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Sleep quality before elective cesarean delivery is not associated with postoperative pain
Abstract Number: F-55
Abstract Type: Original Research
Sleep quality is negatively associated with depression, pain tolerance and chronic pain (1-3). The Pittsburgh sleep quality index (PSQI) questionnaire is a validated tool that evaluates sleep characteristics on a scale from 0 to 21, with a score above 5 consistent with bad sleep (4). In a recent study, PSQI was in the order of 7±3 in nulliparous women evaluated in late 3rd trimester (5). To our knowledge, sleep quality has not been investigated in the context of post-cesarean pain. We designed a prospective observational study in women scheduled for cesarean delivery to investigate whether sleep quality influences acute postoperative pain.
133 women scheduled for a cesarean delivery with a standardized spinal anesthetic (bupivacaine 12mg, fentanyl 20mcg, morphine 100mg) were enrolled. PSQI was recorded preoperativlely (19 items generating 7 composite scores; sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, use of sleep medications and daytime dysfunction). Outcome measures included: average and peak pain at rest, upon movement and uterine cramping during the first 24h (numerical rating scale; 0-100). Statistical analysis included t-test for equality of means (p<0.05). Pearson correlation coefficients were calculated to assess the association between PSQI and postoperative pain.
The average PSQI in our cohort was 8.2 ± 4.0, and 39 women had a PSQI >5 (Table). There was no association between PSQI score and postoperative pain (Table). Pearson correlation coefficients were also not statistically significant for any of the postoperative pain measures.
Based on previously established criteria, we found that 70% of women were ‘poor sleepers’, however this does not seem to influence acute post-cesarean pain. This finding is somewhat contrary to our expectation, and further evaluation may be needed to identify whether other parameters such as anxiety or chronic sleep deprivation impact more significantly acute post-cesarean pain.
1. J Pain 2013;14:1539-52.
2. Psychosom Med 2004; 70:92-61.
3. Clin J Pain 2014; jan 20 Epub ahead
5. Sleep 2012;35:257-82.