title: Sleep Trajectories of Women Undergoing Elective Cesarean Section: Effects on Body Weight and Psychological Well-Being.
abstract: BACKGROUND
  After cesarean section (CS), women may be at great risk for sleep disturbance, but little is known about temporal changes in their sleep patterns and characteristics. We had two aims: 1) to identify distinct classes of sleep-disturbance trajectories in women considering elective CS from third-trimester pregnancy to 6 months post-CS and 2) to examine associations of sleep trajectories with body mass index (BMI), depressive symptoms, and fatigue scores.
  
  
  METHODS
  We analyzed data from a prospective cohort study of 139 Taiwanese pregnant women who elected CS. Sleep components were assessed using the Pittsburgh Sleep Quality Index in third-trimester pregnancy, 1 day, 1 week, 1 month, and 6 months post-CS. Data were collected on depressive symptoms, fatigue symptoms, and BMI. Sleep-quality trajectories were identified by group-based trajectory modeling.
  
  
  RESULTS
  We identified three distinct trajectories: stable poor sleep (50 women, 36.0%), progressively worse sleep (67 women, 48.2%), and persistently poor sleep (22 women, 15.8%). Poor sleep was significantly associated with pre-pregnancy BMI and more baseline (third-trimester pregnancy) depressive and fatigue symptoms. At 6 months post-CS, women classified as progressively worse or persistently poor sleepers showed a trend toward higher BMI (p<0.03), more depressive symptoms (p<0.001), and higher fatigue scores (p<0.001) than those with stable poor sleep.
  
  
  CONCLUSIONS
  Women had three distinct sleep-disturbance trajectories before and after elective CS. These poor-sleep courses were associated with BMI and psychological well-being. Our findings suggest a need to continuously assess sleep quality among women considering elective CS and up to 6 months post-CS.
authors.affiliation: School of Nursing, China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Ya-Ling
authors.initials: YL
authors.lastname: Tzeng
authors.affiliation: Department of Nursing, Hungkuang University, Taichung, Taiwan.
authors.forename: Shu-Ling
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
authors.forename: Chuen-Fei
authors.initials: CF
authors.lastname: Chen
authors.affiliation: School of Nursing, China Medical University and China Medical University Hospital, Taichung, Taiwan.
authors.forename: Fong-Chen
authors.initials: FC
authors.lastname: Wang
authors.affiliation: School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Kuo
mesh_terms: D000328:Adult; D001835:Body Weight; D002585:Cesarean Section; D003863:Depression / Q000503:physiopathology*; D017558:Elective Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D012894:Sleep Stages