Factors associated with poor sleep quality on the Pittsburgh Sleep Quality Index among hospitalized Ghanaian obstetrical patients

BACKGROUND

Sleep is crucial for overall health, especially during the transformative pregnancy period. However, pregnancy is associated with numerous changes that disrupt sleep patterns and quality. A decrease in sleep quality during the antenatal period is associated with negative fetal and maternal outcomes, including perinatal depression and hypertensive disorders of pregnancy (leading cause of maternal mortality in Ghana). There are limited studies from the sub-Saharan African region, including Ghana, that explored this subject. This study therefore sought to investigate sleep quality and the associated factors among antepartum and postpartum in-patients at the largest tertiary referral center in Ghana.

OBJECTIVE

To determine the sleep quality and associated factors among obstetric inpatients in Ghana.

STUDY DESIGN

This was a facility-based, cross-sectional study of obstetrical patients who were admitted to the Korle Bu Teaching Hospital in Ghana between November 20 and December 22, 2023. Antenatal and postpartum in-patients who were aged 18 years and older were included. Those critically ill or younger than 18 years were excluded. Using a structured questionnaire, we collected data on the participants’ sociodemographic characteristics, medical and obstetrical history, and current pregnancy or postpartum presentation and outcomes. We subsequently administered the validated Pittsburgh Sleep Quality Index tool to measure sleep quality, followed by pregnancy distress and perinatal depression screening using the Tilburg Pregnancy Distress Scale and the Patient Health Questionnaire-9, respectively. A logistic regression was used to evaluate factors associated with a positive Pittsburgh Sleep Quality Index screen, which indicated poor sleep quality.

RESULTS

A total of 416 (99%) of the 420 enrolled participants completed the Pittsburgh Sleep Quality Index questionnaire. Overall, 228 (54.3%) participants screened positive for poor sleep quality on the Pittsburgh Sleep Quality Index, including 88 (53.0%) of the 166 antepartum participants and 140 (56.0%) of the 250 postpartum participants. In the final, multivariable model, antepartum participants who had a shorter duration of admission were less likely to have a positive Pittsburgh Sleep Quality Index (marginal effect, −0.009), and postpartum participants who had an emergency cesarean delivery were more likely to have a positive Pittsburgh Sleep Quality Index (marginal effect, 0.166). In addition, a positive screen for pregnancy distress (Tilburg Pregnancy Distress Scale), and depression (Patient Health Questionnaire-9) were associated with poor sleep quality (P<.01).

CONCLUSION

Obstetrics participants with an increased duration of hospital stay, emergency cesarean delivery, and concomitant positive screen for depression or pregnancy distress were more likely to have poor sleep quality. These identified factors can help tailor sleep quality screening among obstetrics patients in Ghana to allow for timely, appropriate interventions to reduce the associated negative pregnancy outcomes.