Effect of Virtual Reality on Sleep Quality and Stress Load in Critically Ill Patients (VIRES): Study Protocol For A Randomized Controlled Trial

Effect of Virtual Reality on Sleep Quality and Stress Load in Critically Ill Patients (VIRES): Study Protocol For A Randomized Controlled Trial | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Virtual Reality on Sleep Quality and Stress Load in Critically Ill Patients (VIRES): Study Protocol For A Randomized Controlled Trial Filip Hromádka, Martin Duksa, Marie Gajošová This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8852663/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Hospitalization in the Intensive Care Unit (ICU) is associated with significant sleep deprivation and fragmentation caused by environmental factors such as constant noise, perpetual lighting, and frequent nursing interventions. This lack of quality sleep is linked to serious physiological and psychological consequences, including an increased risk of delirium, weakened immune response, and delayed recovery. Virtual Reality (VR) offers an innovative non-pharmacological solution by allowing for sensory isolation from the stressful ICU environment and inducing relaxation through immersive, nature-based scenes. Objectives: The VIRES (VIrtual REality Sleep study) aims to investigate the efficacy and feasibility of immersive VR relaxation for improving both subjective and objective sleep quality while mitigating the physiological stress response in conscious, critically ill patients. Methods: This study is a single-center, prospective, randomized controlled trial (RCT) utilizing a parallel-group PROBE (Prospective Randomized Open Blinded Endpoint) design. A total of 60 participants (30 per group) will be enrolled at the University Hospital Ostrava. The experimental group will undergo a 15–30 minute VR relaxation session (using the Oculus Quest 3 with the VRelax application) for three consecutive evenings (19:00–21:00), while the control group receives standard nursing care. The primary outcome is the comparison of subjective sleep quality using the Richards-Campbell Sleep Questionnaire (RCSQ) and objective sleep parameters (Total Sleep Time and Sleep Efficiency) measured via wrist actigraphy. The secondary outcome involves evaluating the HPA axis activity by measuring the circadian profiles of plasma cortisol and ACTH levels at three specific time points daily. Discussion: By integrating subjective assessments with advanced technological and biochemical markers, the VIRES study seeks to address existing evidence gaps regarding the physiological impact of VR in critical care. The findings may support the implementation of VR as a standard, non-pharmacological intervention to enhance patient comfort and recovery in the ICU. Trial Registration: The study will be registered at ClinicalTrials.gov prior to the start of participant recruitment. Anesthesiology & Pain Medicine Intensive Care Unit (ICU) Virtual Reality (VR) Sleep Quality Cortisol Actigraphy Richards-Campbell Sleep Questionnaire (RCSQ) Critical Care Stress Response Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8852663","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":590162202,"identity":"aa1b48f5-a4ee-4355-9969-786b1ab11c48","order_by":0,"name":"Filip Hromádka","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3klEQVRIiWNgGAWjYBAC9mbmhgMMDAfAHMkGBht+glp4DjOiaEkDYkJaDjCC1MC1HCZCCztj4+EChjv5/GKHH96cUXNewpy9gfHjD3xamBkbDs9geGY5c3aaseWGY7clLHsOMEtI4NFiD9LCw3DYwOB2gpnkA7bbdQY3EtgYDAjZAtGS/k3ywb9zEmAtCcRpyTGT3Nh2AKLlAEG/GBw2kJydU2w5sy9ZwuDMwWa8wcbDf/jw54KKwwb80ukbb/Z8s5MwON58EG+IgQAzmm8Z8dkB0zIKRsEoGAWjAB8AAFrmT827zXUdAAAAAElFTkSuQmCC","orcid":"","institution":"Fakultní nemocnice Ostrava","correspondingAuthor":true,"prefix":"","firstName":"Filip","middleName":"","lastName":"Hromádka","suffix":""},{"id":590162203,"identity":"528faf26-bc2e-4092-bef5-815317f27614","order_by":1,"name":"Martin Duksa","email":"","orcid":"","institution":"Fakultní nemocnice Ostrava","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"","lastName":"Duksa","suffix":""},{"id":590162204,"identity":"538694d3-4336-44ca-962e-22be91dd17f8","order_by":2,"name":"Marie Gajošová","email":"","orcid":"","institution":"Fakultní nemocnice Ostrava","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Gajošová","suffix":""}],"badges":[],"createdAt":"2026-02-11 14:09:41","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":true,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8852663/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8852663/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102592778,"identity":"65b51120-609b-4d7c-9124-d2dae96c072e","added_by":"auto","created_at":"2026-02-13 11:42:07","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":403389,"visible":true,"origin":"","legend":"","description":"","filename":"SPIRITprotokol.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8852663/v1_covered_c53c6ca5-6cb1-44cf-8e8d-796adc780eb5.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003eEffect of Virtual Reality on Sleep Quality and Stress Load in Critically Ill Patients (VIRES): Study Protocol For A Randomized Controlled Trial\u003c/p\u003e","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"LERCO","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Intensive Care Unit (ICU), Virtual Reality (VR), Sleep Quality, Cortisol, Actigraphy, Richards-Campbell Sleep Questionnaire (RCSQ), Critical Care, Stress Response","lastPublishedDoi":"10.21203/rs.3.rs-8852663/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8852663/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground: Hospitalization in the Intensive Care Unit (ICU) is associated with significant sleep deprivation and fragmentation caused by environmental factors such as constant noise, perpetual lighting, and frequent nursing interventions. This lack of quality sleep is linked to serious physiological and psychological consequences, including an increased risk of delirium, weakened immune response, and delayed recovery. Virtual Reality (VR) offers an innovative non-pharmacological solution by allowing for sensory isolation from the stressful ICU environment and inducing relaxation through immersive, nature-based scenes.\u003c/p\u003e\n\u003cp\u003eObjectives: The VIRES (VIrtual REality Sleep study) aims to investigate the efficacy and feasibility of immersive VR relaxation for improving both subjective and objective sleep quality while mitigating the physiological stress response in conscious, critically ill patients.\u003c/p\u003e\n\u003cp\u003eMethods: This study is a single-center, prospective, randomized controlled trial (RCT) utilizing a parallel-group PROBE (Prospective Randomized Open Blinded Endpoint) design. A total of 60 participants (30 per group) will be enrolled at the University Hospital Ostrava. 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