Traumatic childhood experiences and multiple dimensions of poor sleep among adult women

The time sensitive and dose-responsive association between parental corporal punishment and sleep disturbances in preschoolers: A prospective cohort study

BACKGROUND

To examine whether parental corporal punishment is associated with increased risk of concurrent and later sleep disturbances among preschoolers, and whether the association is time-sensitive or dose-responsive.

METHODS

This 3-year prospective cohort study used data from the Shanghai Children's Health, Education and Lifestyle Evaluation, Preschool(SCHEDULE-P). Participants were newly enrolled preschoolers in November 2016(wave 1) and followed up in April 2018(wave 2) and April 2019(wave 3). Parents reported the children's corporal punishment experiences and sleep disturbances at each wave survey. Children's risk of sleep disturbances in relation to corporal punishment was examined using logistic regression, adjusting for children's age, gender, emotional/behavioral problems, family annual income, and maternal educational level.

RESULTS

The participants of 19,668 children included 9436(47.98 %) females, with a mean age of 3.73(SD = 0.29) years at wave 1. Exposure to corporal punishment was associated with increased odds of concurrent sleep disturbances at wave 1, 2, and 3 (aOR,1.57; 95 % CI, 1.40-1.75; P < .001; aOR,1.60; 95 % CI, 1.43-1.80; P < .001; aOR,1.74; 95 % CI, 1.54-1.95; P < .001), respectively. Exposure to corporal punishment at any wave of preschool was associated with increased odds of sleep disturbances at wave 3, and the risks were greater for proximal and accumulative corporal punishment exposure.

CONCLUSION

There is a time-sensitive and dose-responsive association between corporal punishment and sleep disturbance among preschoolers, with greater risk of sleep disturbances for proximal and accumulative exposure of corporal punishment. Promoting positive parenting strategies and avoiding corporal punishment can be a promising strategy to prevent and intervene sleep disturbances in preschoolers.

Childhood maltreatment and sleep apnea: Findings from a cross-sectional general population study

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.

Exposure to indoor light at night in relation to multiple dimensions of sleep health: findings from the Sister Study

STUDY OBJECTIVE

To examine the association between light at night (LAN) and multiple sleep health dimensions.

METHODS

Among 47 765 Sister Study participants, indoor LAN (TV on in the room, light(s) on in room, light from outside the room, nightlight, no light) and sleep dimensions were self-reported at baseline (2003-2009). We used Poisson regression with robust variance to estimate adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the cross-sectional associations between LAN and short sleep duration (<7 hours/night), insomnia symptoms (difficulty falling or staying asleep), frequent napping (≥3 naps/week), inconsistent sleep/wake time (differed day-to-day and week-to-week), sleep debt (≥2 hours between longest and shortest duration), recent sleep medication use, and a cumulative poor sleep score (≥3 poor sleep dimensions). Population-attributable risks (PARs) were determined for any light exposure vs. none by race/ethnicity.

RESULTS

Compared to sleeping with no light in the bedroom, sleeping with a TV on was associated with a higher prevalence of most dimensions of poor sleep (e.g. short sleep duration: PR = 1.38, 95% CI: 1.32 to 1.45; inconsistent sleep/wake time: PR = 1.55, 95% CI: 1.44 to 1.66; sleep debt: PR = 1.36, 95% CI: 1.29 to 1.44; poor sleep score: PR = 1.58, 95% CI: 1.48-1.68). PARs tended to be higher for non-Hispanic black women compared to non-Hispanic white women.

CONCLUSIONS

Sleeping with a TV on was associated with poor sleep health among US women, and non-Hispanic black women may be disproportionately burdened.

Association between adverse childhood experiences and sleep quality, emotional and behavioral problems and academic achievement of children and adolescents

