Association of dexmedetomidine use during combined spinal-epidural anesthesia with postoperative sleep quality and anxiety in cesarean section: a prospective cohort study

BACKGROUND: Postoperative sleep disturbance and anxiety are common after cesarean delivery and may impair early maternal recovery and psychological well-being. Dexmedetomidine (DEX), a selective α₂-adrenergic agonist, provides sedative and anxiolytic effects that may confer perioperative benefits beyond hemodynamic stabilization. METHODS: This prospective observational cohort study enrolled 120 women (22-38 years, ASA physical status II) undergoing elective cesarean delivery under combined spinal-epidural anesthesia. Participants were categorized into DEX or control groups according to intraoperative dexmedetomidine administration. The primary outcome was postoperative sleep quality assessed using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) on postoperative days 1-3. Secondary outcomes included anxiety evaluated by the State-Trait Anxiety Inventory (STAI), postoperative pain assessed by the visual analog scale (VAS), hemodynamic parameters, perioperative adverse events, and neonatal Apgar scores. Statistical analyses included independent-samples t tests, χ² tests, and repeated-measures analysis of variance. RESULTS: All 120 participants were included in the analysis (DEX: n = 60; control: n = 60), with comparable baseline characteristics between groups. Compared with controls, the DEX group demonstrated significantly lower PSQI and ESS scores across postoperative days 1-3 (day 1 PSQI: 4.88 ± 1.15 vs. 6.42 ± 1.21; ESS: 7.18 ± 1.64 vs. 9.32 ± 1.85; both P < 0.001). Repeated-measures analysis confirmed significant group, time, and group-by-time interaction effects (all P < 0.01). Anxiety levels decreased more prominently in the DEX group (48 h STAI: 34.85 ± 3.98 vs. 37.62 ± 4.16, P = 0.002). Postoperative pain scores were consistently lower with DEX (VAS at 24 h: 2.68 ± 0.74 vs. 3.52 ± 0.79, P < 0.001). Intraoperative hemodynamic variability was reduced in the DEX group for mean arterial pressure (Δ + 5.6 vs. +9.8 mmHg, P < 0.001) and heart rate (7.8 vs. 12.1 bpm, P < 0.001). No significant differences were observed in adverse events or neonatal Apgar scores. Improvement in anxiety was moderately associated with better postoperative sleep quality (β = 0.46, P < 0.001). CONCLUSION: Intraoperative dexmedetomidine administration was associated with improved short-term postoperative sleep quality, reduced anxiety, and enhanced hemodynamic stability without compromising maternal or neonatal safety in women undergoing cesarean delivery.