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Spitzer C, Weihs A, Ewert R, Stubbe B, Penzel T, Fietze I, Völzke H, Grabe HJ. Childhood maltreatment and sleep apnea: Findings from a cross-sectional general population study. J Psychosom Res 2024; 178:111600. [PMID: 38340571 DOI: 10.1016/j.jpsychores.2024.111600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Cumulative evidence indicates that childhood maltreatment (CM) is associated with sleep disturbances possibly suggesting sleep apnea. However, the relation between CM and objective measures of sleep apnea as determined by polysomnography (PSG) has not yet been assessed. METHODS Using a cross-sectional design and based on PSG measurements from N = 962 subjects from the SHIP-Trend general population study, we used linear regression models to investigate the relationship between apnea-hypopnea (AHI) and oxygen desaturation index (ODI) and Epworth sleepiness scale (ESS) metrics and the Childhood Trauma Questionnaire (CTQ). All significant models were additionally adjusted for obesity, depression, metabolic syndrome, risky health behaviors, and socioeconomic factors. RESULTS While both AHI and ESS were positively associated with the CTQ sum score, ODI was not. Investigating the CTQ subscales, ESS was associated with emotional abuse and emotional neglect; AHI was associated with physical and sexual abuse as well as physical neglect. For both the sum score and the subscales of the CTQ, ESS effects were partially mediated by depressive symptoms, while AHI effects were mediated by obesity, risky health behaviors, and metabolic syndrome. CONCLUSION The findings of this general population study suggest an association between CM, particularly physical neglect, and objective as well as subjective indicators of sleep apnea, which were partially mediated by depressive symptoms and obesity.
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Affiliation(s)
- Carsten Spitzer
- Department of Psychosomatic Medicine and Psychotherapy, University Medicine Rostock, Rostock, Germany.
| | - Antoine Weihs
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany
| | - Ralf Ewert
- Department of Internal Medicine B - Cardiology, Pulmonary Medicine, Infectious Diseases and Intensive Care Medicine, University Medicine Greifswald, Germany
| | - Beate Stubbe
- Department of Internal Medicine B - Cardiology, Pulmonary Medicine, Infectious Diseases and Intensive Care Medicine, University Medicine Greifswald, Germany
| | - Thomas Penzel
- Center of Sleep Medicine, University Hospital Charité Berlin, Berlin, Germany
| | - Ingo Fietze
- Center of Sleep Medicine, University Hospital Charité Berlin, Berlin, Germany
| | - Henry Völzke
- Department of Community Medicine, SHIP/Clinical Epidemiology Research, University Greifswald, Greifswald, Germany; German Centre for Diabetes Research, DZD, Partner Site Greifswald, Germany; German Centre for Cardiovascular Research, DZHK, Site Greifswald, Germany
| | - Hans J Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany; German Center for Neurodegenerative Disease (DZNE), site Rostock/Greifswald, Germany
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Kaubrys M, Mischel E, Frazier P. Examining mediators of the association between child maltreatment and sleep disturbance in college students. CHILD ABUSE & NEGLECT 2024; 149:106698. [PMID: 38401368 DOI: 10.1016/j.chiabu.2024.106698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Childhood maltreatment has been associated with poorer mental and physical health across the lifespan, including disrupted sleep. OBJECTIVE The aim of this study was to assess four potential mediators of the association between child maltreatment and sleep in a sample of college students: daily rumination, perceptions of control over stressors, sleep hygiene, and distress. PARTICIPANTS AND SETTING University students (N = 234) completed self-report measures online. METHODS Childhood maltreatment was assessed at baseline and rumination, perceived control, sleep hygiene, and distress were assessed daily for 14 days and aggregated across days. Structural equation models were used to test hypotheses. The hypothesized model was compared to an alternate path reversal model. RESULTS Maltreatment was significantly associated with greater sleep disturbance (β = 0.17, p < .05). Of the mediators, only sleep hygiene partially mediated the association between maltreatment and sleep (β = 0.07, p < .01). The alternate path reversal model demonstrated that sleep disturbances mediated the relation between child maltreatment and sleep hygiene (β = 0.11, p < .001) and perceived control (β = 0.07, p < .05), and sleep disturbances partially mediated the relation between maltreatment and distress (β = 0.10, p < .01) and rumination (β = 0.09, p < .01). CONCLUSIONS Sleep hygiene may be implicated in the long-term health effects of child maltreatment. Further, sleep hygiene interventions may be useful for improving sleep among college students who have experienced maltreatment, and targeting students' sleep may have benefits for students' cognition and mood.
