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The present study evaluated the extent to which sleep assessed soon after a trauma predicted subsequent physical health and immune functioning in rescue workers.Participants included 159 men and women who performed rescue and clean-up operations at the site of a major airplane crash. One hundred twenty-eight participants were retained for a 1-year follow-up. Self-report measures of sleep quality and psychological distress were obtained within 2 months of the crash, and a physical health questionnaire was completed at 1-year follow-up. Natural killer cell number and cytotoxicity were assessed using blood samples collected from a subset of participants (n=51) at 1-year follow-up.After adjustment for sex, age, body mass index, and initial distress, initial sleep quality complaints were associated with more physical symptoms (β=.32; p.001), poorer perceived health (β=-.27; p=.009), and increased healthcare utilization (β=.31; p=.003) on follow-up. In contrast, initial sleep quality was not associated with natural killer cell number (r=0.10; p=.55) or activity (r=0.02; p=.90). Change in sleep quality during the year after the crash was not a significant predictor of health or immune outcomes.These data suggest that poor sleep quality in the aftermath of trauma signals an increased risk for future adverse physical health outcomes and underscore the importance of addressing sleep complaints soon after trauma to mitigate negative impact on physical health.