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Published on: August 8, 2019
Postpartum sleep quality and physical activity profiles following elective cesarean delivery: a longitudinal
P Pandal1, B Carvalho1, C-H Shu1
1Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA.
Introduction:
While sleep and activity levels are impacted by childbirth, these changes before and after cesarean delivery are under explored. Few studies have characterized sleep and physical activity before and after cesarean delivery using objective measures. The aim of this study was to characterize sleep and activity before and after cesarean delivery using wrist-worn Actigraphy. Secondary aims were to explore associations between physical activity and sleep following scheduled cesarean delivery.
Methods:
Following IRB approval, ASA 2 and 3 patients aged 18-50 years, term gestation, singleton pregnancy, undergoing scheduled cesarean delivery under neuraxial anesthesia were invited to participate. Consented patients continuously wore an Actigraph GT9X device on their non-dominant wrist from 7 days prior to scheduled cesarean delivery until 28 days post-delivery. Sleep metrics included quality, duration, disruption and efficiency. Physical activity metrics included average daily moderate to vigorous physical activity bouts, metabolic equivalents (METs) and caloric expenditure. Granular data regarding sleep and activity were recorded and analyzed based on established algorithms and trend analysis using methodology previously described.
Results:
Among the 38 recruited patients, analyzable actigraphy data were available in 21 patients. Trend analysis from day -7 (pre-delivery) to 28 (post-delivery) demonstrated that most variables did not differ significantly, indicating that at month 1, most activity and sleeping variables returned to third trimester levels. Some metrics of sleep improved in the first week postpartum compared to third trimester, however, total sleep time worsened and did not recover by day 28 compared to the third trimester durations. Physical activity levels dropped significantly immediately after delivery, then improved from day 0 to 28 post-surgery.
Conclusions:
Most sleep and physical activity metrics return to third trimester levels by 1 month postpartum. Several sleep metrics such as sleep efficiency and awakening after sleep were better in the first postpartum week than in the third trimester of pregnancy, but total sleep continues to be significantly impacted at day 28 postpartum. Physical activity returns to third trimester levels by one month postpartum. Future studies are needed to identify risk factors for worse physical recovery and sleep following cesarean delivery and to compare metrics following different peripartum complications.