The impact of adverse childhood experiences (ACEs) on adult health has been extensively examined, but the association between ACEs and sleep, emotion, behavior and academic outcomes of children and adolescents is not well known. A total of 6363 primary and middle school students were included to examine the effect of ACEs on sleep quality, emotional and behavioral problems and academic achievement and further explore the mediation role of sleep quality and emotional and behavioral problems. Children and adolescents with ACE exposure had 1.37 times risk of poor sleep quality (adjusted odds ratio [OR] = 1.37, 95% confidence interval [CI]: 1.21-1.55), 1.91 times risk of emotional and behavioral problems (adjusted OR = 1.91, 95%CI: 1.69-2.15) and 1.21 times risk of self-reported lower academic achievement (adjusted OR = 1.21, 95%CI: 1.08-1.36). Most types of ACEs were significantly associated with poor sleep quality, emotional and behavioral problems and lower academic achievement. There were dose-response relationships between cumulative ACE exposure and risk of poor sleep quality, emotional and behavioral problems, and lower academic achievement. Sleep quality and emotional and behavioral performance mediated 45.9% of the effect of ACEs exposure on math scores and 15.2% of the effect of ACEs exposure on English scores. Early detection and prevention of ACEs among children and adolescents are urgent and essential, and targeted interventions for sleep and emotional and behavioral performance as well as early educational interventions are recommended for children with ACEs exposure.

Associations of adverse childhood and lifetime experiences with sleep quality and duration among women in midlife

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.

Effects of childhood trauma on sleep quality and stress-related variables in adulthood: evidence from two multilevel studies

Childhood trauma has been found to have serious negative consequences for mental and physical health. However, the precise mechanisms through which trauma influences health outcomes are unclear. Childhood trauma-related disruptions to sleep in adulthood represent an important potential mechanism. Two 7-day multilevel studies investigated the effects of childhood trauma on daily sleep outcomes and stress-related variables and whether the effects of trauma on sleep outcomes were mediated through these stress-related variables (or vice versa). Participants completed the Childhood Trauma Questionnaire before a 7-day online daily diary study. Measures of daily stress, perseverative cognition, and sleep were completed daily. Multi-level modelling found that higher levels of childhood neglect were associated with poorer daily sleep quality, shorter sleep duration, longer sleep onset latency, and higher daily stress and rumination levels. Higher childhood abuse was associated with shorter sleep duration, greater morning tiredness, and higher levels of daily stress, rumination, and worry. Childhood trauma was found also to have bidirectional, indirect effects on sleep quality and morning tiredness through daily stress-related variables. The current findings suggest that interventions aimed at mitigating the negative effects of childhood trauma should also incorporate components that target modifiable risk factors, such as sleep, stress, worry, and rumination.

Sleep Quality, Sleep-Related Experiences, and Dissociation in Adult Survivors of Childhood Trauma

OBJECTIVES

Exposure to traumatic stress in childhood increases the risk of sleep disturbances. Preliminary evidence suggests that the relationship between childhood trauma and sleep may depend on trauma chronicity. Additionally, little is known about the relationship between sleep and dissociation, a common symptom in post-traumatic stress disorder. This study examined sleep quality, sleep-related experiences, and dissociation in survivors of childhood trauma with different trauma chronicity.

METHOD

Nine-hundred-and-fourteen community-dwelling adults completed an online survey. They were divided into three groups: no childhood trauma, short-term childhood trauma, and chronic childhood trauma.

RESULTS

We found that survivors of chronic childhood trauma had poorer sleep quality than survivors of short-term childhood trauma and individuals without a history of childhood trauma, controlling for age, number of trauma types experienced, psychological distress, and PTSD symptoms. The relationship between dissociation and sleep quality was moderated by trauma chronicity such that dissociation was associated with better sleep quality only in the chronic trauma group. Dissociation was positively associated with sleep-related experiences regardless of trauma exposure and trauma chronicity.

CONCLUSION

Our findings highlighted the differential impact of acute and chronic traumatic stress on sleep, and suggested that the relationship between dissociation and sleep could depend on trauma chronicity.

The need to promote sleep health in public health agendas across the globe

Healthy sleep is essential for physical and mental health, and social wellbeing; however, across the globe, and particularly in developing countries, national public health agendas rarely consider sleep health. Sleep should be promoted as an essential pillar of health, equivalent to nutrition and physical activity. To improve sleep health across the globe, a focus on education and awareness, research, and targeted public health policies are needed. We recommend developing sleep health educational programmes and awareness campaigns; increasing, standardising, and centralising data on sleep quantity and quality in every country across the globe; and developing and implementing sleep health policies across sectors of society. Efforts are needed to ensure equity and inclusivity for all people, particularly those who are most socially and economically vulnerable, and historically excluded.

The association between adverse childhood experiences and insomnia symptoms from adolescence to adulthood: Evidence from the Add Health study

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.

