title: Preoperative sleep quality predicts postoperative pain after planned caesarean delivery.
abstract: Severe post-caesarean pain remains an important issue associated with persistent pain and postpartum depression. Women's sleep quality prior to caesarean delivery and its influence on postoperative pain and analgesic intake have not been evaluated yet.
  
  
  
  Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12 mg, fentanyl 20 μg, morphine 100 μg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) questionnaire (PSQI 0-5 indicating good sleep quality, PSQI 6-21 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24 h using a verbal numerical pain score (VNPS; 0 indicating no pain and 100 indicating worst pain imaginable), and analgesic intake was recorded. Primary outcome was peak pain upon movement during the first 24 h.
  
  
  
  Seventy-eight of 245 women reported good sleep quality (31.2%; average PSQI 3.5 ± 1.2) and 167 poor sleep quality (68.2%; average PSQI 16.0 ± 3.4; p < 0.001). Women with poor sleep quality had significantly higher peak pain scores upon movement (46.7 ± 28.8 vs. 36.2 ± 25.6, respectively; p = 0.006). With multivariable logistic regression analysis, poor sleep quality significantly increased the risk for severe peak pain upon movement (VNPS ≥70; OR 2.64; 95% CI 1.2-6.0; p = 0.02).
  
  
  
  A significant proportion of women scheduled for caesarean delivery were identified preoperatively as having poor sleep quality, which was associated with more severe pain and increased analgesic intake after delivery. The PSQI score may therefore be a useful tool to predict increased risk for acute post-caesarean pain and higher analgesic requirements, and help tailor anaesthetic management.
  
  
  
  Multiple studies have evaluated predictors for severe acute pain after caesarean delivery that may be performed in a clinical setting, however, sleep quality prior to delivery has not been included in predictive models for post-caesarean pain. The PSQI questionnaire, a simple test to administer preoperatively, identified that up to 70% of women report poor sleep quality before delivery, and poor sleep quality was associated with increased post-caesarean pain scores and analgesic intake, indicating that PSQI could help identify preoperatively women at risk for severe pain after caesarean delivery.
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Orbach-Zinger
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: S
authors.initials: S
authors.lastname: Fireman
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Ben-Haroush
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: T
authors.initials: T
authors.lastname: Karoush
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: Z
authors.initials: Z
authors.lastname: Klein
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Mazarib
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Artyukh
authors.affiliation: Department of Obstetrics and Gynecology, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: R
authors.initials: R
authors.lastname: Chen
authors.affiliation: Department of Anesthesia, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
authors.forename: A
authors.initials: A
authors.lastname: Ioscovich
authors.affiliation: Department of Anesthesia, Rabin Medical Center, Beilinson Hospital, Petach Tikvah, Israel.
authors.forename: L A
authors.initials: LA
authors.lastname: Eidelman
authors.affiliation: Department of Anesthesia, Columbia University College of Physicians and Surgeons, New York, USA.
authors.forename: R
authors.initials: R
authors.lastname: Landau
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D000775:Anesthesia, Spinal / Q000009:adverse effects*; D002585:Cesarean Section / Q000009:adverse effects*; D005260:Female; D005283:Fentanyl / Q000627:therapeutic use; D006801:Humans; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy / Q000209:etiology*; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology; D011247:Pregnancy; D012890:Sleep / Q000502:physiology*; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D009020:Morphine; D005283:Fentanyl