Abstract Body: Background: Psychosocial factors are linked to poor cardiovascular health (CVH) and elevated CVD risk through biological and behavioral pathways that may impair sleep. Postpartum (PP) women remain understudied despite this period being characterized by heightened stress and cardiovascular vulnerability. This study examined associations between psychosocial factors and sleep characteristics in PP women.

Methods: PP (<6mos) women from the NANIT baby monitor database were recruited (N=415, mean age=33±3.85y; 25% racial/ethnic minority). Sleep was assessed using validated instruments which measured sleep duration and quality (Pittsburgh Sleep Quality Index [PSQI]), chronotype (Morning-Eveningness Questionnaire [MEQ]), and insomnia symptoms (Insomnia Severity Index [ISI]). Depression, social support and caregiver strain were assessed using the validated Beck Depression Inventory-II (BDI-II), the ENRICHD Social Support Instrument (ESSI), and the Caregiver Strain Index (CSI), respectively. Logistic regression models evaluated associations between psychosocial factors and sleep outcomes, adjusting for age, race/ethnicity, education and insurance.

Results: Overall, 43% of women reported depressive symptoms (BDI-II>13), 11% low social support, and 17% high caregiver strain (CSI>7). Short sleep duration (<7h/night) was reported by 63%, poor quality sleep (PSQI>5) by 75%, and insomnia symptoms (ISI≥8) by 50%; 5% were evening chronotype (MEQ score <42) and 30% took >20 min to fall asleep. After adjustment, depressive symptoms were associated with multiple sleep disturbances, including short sleep duration (OR:2.33, 95%CI=1.53-3.57), poor sleep quality (OR:5.71, 95%CI=3.22-10.77), and insomnia (OR:5.18, 95%CI=3.93-8.00), as well as sleep onset >20 min (OR:1.86, 95%CI=1.21-2.87) and evening chronotype (OR:2.53, 95%CI=1.04-6.56). Low social support was also associated with insomnia (OR:3.92, 95%CI=1.94-8.60). High caregiving strain was associated with poor sleep quality (OR:5.45, 95%CI=2.13-16.88).

Conclusions: Among PP women, psychosocial challenges were common and strongly associated with sleep disturbances. Depression was associated with multiple adverse sleep outcomes. Low social support was associated with insomnia symptoms and high caregiving strain was associated with poor sleep quality. These findings underscore psychosocial pathways that may connect sleep and CVH in PP women, highlighting the potential for interventions to improve CVH during this vulnerable period.