The bridge symptoms of childhood trauma, sleep disorder and depressive symptoms: a network analysis

BACKGROUND

This study aimed to elucidate the characteristics of symptom network of childhood trauma (CT) and sleep disorder (SD) in Chinese adolescents, with the influence of depressive symptoms taken into account.

METHOD

A total of 1301 adolescent students were included, and their CT, SD and depressive symptoms were measured using the Pittsburgh sleep quality index (PSQI), the Childhood Trauma Questionnaire-Short Form (CTQ-SF), and The Patient Health Questionnaire-9 (PHQ-9), respectively. Central symptoms and bridge symptoms were identified based on centrality indices and bridge centrality indices, respectively. Network stability was examined using the case-dropping procedure.

RESULTS

In CT and SD symptom network, emotional abuse and sleep quality symptoms had the highest centrality values, and two bridge symptoms, i.e., emotional abuse and sleep disturbance symptoms, were also identified. In symptom network for CT, SD, and depressive symptoms, sleeping difficulty symptoms, daily dysfunction symptoms, and emotional abuse appeared to be potential bridge symptoms. In symptom network of CT, SD, and depressive symptoms (excluding the symptom of sleeping difficulty), daily dysfunction symptoms, emotional abuse, and sleep disturbance symptoms appeared to be bridge symptoms.

CONCLUSIONS

In this study, emotional abuse and poor sleep quality were found to be central symptoms in the CT-SD network structure among Chinese adolescent students, with daytime dysfunction as the bridge symptom in the CT-SD-depression network structure. Systemic multi-level interventions targeting the central symptoms and bridge symptoms may be effective in alleviating the co-occurrence of CT, SD and depression in this population.

Adverse childhood experiences and sleep duration among U.S. 65 years and older: results from the 2020 BRFSS

BACKGROUND

Adverse childhood experiences (ACEs) are a risk factor for many chronic diseases and health behaviors. This study explores the relationship between ACEs and sleep duration in elderly populations in 22 U.S. states in 2020.

METHODS

This study is a cross-sectional analysis of aged 65 years or older in the 2020 Behavioral Risk Factor Database (BRFSS). The weighted multivariate logistic regression was used to assess the association of ACEs status, ACEs type, and ACE scores with sleep duration. Subgroup analysis was used to estimate differences based on covariates.

RESULTS

Among the 42,786 participants (55.8 % female) included in this analysis, 50.5 % reported at least one ACE, and 7.3 % reported 4 or more ACEs. Adjusting for confounding factors, experiencing ACEs was associated with short and long sleep duration (Odds Ratio (OR): 2.03, 95 % Confidence Interval (CI): 1.51,2.73; OR:1.78, 95%CI:1.34,2.36). Older adults who experienced sexual abuse in children were 146 % more likely to short sleep (OR:2.46,95%CI:1.84,3.31) and 99 % more likely to long sleep (OR:1.99, 95%CI:1.35,2.92). There was a dose-response gradient between ACEs scores and sleep duration, reporting ≥ 4 ACEs had 3.10 (OR:3.10,95%CI:2.12,4.53) and 2.13 (OR:2.13, 95%CI:1.33,3.40) times the risk for short-sleep and long-sleep duration compared to respondents reporting no ACEs.

CONCLUSIONS

This study showed the association between ACEs and a high risk of sleep duration, which increased with increasing ACEs scores.

A First Look at Childhood Abuse in Women with Obstructive Sleep Apnea

Study objectives. Women who experienced childhood sexual abuse have higher rates of obesity, a risk factor for obstructive sleep apnea (OSA). We assessed if prior childhood sexual abuse was more common in women with OSA vs. control, with possible mediation by obesity. Methods . We studied 21 women with OSA (age mean±s.d. 59±12 years, body mass index (BMI) 33±8 kg/m 2 , respiratory event index [REI] 25±16 events/hour, Epworth Sleepiness Scale [ESS] 8±5) and 21 women without OSA (age 53±9 years, BMI 25±5 kg/m 2 , REI (in 7/21 women) 1±1 events/hour, ESS 5±3). We evaluated four categories of trauma (general trauma, physical, emotional, and sexual abuse) with the early trauma inventory self-report-short form (ETISR-SF). We assessed group differences in trauma scores with independent samples t-tests and multiple regressions. Parametric Sobel tests were used to model BMI as a mediator for individual trauma scores predicting OSA in women. Results. Early childhood sexual abuse reported on the ETISR-SF was 2.4 times more common in women with vs. without OSA ( p =0.02 for group difference). Other trauma scores were not significantly different between women with and without OSA. However, BMI was a significant mediator ( p =0.02) in predicting OSA in women who experienced childhood physical abuse. Conclusions. Childhood sexual abuse was more common in a group of women with OSA than those without OSA. Additionally, BMI was a mediator for OSA of childhood physical but not sexual abuse. There may be physiological impacts of childhood trauma in women that predispose them to OSA.

