Validation of the Richards–Campbell Sleep Questionnaire Against Actigraphy in Hospitalized Patients and Its Association with Delirium Risk

Martin Milata,1 Hana Locihová,2,3 Karel Sonka,1 Marek Susta4 1Department of Neurology and Center of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic; 2Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Faculty of Medicine and University of Ostrava, Ostrava, Czech Republic; 3Department of Nursing and Midwifery, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; 4Proverbs a.s., Prague, Czech RepublicCorrespondence: Martin Milata, Department of Neurology and Center of Clinical Neurosciences, First Faculty of Medicine, Charles University and General University Hospital, Kateřinská 30, Praha, 2, 12821, Prague, Czech Republic, Tel +420725054052, Email [email protected]: To validate the Richards–Campbell Sleep Questionnaire (RCSQ) relative to actigraphy on general hospital wards and to examine the predictive value of sleep parameters for delirium.Patients and Methods: This multicenter, prospective observational study was conducted on internal medicine, surgical, and neurology wards across seven healthcare institutions in the Czech Republic. The analysis included 133 patients (424 nights). Individual RCSQ items and corresponding nocturnal actigraphic sleep parameters (MotionWatch 8) were compared using linear mixed-effects models (LMM). Associations with delirium occurrence were evaluated using binary logistic regression.Results: Patients rated their sleep as moderately good on the RCSQ despite objectively impaired sleep on actigraphy. Only the sleep-depth item showed significant associations, with higher scores linked to higher immobile time and lower fragmentation. No significant associations were found for remaining parameters. The RCSQ total score showed only weak associations with sleep efficiency and percent sleep. Subjective sleep ratings did not predict delirium, whereas higher actigraphic sleep efficiency was associated with lower delirium risk.Conclusion: In hospitalized patients, only the RCSQ item assessing sleep depth showed meaningful correspondence with actigraphic measures. The RCSQ total score showed limited concurrent validity against actigraphy and was not useful for predicting delirium, whereas low actigraphy-measured sleep efficiency appeared to be a clinically relevant marker of delirium risk.Keywords: actigraphy, RCSQ, sleep quality, general wards, sleep monitoring