Prevalence of poor sleep quality before cesarean delivery and its association with postpartum quality of recovery and postpartum depressive symptoms: a prospective observational study

J Anesth. 2025 Nov 2. doi: 10.1007/s00540-025-03616-5. Online ahead of print.

ABSTRACT

PURPOSE: The primary objective of this study was to estimate the prevalence of sleep quality among patients hospitalized for cesarean delivery, with a secondary objective of assessing the impact of sleep quality on postpartum outcomes.

METHODS: This prospective observational study included patients aged ≥18 years scheduled for elective cesarean delivery under spinal anesthesia admitted a day before delivery. The incidence of poor sleep quality (Richards-Campbell Sleep Questionnaire score <50) was estimated. Mean differences in obstetric quality-of-recovery-11 (ObsQoR-11) scores on postpartum days 1, 3, and 5 and the Edinburgh Postnatal Depression Scale (EPDS) score at 1 month after childbirth between those with and without poor sleep quality were evaluated using effect sizes. Multiple linear regression adjusted for relevant factors, including the Pittsburgh Sleep Quality Index, was used to evaluate the impact of poor sleep quality on the ObsQoR-11 score on only postpartum day 1.

RESULTS: Of 93 included patients, 48.3% (38.4-58.4%) met the criteria for poor sleep quality. The effect sizes for poor preoperative sleep quality and the ObsQoR-11 and EPDS scores ranged from 0.28 to 0.55. Multiple regression analyses revealed an association of preoperative poor sleep quality with the ObsQor-11 score on postoperative day 1 [Adjusted beta (95% confidence interval): – 18.8 [(- 36.5, – 1.2)].

CONCLUSION: The prevalence of preoperative poor sleep quality in hospitalized pregnant women scheduled for elective cesarean delivery was 48%, which was significantly associated with quality of recovery on postpartum day 5 and EPDS scores at 1 month post-childbirth.

PMID:41176547 | DOI:10.1007/s00540-025-03616-5