Adverse childhood experiences and sexual dysfunction in midlife women: Is there a link?

BACKGROUND

One in 3 children has had at least 1 adverse childhood experience (ACE), and ACEs have been associated with multiple medical and psychiatric morbidities in women later in life, including greater menopause symptom burden.

AIM

To evaluate the association between ACEs and female sexual dysfunction (FSD) in midlife women.

METHODS

A cross-sectional analysis from DREAMS-the Data Registry on Experiences of Aging, Menopause, and Sexuality-was conducted with questionnaires completed by women aged 40 to 65 years who presented to a women's health clinic at Mayo Clinic in Rochester, Minnesota, from May 2015 to December 2016. History of ACEs was obtained with the validated ACE questionnaire. FSD was assessed by the Female Sexual Function Index and the Female Sexual Distress Scale-Revised.

OUTCOMES

The association between ACEs and FSD (defined as Female Sexual Function Index score ≤26.55 and Female Sexual Distress Scale-Revised score ≥11) was evaluated via a multivariable logistic regression model, adjusting for age, menopause status, hormone therapy use, anxiety, depression, relationship satisfaction, hot flash severity, and history of abuse in the past year.

RESULTS

Women (N = 1572) had a mean age of 53.2 years. Overall 59% reported having at least 1 ACE. When compared with no ACEs, a history of ≥4 ACEs significantly increased the odds of not being sexually active (odds ratio, 1.83; 95% CI, 1.30-2.57; P < .001). Among sexually active women, the proportion of women with FSD increased sequentially as the number of ACEs increased. In the univariate analysis, a history of ≥4 ACEs significantly increased the odds of FSD as compared with no ACEs (odds ratio, 2.12; 95% CI, 1.50-2.99; P < .001). The association remained statistically significant in the multivariable analysis after adjusting for confounders (odds ratio, 1.75; 95% CI, 1.15-2.68; P = .009).

CLINICAL IMPLICATIONS

The findings highlight an opportunity for clinicians to screen for ACEs in women with sexual dysfunction and offer appropriate treatment and counseling as indicated.

STRENGTHS AND LIMITATIONS

Strengths of the study include the large cohort, the use of validated tools for assessment of ACEs and FSD, and the adjustment for multiple potential confounding factors. Limitations include the cross-sectional study design, recall bias in reporting ACEs and recent abuse, and the low representation of racially and ethnically diverse women in the cohort.

CONCLUSION

The study demonstrates an increased risk of sexual inactivity and sexual dysfunction in midlife women who experienced childhood adversity. The sexual dysfunction in women with ACEs seems to be independent of other factors that potentially affect female sexual function in midlife.

Adverse childhood experiences and sleep links in a predominantly Black sample of overweight adults

Adverse childhood experiences (ACEs) have been associated with worse sleep, but existing literature is limited by use of predominantly White samples, lack of objective sleep measurement, and use of non-standardized questionnaires. We investigated associations between retrospectively reported ACEs and sleep in adulthood in a sample of 43 adults 20-53 years of age, free from chronic conditions, with a Body mass index (BMI) ≥ 25 (Mean age = 33.14 [SD = 10.05], 74% female, 54% Black). Sleep efficiency (SE), total sleep time (TST), wake after sleep onset (WASO), and sleep onset latency (SOL), were measured by actigraphy and daily diary. Global sleep quality and insomnia severity were measured by questionnaires. Sleepiness, fatigue, and sleep quality were also measured by daily diary. Adjusting for demographic characteristics and BMI, ACEs were significantly associated with poorer global sleep quality and diary measures of greater daytime sleepiness, fatigue, and poorer sleep quality. There were no significant associations between ACEs and SE, TST, WASO, or SOL measured by diary or actigraphy. Findings suggest that ACEs are associated with worse sleep perception and daytime functioning in adulthood. Larger prospective studies are needed to replicate these findings, examine racial/ethnic differences, and determine temporal associations between ACEs, sleep, and health (e.g., BMI).

