The effect of pre-operative sleep quality on postoperative pain and quality of recovery in women undergoing cesarean section: a prospective cohort study

Sleep is a vital physiological process that promotes healing and recovery. During pregnancy, hormonal, mechanical, and psychological factors often impair sleep, potentially affecting postoperative outcomes following cesarean section. However, the link between preoperative sleep quality and postoperative pain and recovery remains underexplored. A prospective cohort of 162 women undergoing cesarean section were stratified into "Good Sleep" (N = 81) and "Poor Sleep" (N = 81) groups based on pre-operative assessment. We compared postoperative pain scores (Visual Analogue Scale, VAS), time to first patient-requested analgesia (survival analysis), and overall quality of recovery (QOR score) between the groups. Multivariable regression models were used to adjust for potential confounders including anxiety, age, BMI, and procedure duration. The groups were well-matched demographically. Patients in the Poor Sleep group reported significantly higher pain scores at 2, 4, 8, and 12 h postoperatively (all p < 0.05). The mean QOR score was significantly lower in the Poor Sleep group (148.56 ± 16.94 vs. 155.75 ± 11.89, p = 0.002). Multiple linear regression confirmed Poor Sleep as an independent predictor of lower QOR (β = -8.82, 95% CI: -12.50 to -5.14, p < 0.001), alongside high anxiety, higher 12-h pain, and longer procedure duration. Poor pre-operative sleep quality is a strong, independent risk factor for worse pain control, increased analgesic requirement, and inferior quality of recovery after cesarean section. Pre-operative sleep assessment and intervention represent critical targets for improving post-cesarean outcomes.