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Affiliation(s)
- McKenzie Kaubrys
- Department of Psychology, University of Minnesota, Twin Cities, United States
| | - Emily Mischel
- Department of Psychology, University of Minnesota, Twin Cities, United States
| | - Patricia Frazier
- Department of Psychology, University of Minnesota, Twin Cities, United States.
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Petrov ME, Calvin S, Wyst KBV, Whisner CM, Meltzer LJ, Chen ACC, Felix KN, Roe-Sepowitz D. Sleep Disturbances and Hygiene of Adolescent Female Survivors of Domestic Minor Sex Trafficking. J Pediatr Health Care 2024; 38:52-60. [PMID: 37610406 DOI: 10.1016/j.pedhc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/28/2023] [Accepted: 07/28/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION This cross-sectional quantitative study investigated the sleep hygiene and disturbances of adolescent female survivors of domestic minor sex trafficking (DMST) compared to an online sample of community-dwelling adolescent females. METHOD Community-dwelling adolescent females (aged 13-17 years, n = 61) and survivors of DMST housed in residental care (aged 12-17 years, n = 19) completed the Children's Report of Sleep Patterns (adolescent version). Descriptive statistics on sleep health in both samples were computed and compared using chi-square and t-tests. RESULTS Among the survivors of DMST, the majority reported insufficient sleep duration, okay-to-poor sleep quality, waking thirsty, and frequent nightmares. Compared with community-dwelling adolescents, survivors of DMST had more symptoms of insomnia, sleepiness, nightmares, and waking thirsty (p < .05). DISCUSSION Sleep disturbances among adolescent female survivors of DMST may be more prevalent than in community-dwelling adolescent females. Further empirical research on appropriate assessment and trauma-informed treatment of sleep in this population is needed.
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Oken E, Rifas-Shiman SL, Joffe H, Manson JE, Spagnolo PA, Bertisch SM, Klerman EB, Chavarro JE. Associations of adverse childhood and lifetime experiences with sleep quality and duration among women in midlife. Sleep Health 2023; 9:860-867. [PMID: 37923668 PMCID: PMC10840935 DOI: 10.1016/j.sleh.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/24/2023] [Accepted: 09/09/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Many women experience sleep problems during midlife. Associations of adverse lifetime experiences-more common among women-with sleep outcomes are understudied. METHODS We studied 476 women enrolled in Project Viva 1999-2002. At enrollment, participants reported any lifetime history of abuse and/or financial hardship. At midlife follow-up ∼20 years later, they reported a history of up to 10 adverse childhood experiences (ACEs); 7-day sleep quality (patient-reported outcomes measurement information system sleep disturbance and sleep-related impairment T-scores); and past month average sleep duration. We examined associations of adverse experiences with sleep outcomes, adjusted for childhood sociodemographic variables. We also explored mediation by current depression and anxiety symptoms, hot flash severity, general health, and body mass index. RESULTS ACEs were common: 301 women (63%) reported one or more. Each additional ACE was associated with higher midlife sleep disturbance (adjusted β = 0.65 points, 95% confidence interval [CI]: 0.27, 1.02) and sleep-related impairment (0.98, 95% CI: 0.54, 1.41) T-scores, and with sleep duration <6 hour/night (odds ratio 1.19, 95% CI: 1.00, 1.42), but not with continuous sleep duration (-2 minutes, 95% CI: -5, 1). Adverse experiences in adulthood were less consistently associated with sleep quality but were associated with sleep duration, for example, financial hardship during the index pregnancy was associated with 75 minutes (95% CI: -120, -29) shorter sleep duration 2 decades later. Associations of ACEs with sleep disturbance and sleep-related impairment were mediated by midlife depression anxiety and physical health but not by hot flash severity or body mass index. CONCLUSIONS Adverse lifetime experiences have deleterious associations with sleep duration and quality in midlife women.