Acute sleep interventions as an avenue for treatment of trauma-associated disorders

Scientific evidence that acute, posttrauma sleep disturbances (eg, nightmares and insomnia) can contribute significantly to the pathogenesis of trauma-induced disorders is compelling. Sleep disturbances precipitating from trauma are uniquely predictive of daytime posttrauma symptom occurrence and severity, as well as subsequent onset of mental health disorders, including post-traumatic stress disorder. Conversely, adequate sleep during the acute posttrauma period is associated with reduced likelihood of adverse mental health outcomes. These findings, which are broadly consistent with what is known about the role of sleep in the regulation of emotion, suggest that the acute posttrauma period constitutes a "window of opportunity" during which treatment of sleep disturbances may be especially effective for preventing or mitigating progression of aberrant psychophysiological processes. At this point, the weight of the scientific evidence supporting this possibility warrants initiation of clinical trials to confirm the benefits of targeted prophylactic sleep enhancement, and to establish treatment guidelines as appropriate.

CITATION

Swift KM, Thomas CL, Balkin TJ, Lowery-Gionta EG, Matson LM. Acute sleep interventions as an avenue for treatment of trauma-associated disorders. J Clin Sleep Med. 2022;18(9):2291-2312.

The association of adverse childhood experiences and its subtypes with adulthood sleep problems: A systematic review and meta-analysis of cohort studies

Adverse childhood experience (ACE) is a powerful risk factor for long-term sleep health. However, the degree to which ACE and its subtypes contribute to adulthood sleep problems remains unknown. For this systematic review and meta-analysis, PubMed, Embase, Web of Sciences, Cochrane library, and CNKI (Chinese) were searched from inception to 1 December 2021. Cohort studies that examined the association between ACEs (aged <18 y) and adulthood sleep outcomes (aged ≥18 y) were included. The most fully adjusted odds ratios (ORs) were extracted and pooled using the random-effects model. A total of nine articles involving 108 330 participants from five high-income countries were identified. Individuals with at least one ACE subtype were more likely to report adulthood sleep problems (OR = 1.14, 1.09-1.20, I² = 77.5%, n = 9 studies) compared with those without ACE. The pooled ORs were approximately 1.20 for sexual, physical, and emotional abuse with high heterogeneity (I² > 80%), 1.09 (95% CI: 0.99-1.19, I² = 0%, n = 2) for neglect, and 1.21 (95% CI: 1.14-1.30, I² = 73.6%, n = 3) for family dysfunction. Individuals with multiple ACEs were associated with a higher magnitude of the risk for sleep problems (OR = 1.33, 95% CI: 1.18-1.49, I² = 87.3%, n = 3). In conclusion, the magnitude of the risk for sleep problems was similar across ACE subtypes except for childhood neglect. ACE may have cumulative detrimental effects on sleep health. More longitudinal evidence regarding ACE-sleep relationships, particularly in low- and middle-income countries, is needed. Furthermore, more policy efforts and evidence-based preventions are warranted to address ACEs among children.

Adverse Childhood Experiences and Their Impact on Sleep in Adults: A Systematic Review

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.

The association between traumatic life events and insomnia symptoms among men and women: Results from the Baltimore Epidemiologic Catchment Area follow-up study

STUDY OBJECTIVES

Trauma exposure likely contributes to poor sleep, but relatively few studies have empirically tested this, instead focusing on posttraumatic stress disorder. Moreover, little is known about sex differences in sleep after trauma. The current study used a cross-sectional and retrospective design to test hypotheses that trauma exposure would be associated with subsequent insomnia symptoms, particularly among women, even after accounting for important covariates.

METHOD

Data from Wave 3 (1993-1996) of the Baltimore Epidemiologic Catchment Area Study (N = 1920) were used to examine associations between remote (prior to past year) and recent (past year) trauma and current sleep disturbance (insomnia, hypersomnia symptoms) in the total sample (Mage= 55, 63.2% women, 57.7% white), and separately in men and women. Sensitivity analyses were conducted among individuals with no pretrauma sleep disturbance to examine incident sleep disturbance.

