Preoperative sleep deficiency aggravates acute worst pain within the first 24 hours after planned cesarean section

Background Postoperative pain represents a prevalent clinical challenge among patients undergoing cesarean section, yet current evidence lacks robust predictive markers for pain severity. The potential correlation between preoperative sleep deficiency and postoperative worst pain intensity within24 hours following cesarean section remains poorly characterized. This study was designed to systematically evaluate the hypothesis that preoperative sleep deficiency may exacerbate acute postoperative worst pain in patients within the first 24 hours after planned cesarean section. Methods This study investigated the association between preoperative sleep deficiency and acute postoperative pain in 228 women undergoing planned cesarean section (February-July 2024). Sleep quality was objectively assessed using the Pittsburgh Sleep Quality Index (PSQI) during pre-anesthesia evaluation. All participants received standardized postoperative analgesia combining patient-controlled intravenous analgesia (PCIA) and ultrasound-guided transversus abdominis plane (TAP) block within 30 minutes post-surgery. The primary outcome was the area under curve(AUC) of pain score within 24 hours postoperatively. Secondary outcomes included Visual Analogue Scale (VAS) score at each time point (6 hours, 12 hours, 24 hours) in resting, exercise, and uterine contraction states after the operation; the number of presses on the analgesic pump and the usage rate of indomethacin suppositories for pain relief; adverse events; local anesthetic-related serious adverse events up to 3 months. Results A total of 228 patients completed the study, revealing distinct cohorts: 106 patients (46.49%) with good sleep quality (median PSQI = 3.0, IQR 2.0–4.0) and 122 patients (53.51%) with poor sleep quality (median PSQI = 8.0, IQR 7.0–10.0). Key findings demonstrated that the poor-sleep group exhibited: 1. Higher pain burden: Significant increase in pain AUC (3.72 ± 1.05 vs 3.01 ± 1.10, p < 0.001). 2. Greater analgesic demand: Higher PCIA utilization rate (63.93% vs 34.91%, p < 0.001). Conclusions The results of this study suggest that preoperative sleep deficiency exacerbates acute postoperative pain, indicating that sleep quality could potentially serve as a predictive risk factor for acute pain following cesarean section. Trial registration: Chinese Clinical Trial Registry(https://www.chictr.org.cn/), ChiCTR2500096601, date of registration: 26/01/2025, retrospectively registered.