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Affiliation(s)
- Emily Oken
- Division of Chronic Disease Research Across the Lifecourse, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA; Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | | | - Hadine Joffe
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Connors Center for Women Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - JoAnn E Manson
- Connors Center for Women Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Primavera Alessandra Spagnolo
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Connors Center for Women Health and Gender Biology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Suzanne M Bertisch
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA
| | - Elizabeth B Klerman
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA; Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Jorge E Chavarro
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
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Desch J, Bakour C, Mansuri F, Tran D, Schwartz S. The association between adverse childhood experiences and insomnia symptoms from adolescence to adulthood: Evidence from the Add Health study. Sleep Health 2023; 9:646-653. [PMID: 37419708 DOI: 10.1016/j.sleh.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 05/25/2023] [Accepted: 06/01/2023] [Indexed: 07/09/2023]
Abstract
OBJECTIVES Adverse childhood experiences are potentially traumatic events that occur up to age 17, including abuse, neglect, and household dysfunction. Such trauma often results in chronic stress and poor sleep health, which are linked to negative health outcomes across the lifespan. This study examines the longitudinal association between adverse childhood experiences (ACEs) and insomnia symptoms from adolescence to adulthood. METHODS Data from the National Longitudinal Study of Adolescent to Adult Health were used to examine the association between ACEs and insomnia symptoms (trouble falling asleep or staying asleep, dichotomized based on self-reported frequency of 3 times per week or more). We used weighted logistic regression to examine the association between cumulative ACE score (0, 1, 2-3, 4+), 10 specific ACEs, and insomnia symptoms. RESULTS Of 12,039 participants, 75.3% experienced at least one adverse childhood experience and 14.7% experienced 4 or more. We found specific adverse childhood experiences, including physical abuse, emotional abuse, neglect, parental incarceration, parental alcoholism, foster home placement, and community violence were associated with experiencing insomnia symptoms throughout the entire 22-year follow-up period from adolescence to mid-adulthood (p < .05), while childhood poverty was only associated with insomnia symptoms in mid-adulthood. The number of adverse childhood experiences showed a dose-response association with insomnia symptoms in adolescence (1 adverse childhood experience: adjusted odds ratio (aOR)=1.47 [1.16, 1.87], 4+ adverse childhood experiences: aOR= 2.76, [2.18, 3.50]), early adulthood (1 adverse childhood experience: aOR= 1.43 [1.16, 1.75], 4+ adverse childhood experiences: aOR= 3.07 [2.47, 3.83]) and mid-adulthood (1 adverse childhood experience: aOR= 1.13 [0.94, 1.37], 4+ adverse childhood experiences: aOR= 1.89 [confidence interval: 1.53, 2.32]). CONCLUSIONS Adverse childhood experiences are associated with an increased risk for insomnia symptoms across the lifespan.
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Affiliation(s)
- Jill Desch
- College of Public Health, University of South Florida, Tampa, Florida, USA.
| | - Chighaf Bakour
- College of Public Health, University of South Florida, Tampa, Florida, USA.
| | - Fahad Mansuri
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Dieu Tran
- College of Public Health, University of South Florida, Tampa, Florida, USA.
| | - Skai Schwartz
- College of Public Health, University of South Florida, Tampa, Florida, USA.
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Abstract
Adverse childhood experiences (ACEs) before the age of 18 years are pervasive and noteworthy public health concerns. The ACEs are associated with sleep disorders in later life. In this study, we conduct a systematic review to explore the effects of ACEs on sleep in adulthood. Using Medical Subject Headings keywords, we searched Medline, PubMed, PubMed Central, the American Psychological Association PsycArticles, and PsychInfo databases to evaluate the association between ACEs and sleep disturbances. ACEs increase the odds of developing chronic short sleep duration, that is, <6 hours of sleep per night compared with optimal sleep duration of 7-9 hours per night during adulthood. The ACEs are positively associated with poor sleep characteristics such as short sleep duration and long-term sleep problems. Clinicians should pay close attention to developmental trauma care, access community health programs, and help develop better coping skills, resiliency, and good sleep habits in their patients.