RESULTS

Among all participants, both remote (odds ratio [OR] = 1.95, 95% confidence interval [CI] [1.34, 2.85]) and recent (OR = 1.94, 95% CI [1.31, 2.87]) trauma exposure were associated with increased odds of insomnia (OR = 2.41, 95% CI [1.54, 3.76]) but not hypersomnia. Associations between trauma and insomnia were particularly strong among women, but null among men. The relationship between trauma exposure and insomnia symptoms persisted among individuals with no pretrauma history of insomnia.

CONCLUSION

Results suggest women may be vulnerable to insomnia symptoms as sequelae of trauma. Future research should examine prospective associations between trauma and sleep in larger samples and how assessment and treatment of insomnia among women trauma survivors reduces the public health impact of trauma and poor sleep.

Associations between Childhood Maltreatment and Behavioral Sleep Disturbances Across the Lifespan: A Systematic Review

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.

Childhood Maltreatment, Sleep Disturbances, and Anxiety and Depression: A Prospective Longitudinal Investigation

This research sought to determine whether inadequate sleep conditions in childhood and sleep problems in young adulthood in part explain the relationship between childhood abuse and neglect and anxiety and depression later in life. Children with documented histories of abuse and neglect and matched controls were followed up and assessed in young and middle adulthood. Abused and neglected children were more likely to report experiencing inadequate sleep conditions in childhood, sleep problems in young adulthood, and higher levels of depression and anxiety later in middle adulthood. Results revealed significant indirect paths from childhood maltreatment to anxiety and depression in middle adulthood through inadequate sleep conditions in childhood and sleep problems in young adulthood. This longitudinal follow-up of children with documented cases of maltreatment reveals the important role of sleep disturbances in the lives of maltreated children and adults and sleep disturbances in the development of subsequent anxiety and depression.

Associations of adverse childhood experiences with adolescent total sleep time, social jetlag, and insomnia symptoms

STUDY OBJECTIVE

Adverse childhood experiences (ACEs) are associated with sleep problems in adulthood, but less research has focused on ACEs and sleep during adolescence. The goal of the present study was to explore associations between ACEs reported at ages 5 and 9 years, and sleep (ie, total sleep time (TST), social jetlag, and insomnia symptoms) at age 15.

METHODS

Participants comprised 817 families from the Fragile Families and Child Wellbeing Study, a nationally representative sample of children born to unwed parents. Number of ACEs was constructed from primary-caregiver reports at ages 5 and 9, and sleep measures (ie, TST, social jetlag, and insomnia symptoms) were derived from adolescent-reported sleep behaviors at age 15.

RESULTS

Adjusting for sex and race/ethnicity, ACEs at age 9 were associated with longer weekend TST (B = 0.16, 95% CI = 0.04, 0.28), more social jetlag (B = 0.17, 95% CI = 0.07, 0.27), and higher odds of trouble falling asleep ≥3 times per week (Odds Ratio = 1.24, 95% CI = 1.01, 1.53). In females only, ACEs were associated with greater school night TST (B = 0.12, 95% CI = 0.01, 0.23). Results were similar after further adjustment for symptoms of anxiety and depression. Associations among ACEs, social jetlag, and insomnia symptoms appeared strongest among Non-Hispanic Black adolescents.

CONCLUSION

ACEs appear to be related to multiple aspects of sleep in adolescence. Additional research is needed to confirm these associations and examine the extent to which sleep disturbances associated with ACEs account for later health outcomes.

Childhood maltreatment reports in adult seasonal affective disorder: Associations with sleep disturbances, maladaptive cognitions, and brooding

BACKGROUND

Although childhood maltreatment has been studied in multiple psychopathologies, its role in Seasonal Affective Disorder (SAD) is unknown. The current study examined possible mediators of the relationship between retrospectively-reported childhood maltreatment and adult SAD symptom severity during a major depressive episode in winter.

METHODS

Participants (N = 113), ages 18 to 65, completed measures of childhood maltreatment, SAD severity, sleep disturbances, ruminative brooding, and maladaptive cognitions. Mediation analyses testing the relationship between childhood maltreatment and SAD symptom severity via sleep and cognitive factors were conducted using PROCESS (Hayes, 2012).

