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Sleep quality after caesarean delivery: associated factors and effects on quality of life and early breastfeeding

Thatchanan Jintadawong,Patchareya Nivatpumin,Manussawee Swaengrujitham,Wiruntri Punchuklang,Tripop Lertbunnaphong

Published 2025 in Annals medicus

ABSTRACT

Abstract Background We investigated the prevalence and associated factors of poor sleep quality after caesarean delivery on the first postoperative night. We also evaluated its impact on quality of life and early breastfeeding effectiveness. Methods This single-centre, cross-sectional study collected data from February 2023 to March 2024. We enrolled patients who underwent caesarean delivery under spinal anaesthesia. We gathered perioperative data and utilized the Thai version of the Richards–Campbell Sleep Quality Questionnaire (RCSQ) to evaluate sleep quality. An overall score of below 50 indicated poor sleep quality. The Thai version of the EuroQol Five Dimensions Five Levels (EQ-5D-5L) questionnaire was used to assess quality of life, and the latch, audible swallowing, type of nipple, comfort and hold (positioning) (LATCH) score was employed to evaluate breastfeeding effectiveness. Multivariable logistic regression models were used to analyse associated factors, with data presented as adjusted odds ratios with 95% confidence intervals. Results The analysis included 284 patients. Seventy-nine patients (27.8%) demonstrated poor sleep quality after caesarean delivery. Three independent factors correlated with poor sleep quality were maternal age ≥35 years (1.880 [1.086–3.252], P = 0.024), urgent/emergency caesarean delivery (1.998 [1.098–3.637], P = 0.023) and moderate to severe pain (numerical rating scale ≥ 4; 1.718 [1.001–2.948], P < 0.049). The Spearman’s rank correlation coefficient between the EQ-5D-5L health scale score and the RCSQ score was 0.442 (P < 0.001). The LATCH scores and hospital stay durations were not significantly different between the groups. Conclusion The findings underscore the importance of recognizing patients at higher risk for poor sleep quality. Careful pain monitoring, timely support for urgent or emergency cases and early identification of potential sleep disturbances may guide individualized postoperative care. WHAT IS ALREADY KNOWN ON THIS TOPIC Postoperative sleep disturbance occurs in 22.8–44.0% of patients. Surgery disrupts sleep cycles and alters brain wave patterns through elevated stress hormone levels and other mechanisms. Multiple perioperative factors influence postoperative sleep quality. These include patient age, preexisting conditions such as coronary artery disease, postoperative pain and environmental conditions. Research on sleep quality during the early postoperative period after caesarean delivery is limited. The associated factors and effects on early breastfeeding remain poorly understood. WHAT THIS STUDY ADDS We observed that 27.8% of women experienced poor sleep quality on postoperative night 1 after caesarean delivery. Three key factors were associated with poor sleep quality: maternal age ≥35 years, urgent/emergency caesarean delivery and moderate to severe postoperative pain. Sleep quality was not significantly correlated with early breastfeeding effectiveness. However, poor sleep quality was moderately correlated with decreased EQ-5D-5L health scale scores. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY Because a substantial proportion of patients experience poor sleep after caesarean delivery, clinicians should provide prenatal counselling about this potential outcome to at-risk individuals. Recognizing the associated factors may facilitate early identification of women at greater risk and enable timely postoperative support. Further prospective and interventional studies are needed to evaluate whether targeted strategies, such as enhanced perioperative support and optimized pain control, can improve sleep and maternal recovery outcomes. Clinical trial registration: Clinicaltrial.gov registration number: NCT05757401 (26 January 2023).

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