The relationship between post-traumatic sleep and related symptoms in children with high-energy trauma: a study based on ecological momentary assessment.

INTRODUCTION

High-energy trauma is characterized by severe injuries, complex clinical conditions, and high mortality rates. Trauma exposure itself induces stress and excessive alertness, leading to sleep disturbances, which in turn exacerbate anxiety, depression, and the risk of post-traumatic stress disorder, while delaying natural recovery after trauma. However, screening for sleep disorders in hospitalized children with high-energy trauma remain insufficient. This study aimed to explore early post‑traumatic sleep status and its associations with related symptoms in children with high‑energy trauma using ecological momentary assessment (EMA).

METHOD: A longitudinal observational design was adopted. Children with high‑energy trauma admitted to our hospital from July 1, 2024, to May 15, 2025 were recruited using convenience sampling. Sleep status and related symptoms were continuously monitored for the first five days post‑trauma. Data were analyzed using generalized estimating equations (GEE) and multivariate linear regression.

RESULTS

A total of 69 patients were included in the final analysis. Pain was the most severe symptom, followed by anxiety, fear, and fatigue. GEE revealed that pain, anxiety, fear, and dizziness were significantly associated with sleep quality (P < 0.001, P = 0.033, P = 0.012, P = 0.034); pain, itching, and numbness were significantly associated with reduced sleep efficiency (P < 0.001, P = 0.003, P = 0.004), whereas fatigue was significantly associated with improved sleep efficiency (P = 0.032); pain and fear were significantly associated with nocturnal awakenings (P < 0.001, P = 0.009). Moreover, symptoms were often inter‑related. Multivariate linear regression showed that factors affecting sleep quality included pain on day 1 and day 3 (P = 0.001, P = 0.018), fear on day 4 (P = 0.045), and fear and itching on day 5 (P = 0.011, P = 0.017). Regarding sleep efficiency, the primary influencing factor were: pain on day 1 post-trauma (P = 0.001), numbness at the affected site on day 2 (P = 0.004), fear, pruritus, and numbness at the affected site on day 4 (P = 0.034, P < 0.001, P < 0.001), and pruritus on day 5 (P < 0.001).

DISCUSSION: Children with high‑energy trauma exhibit certain sleep disturbances in the early post‑traumatic period, and the main factors influencing sleep change over time. Close attention should be paid to sleep disorders and their associated influencing factors, and appropriate interventions should be implemented.