Postpartum Sleep Quality and Early Blood Pressure Levels After Cesarean Delivery in Women with Hypertensive Disorders of Pregnancy: A Prospective Cohort Study

Background: Blood pressure instability is common in the early postoperative period after cesarean delivery among women with hypertensive disorders of pregnancy, while postpartum sleep disturbance is highly prevalent. However, evidence regarding the role of postpartum sleep in early blood pressure regulation remains limited. Objective: To investigate the associations of prenatal and postpartum sleep quality with repeated systolic and diastolic blood pressure levels within 72 h after cesarean delivery in women with hypertensive disorders of pregnancy, and secondarily to explore their associations with categorical postpartum blood pressure control status. Methods: This prospective cohort study enrolled women with hypertensive disorders of pregnancy undergoing cesarean delivery. Prenatal sleep quality was assessed before delivery using the Pittsburgh Sleep Quality Index. Postpartum sleep quality was evaluated repeatedly within 72 h after surgery using the Richards–Campbell Sleep Questionnaire (RCSQ), alongside repeated blood pressure measurements. Multivariable logistic regression and mixed-effects models were applied to examine associations with blood pressure control status and with systolic and diastolic blood pressure, adjusting for relevant clinical and perioperative covariates. Results: A total of 123 women were included. Prenatal sleep quality was not significantly associated with postpartum blood pressure outcomes. In the primary analysis, abnormal postpartum sleep was independently associated with higher systolic (β = 3.63 mmHg, 95% CI 1.82– 5.44) and diastolic blood pressure (β = 1.71 mmHg, 95% CI 0.37– 3.04), while higher overall RCSQ scores and individual sleep item scores were consistently associated with lower systolic and diastolic blood pressure levels. In the secondary analysis, postpartum sleep quality was not significantly associated with binary blood pressure control status. Conclusion: Early postpartum sleep quality was independently associated with continuous blood pressure levels but not with categorical blood pressure control in women with hypertensive disorders of pregnancy after cesarean delivery. These findings support the relevance of sleep assessment in relation to postpartum blood pressure burden, whereas associations with categorical blood pressure control require confirmation in larger studies. Keywords: hypertensive disorders of pregnancy, cesarean section, sleep quality, blood pressure, pregnancy