Sun ZY, Gong H, Zhu PZ, Xia HG, Zhu DQ, Zhang HQ, Zhang JH, Wang DB. Post-traumatic sleep disturbance and psychological distress after chest trauma: A five-year observational study of incidence, predictors, recovery outcomes. World J Psychiatry 2026; 16(9): 119050 [DOI: 10.5498/wjp.119050]
Corresponding Author of This Article
Dong-Bin Wang, MD, Department of Cardio-Thoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, No. 406 Jiefang South Road, Tianjin 300200, China. tjdgwdb@126.com
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Psychiatry
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Sun ZY, Gong H, Zhu PZ, Xia HG, Zhu DQ, Zhang HQ, Zhang JH, Wang DB. Post-traumatic sleep disturbance and psychological distress after chest trauma: A five-year observational study of incidence, predictors, recovery outcomes. World J Psychiatry 2026; 16(9): 119050 [DOI: 10.5498/wjp.119050]
World J Psychiatry. Sep 19, 2026; 16(9): 119050 Published online Sep 19, 2026. doi: 10.5498/wjp.119050
Post-traumatic sleep disturbance and psychological distress after chest trauma: A five-year observational study of incidence, predictors, recovery outcomes
Zhong-Yi Sun, Hao Gong, Peng-Zhi Zhu, Hong-Gang Xia, De-Qing Zhu, Hai-Quan Zhang, Ji-Hui Zhang, Dong-Bin Wang, Department of Cardio-Thoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, Tianjin 300200, China
Co-first authors: Zhong-Yi Sun and Hao Gong.
Author contributions: Sun ZY and Gong H were responsible for study conception and design, patient recruitment, data collection, and drafting of the manuscript; Zhu PZ and Xia HG participated in clinical data acquisition, follow-up assessments, and preliminary data analysis; Zhu DQ and Zhang HQ contributed to questionnaire administration, data management, and interpretation of clinical findings; Zhang JH performed the statistical analysis and assisted in data interpretation; Wang DB conceived and supervised the study, provided critical revisions for important intellectual content, and approved the final version of the manuscript. All authors reviewed and approved the final manuscript and agree to be accountable for all aspects of the work. Sun ZY and Gong H contributed equally to this work as co-first authors.
Supported by Tianjin Youth Medical Talents Fund, No. TJSQNYXXR-D2-142; Natural Science Foundation of Tianjin, No. 24JCZDJC01170; and Key Research Projects of Tianjin Hospital Science and Technology, No. TJYYQ2403.
Institutional review board statement: This study has been reviewed and approved by the Medical Ethics Committee of Tianjin Hospital, No. 2024-198.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that there is no conflict of interest.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Data sharing statement: No additional data are available.
Corresponding author: Dong-Bin Wang, MD, Department of Cardio-Thoracic Surgery, Tianjin Hospital Affiliated to Tianjin University, No. 406 Jiefang South Road, Tianjin 300200, China. tjdgwdb@126.com
Received: March 3, 2026 Revised: March 26, 2026 Accepted: April 8, 2026 Published online: September 19, 2026 Processing time: 173 Days and 21.8 Hours
Abstract
BACKGROUND
Chest trauma is an important clinical challenge, accounting for approximately 15% to 25% of all trauma-related hospitalizations. Immediate complications such as pneumothorax and hemothorax are well-documented, but long-term psychological sequelae, particularly sleep disturbances, remain inadequately characterized. Sleep disruption following trauma is both a hallmark and potential predictor of development of post-traumatic stress disorder. We hypothesized that sleep disturbance and psychological distress considerably impact recovery outcomes in patients with chest trauma.
AIM
To investigate the incidence, predictors, and impact of post-traumatic sleep disturbance and psychological distress on recovery outcomes in patients following chest trauma.
METHODS
This observational study involved 128 consecutive patients with chest trauma admitted to Tianjin Hospital, a tertiary referral trauma center in Tianjin, China, between January 2019 and December 2023. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), psychological distress was evaluated using the Hospital Anxiety and Depression Scale (HADS), and post-traumatic stress symptoms were measured using the Impact of Event Scale-Revised (IES-R). Assessments were conducted at admission, discharge, and 3, 6, and 12 months after injury. Multivariate logistic regression analysis was used to identify predictors of persistent sleep disturbance.
RESULTS
At discharge, 71.9% (92/128) of patients presented with sleep disturbance (PSQI > 5); at the 12-month follow-up visit, 34.4% (44/128) continued to experience clinically meaningful sleep problems. Patients with persistent sleep disturbance demonstrated higher HADS-Anxiety (9.82 ± 3.41 vs 5.63 ± 2.18, P < 0.001) and HADS-Depression (8.45 ± 2.97 vs 4.82 ± 2.05, P < 0.001) scores. Independent predictors of persistent sleep disturbance included an Injury Severity Score (ISS) of ≥ 16 [odds ratio (OR) = 3.24, 95% confidence interval (CI): 1.58–6.64], four or more rib fractures (OR = 2.87, 95%CI: 1.42-5.81), and baseline IES-R score of ≥ 24 (OR = 4.15, 95%CI: 1.96-8.79).
CONCLUSION
Sleep disturbance and psychological distress are highly prevalent following chest trauma and considerably impact recovery. An ISS of ≥ 16, four or more rib fractures, and baseline IES-R score of ≥ 24 were identified as independent predictors of persistent sleep disturbance. Early identification and intervention targeting patients at high risk may improve long-term outcomes.
Core Tip: This five-year observational study of 128 chest trauma patients reveals that sleep disturbance affects over 70% of patients at discharge, with one-third experiencing persistent problems at one year. We identified Injury Severity Score ≥ 16, multiple rib fractures, and elevated baseline post-traumatic stress symptoms as independent predictors of chronic sleep disturbance. The strong association between sleep problems and psychological distress suggests that integrated screening and early intervention protocols may significantly improve long-term recovery outcomes in this vulnerable population.