RESULTS

Mediation analyses suggested that insomnia, hypersomnia, brooding, and seasonal maladaptive beliefs may account for the association between childhood maltreatment and SAD symptom severity.

LIMITATIONS

Analyses were cross-sectional and should be interpreted with caution. Participants completed self-report childhood trauma measure retrospectively as adults.

CONCLUSION

The present study is the first to examine childhood maltreatment in SAD, a disorder commonly viewed with circadian etiology. Covariance between childhood maltreatment and SAD symptom severity is indirectly explained by sleep difficulties, cognitive factors, and brooding, which may suggest therapeutic targets if replicated in longitudinal or experimental manipulations of sleep and cognition.

Sleep disturbance and the long-term impact of early adversity

Sleep disturbance may be a central, yet underappreciated mechanism by which early adversity has a long-term impact upon mental and physical health. The fundamental regulatory processes shaped by early adversity - neural, neuroendocrine, and immune - are also central to sleep. Sleep problems, in turn, lead to a similar constellation of chronic health problems that have been linked to early adversity. We bring together work from the fields of early adversity and sleep in order to suggest a model by which sleep disturbance plays a critical role in the far-reaching impacts of early adversity on health. Future research should employ more longitudinal designs and pay particular attention to the impact of developmental periods such as adolescence and midlife when maturational and environmental factors conspire to create a unique time of sleep disturbance. We also suggesting that intervening to minimize sleep disturbance may be a promising means by which to test the model, as well as potentially blunt the long-term impact of early adversity on health.

Socioeconomic Status Moderates the Impact of Emotional but not Physical Childhood Abuse on Women's Sleep

A recent systematic review highlighted associations between childhood abuse and adult sleep quality, and the need for research focused specifically on women and the role of moderating variables. The objectives of the present study were (1) to assess the impact of frequent physical and emotional child abuse on adult sleep among women; and (2) to assess the role that childhood socioeconomic status (SES) could play in moderating these associations. In-person data were collected from women living in a mid-sized city in western Canada in 2019–2020 (N = 185; M age = 40 years). Sleep quality was measured using the Pittsburgh Sleep Quality Index. Physical and emotional abuse experienced often or very often in childhood were assessed using single items (yes or no). Childhood SES was assessed by a single item and dichotomized at the sample median. Linear regression models examined associations between each form of abuse and continuous adult sleep quality score adjusted for covariates. Statistically significant interactions were stratified and examined by child SES group. Frequent physical and emotional childhood abuse were each associated with clinically and statistically significant increases in past-month sleep problem scores among women in adjusted models. This association was moderated by childhood SES for emotional child abuse, but not physical child abuse. Findings suggest that growing up in an upper-middle to upper SES household may buffer the adverse impact of frequent emotional child abuse on later adult sleep, but may not promote resilience in the context of frequent physical child abuse. 

Abuse in Childhood and Risk for Sleep Disruption in Adulthood in the Black Women's Health Study

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.

Increased risk for sleep disorders in burn patients: A 14-year nationwide, population-based cohort study

BACKGROUND

Burn is a major trauma that causes physical and psychosocial impairments, leading to sleep disorders. However, the data about risks for sleep disorders in patients over 3 years following burn injury are limited.

AIM

To investigate the long-term risks for sleep disorders in patients after burn injury and identify the high-risk population.

METHODS

A 14-year population-based cohort study was performed using data from the 2000-2013 Taiwan National Health Insurance Research Database (NHIRD) which was a valid representative sample of the total population. All diagnoses of medical records in NHIRD were made by physicians and coded according to the ICD-9-CM. Cases diagnosed with burns (ICD-9 CM: N-code 940-949 and E-code 890-899) were included. The control group (non-burn injury group) was comprised quadruple the number of cases matched by index date, sex and age.

RESULTS

In 2000-2013, among the 10,289 burn patients included and followed-up after the index year, burn injury significantly increased the risks for sleep disorders (Hazard Ratio; HR = 1.36, p = 0.044), including insomnia (HR = 1.41, p = 0.036), sleep disturbance (HR = 2.39, p = 0.005) and sleep apnoea (HR = 1.38, p = 0.029). Compared with the control group, those who were women (HR = 1.73, p = 0.021), adolescents (HR = 5.45, p < 0.001), aged 19-24 years (HR = 1.36, p = 0.034), aged 25-44 years (HR = 1.67, p = 0.007), had low income (HR = 2.14, p = 0.001), and without a history of mental disorders (HR = 1.41, p = 0.024) had significantly higher risks for developing sleep disorders when suffered burn injury.