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Brown SM, Rodriguez KE, Smith AD, Ricker A, Williamson AA. Associations between Childhood Maltreatment and Behavioral Sleep Disturbances Across the Lifespan: A Systematic Review. Sleep Med Rev 2022; 64:101621. [PMID: 35367857 PMCID: PMC9441474 DOI: 10.1016/j.smrv.2022.101621] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 02/26/2022] [Accepted: 02/28/2022] [Indexed: 01/10/2023]
Abstract
Childhood maltreatment has a range of long-term developmental and health consequences. Emerging research suggests that sleep disturbances may be a key behavioral health risk factor implicated in the relationship between maltreatment and poor health across the lifespan. This systematic review examined the association between maltreatment and behavioral sleep disturbances in childhood and adulthood. Studies were identified through PsycINFO, PubMed, and alternative search strategies such as Google Scholar and reference list checks, with an end date of July 2021. Quantitative, peer-reviewed articles examining behavioral sleep outcomes and/or characteristics among maltreatment-exposed samples were included. We assessed the potential risk of bias by examining study design and sleep and maltreatment assessment methods. Across 73 studies included in this review, there was a robust association between childhood maltreatment and behavioral sleep disturbances. Findings suggest that linkages between maltreatment and sleep outcomes diverge with respect to maltreatment characteristics, type of behavioral sleep disturbance assessed, use of subjective versus objective measures, and study design. Given that behavioral sleep disturbances are modifiable, more research is needed that incorporates objective measures of sleep and longitudinal designs to identify specific points of intervention to mitigate the potential long-term impacts of childhood maltreatment on health across socio-demographically diverse populations.
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Boynton-Jarrett R, Sponholtz TR, Rosenberg L, Palmer JR, Bethea TN, Wise LA. Abuse in Childhood and Risk for Sleep Disruption in Adulthood in the Black Women's Health Study. Sleep Med 2021; 83:260-270. [PMID: 34049046 DOI: 10.1016/j.sleep.2021.02.053] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/08/2021] [Accepted: 02/23/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the association of early life abuse with sleep disruption risk in adulthood among U.S. Black women. METHODS We analyzed data from the Black Women's Health Study, a prospective cohort study. In 2005, 29,998 women completed a self-administered questionnaire on early-life experiences of abuse (child and teen) and exposure to danger at any life stage. Participants reported on their sleep quality (snoring and diagnosed sleep apnea) in 2001, whether their "sleep was restless" in 2005, and their average sleep duration in 2009. We used log-binomial regression models to derive risk ratios (RRs) and 95% confidence intervals (CIs) for the association of child/teen abuse and danger at any life stage with snoring, diagnosis of sleep apnea, restless sleep, and short sleep duration. RESULTS Nearly 50% of participants reported one or more measure of sleep disruption in adulthood. Higher severity of physical abuse was associated with increased risk of sleep disruption and higher severity of sexual abuse was associated with increased risk for most sleep disruptions. The RR comparing child/teen physical and sexual abuse relative to no abuse was highest for diagnosed sleep apnea (2.03, 95% CI: 1.70, 2.41). Feeling in danger at any life stage (child, teen, adult, past year) was generally associated with greater increases in risk of sleep disruption among women with a history of early life abuse than among women without such a history. CONCLUSIONS Our findings suggest that abuse as a child and/or teen is related to disrupted sleep in adulthood.
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Affiliation(s)
- Renée Boynton-Jarrett
- Division of General Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA.
| | - Todd R Sponholtz
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Lynn Rosenberg
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University, Boston, MA, USA
| | - Traci N Bethea
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Washington DC, USA
| | - Lauren A Wise
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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