{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T03:07:46Z","timestamp":1792552066999,"version":"4.5.0"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2016,12,15]],"date-time":"2016-12-15T00:00:00Z","timestamp":1481760000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["European Journal of Pain"],"published-print":{"date-parts":[[2017,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Severe post\u2010caesarean 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Women undergoing caesarean delivery with spinal anaesthesia (bupivacaine 12\u00a0mg, fentanyl 20\u00a0\u03bcg, morphine 100\u00a0\u03bcg) were evaluated preoperatively for sleep quality using the Pittsburgh Sleep Quality Index (<jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content>) questionnaire (<jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> 0\u20135 indicating good sleep quality, <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> 6\u201321 poor sleep quality). Peak and average postoperative pain scores at rest, movement and uterine cramping were evaluated during 24\u00a0h using a verbal numerical pain score (<jats:styled-content style=\"fixed-case\">VNPS<\/jats:styled-content>; 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\u00a0h.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy\u2010eight of 245 women reported good sleep quality (31.2%; average <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> 3.5\u00a0\u00b1\u00a01.2) and 167 poor sleep quality (68.2%; average <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> 16.0\u00a0\u00b1\u00a03.4; <jats:italic>p\u00a0<\/jats:italic>&lt;<jats:italic>\u00a0<\/jats:italic>0.001). Women with poor sleep quality had significantly higher peak pain scores upon movement (46.7\u00a0\u00b1\u00a028.8 vs. 36.2\u00a0\u00b1\u00a025.6, respectively; <jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.006). With multivariable logistic regression analysis, poor sleep quality significantly increased the risk for severe peak pain upon movement (<jats:styled-content style=\"fixed-case\">VNPS<\/jats:styled-content> \u226570; <jats:styled-content style=\"fixed-case\">OR<\/jats:styled-content> 2.64; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.2\u20136.0; <jats:italic>p\u00a0<\/jats:italic>=<jats:italic>\u00a0<\/jats:italic>0.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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 <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> score may therefore be a useful tool to predict increased risk for acute post\u2010caesarean pain and higher analgesic requirements, and help tailor anaesthetic management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Significance<\/jats:title><jats:p>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\u2010caesarean pain. The <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> 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\u2010caesarean pain scores and analgesic intake, indicating that <jats:styled-content style=\"fixed-case\">PSQI<\/jats:styled-content> could help identify preoperatively women at risk for severe pain after caesarean delivery.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ejp.980","type":"journal-article","created":{"date-parts":[[2016,12,17]],"date-time":"2016-12-17T10:16:06Z","timestamp":1481969766000},"page":"787-794","source":"Crossref","is-referenced-by-count":61,"title":["Preoperative sleep quality predicts postoperative pain after planned caesarean delivery"],"prefix":"10.1002","volume":"21","author":[{"given":"S.","family":"Orbach\u2010Zinger","sequence":"first","affiliation":[{"name":"Department of Anesthesia Rabin 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