treated in a single tertiary-care trauma ICU between July 2022 and June 2024.
Patients were eligible for sleep assessment when their Richmond Agitation-Sedation Scale score was between −1 and +1.
Patients were screened for delirium using the Confusion Assessment Method for the ICU. Those without delirium were assessed for three consecutive days using the Richards-Campbell Sleep Questionnaire.
Poor sleep was defined as a Richards-Campbell Sleep Questionnaire score below 50.
The investigators also measured ICU noise levels and recorded factors patients believed interfered with their sleep.
Key findings
Overall sleep quality was poor.
The average Richards-Campbell Sleep Questionnaire score was approximately 50, which was at the threshold used to define poor sleep.
Poor sleep was reported in:
• 52.5% of patients on the first ICU day
• 45% on the second day
• 43.75% on the third day
Sleep improved slightly during the ICU stay, but the improvement was limited.
The average sleep score was 45.9 in the poor-sleep group compared with 54.3 in the good-sleep group.
Major sleep disruptors
Noise was the most frequently reported cause of sleep disruption, affecting 52 patients.
Other common causes included:
• Pain, reported by 37 patients
• Light exposure, reported by 18 patients
The average ICU noise level was approximately 48.7 decibels, which exceeded recommended hospital noise levels.
Daytime noise was significantly greater than nighttime noise, although nighttime levels also remained higher than recommended.
Delirium and mortality
The cumulative incidence of delirium was 20%.
Overall mortality was 11.25%.
Mortality was numerically higher among patients with poor sleep, but the difference was not statistically significant.
The study therefore did not demonstrate that poor sleep independently increased mortality in this relatively small trauma population.
Clinical implications
Poor sleep is common among trauma ICU patients and does not substantially improve during the first several days of admission.
Because noise was the most important reported sleep disruptor, ICU teams should consider interventions such as:
• Reducing unnecessary alarms
• Lowering staff conversations near patient rooms
• Grouping nighttime nursing activities when clinically appropriate
• Minimizing unnecessary nighttime vital-sign checks
• Using soft-closing doors and equipment
• Providing earplugs when safe and acceptable
• Establishing designated quiet periods
Pain control is also important because traumatic injuries frequently produce substantial discomfort that interferes with sleep.
Multimodal analgesia should balance adequate pain relief against the risks of excessive opioid administration, respiratory depression, and delirium.
Light exposure may be reduced by dimming lights at night, maintaining normal daytime illumination, and avoiding unnecessary nighttime room entry.
Preserving the normal day-night cycle may support circadian rhythm and reduce sleep fragmentation.
Important limitations
This was a single-center observational study involving only 80 patients.
Sleep quality was measured through patient questionnaires rather than polysomnography or electroencephalographic monitoring.
Patients who were deeply sedated, severely agitated, unable to communicate, or already delirious were excluded from sleep assessment. The results therefore may not represent the sickest trauma ICU patients.
The study assessed sleep for only three days and was not large enough to determine whether poor sleep affects mortality, duration of mechanical ventilation, infection, wound healing, ICU length of stay, or long-term psychological recovery.
Because the study was observational, it could identify associations and reported causes of poor sleep but could not prove that reducing noise, pain, or light would improve clinical outcomes.
Bottom line
Trauma patients requiring intensive care commonly experience poor sleep, with only minimal improvement during the first three ICU days.
Noise was the most important sleep disruptor, followed by pain and light exposure. Measured ICU noise levels exceeded recommended limits.
Poor sleep was not significantly associated with mortality in this study, but its effects on recovery, delirium, immunity, and long-term outcomes remain clinically important.
ICUs should incorporate structured sleep-promoting strategies that reduce environmental noise, improve pain control, limit nighttime light exposure, and preserve normal circadian rhythms.
Thank you to Cureus for allowing us to summarize this article.