CONCLUSION

Burn had long-term negative effects on sleep during both the first year of burn injury and the subsequent follow-up 14 years. It is important for physicians to long-term assess the sleep quality of burn patients regardless of the number of years after burn injury.

Racial/Ethnic Disparities in the Relationship Between Traumatic Childhood Experiences and Suboptimal Sleep Dimensions Among Adult Women: Findings from the Sister Study

BACKGROUND

Traumatic childhood experiences (TCEs) are associated with poor adulthood sleep, but racial/ethnic disparities have not been well-studied. We investigated the TCE-adulthood sleep relationship among non-Hispanic (NH)-White, NH-Black, and Hispanic/Latina women.

METHOD

Women enrolled in the Sister Study from 2003 to 2009 reported the following TCEs in a follow-up interview (2008-2012): natural disasters; major accidents; household dysfunction; and sexual, physical, and psychological/emotional abuse. Sleep characteristics included short sleep duration (< 7 h vs. 7-9 h), long sleep onset latency (SOL) (> 30 vs. ≤ 30 min), frequent night awakenings (≥ 3 times/night ≥ 3 times/week [yes vs. no]), and frequent napping (≥ 3 vs. < 3 times/week). Using log-binomial regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep characteristics among women with vs. without TCEs, we investigated racial/ethnic-specific associations and race/ethnicity as a moderator.

RESULTS

Among 40,082 participants (mean age = 55 ± 8.8 years), 55% reported ≥ 1 TCE (NH-White, 54%; NH-Black, 62%; Hispanic/Latina, 57%). NH-White, NH-Black, and Hispanic/Latina women reporting any TCE had a higher prevalence of short sleep compared with their within-race/ethnicity counterparts without TCEs. Associations were strongest among NH-Whites. Compared to NH-Whites with no TCEs, racial/ethnic minorities who reported any TCEs had a higher prevalence of short sleep (PR_Blacks = 2.13 [95% CI 2.02-2.24], PR_{Hispanics/Latinas} = 1.47 [1.35-1.60]) and long SOL. When comparing racial/ethnic minorities with TCEs to NH-Whites with TCEs, PRs for short sleep (PR_Blacks = 1.98 [1.88-2.08] and PR_{Hispanics/Latinas} = 1.36 [1.25-1.48]) and long SOL were weaker.

CONCLUSION

TCEs were positively associated with poor sleep characteristics among women, and TCEs appear to contribute to short sleep duration and long SOL disparities.

Racial/Ethnic Disparities in Sleep Health and Potential Interventions Among Women in the United States

While essential for health and wellness, the various dimensions of sleep health are generally not equitably distributed across the population, and reasons for racial/ethnic sleep disparities are not fully understood. In this review, we describe racial/ethnic sleep disparities and subsequent implications for health from prior and recently conducted epidemiological and clinical studies as well as the potential sleep interventions presented at the 2018 Research Conference on Sleep and the Health of Women at the National Institutes of Health. Given the clear connection between sleep and poor health outcomes such as cardiovascular disease, we concluded that future studies are needed to focus on sleep health in general, sleep disorders such as insomnia and obstructive sleep apnea in particular, and disparities in both sleep health and sleep disorders among women using an intersectional framework. Future research should also integrate sleep into interventional research focused on women's health as these results could address health disparities by informing, for example, future mobile health (mHealth) interventions prioritizing women beyond the clinical setting.

Racial/ethnic disparities in sleep duration and sleep disturbances among pregnant and non-pregnant women in the United States

Sleep disturbances among pregnant women are increasingly linked to suboptimal maternal/birth outcomes. Few studies in the USA investigating sleep by pregnancy status have included racially/ethnically diverse populations, despite worsening disparities in adverse birth outcomes. Using a nationally representative sample of 71,644 (2,349 pregnant) women from the National Health Interview Survey (2004-2017), we investigated relationships between self-reported pregnancy and six sleep characteristics stratified by race/ethnicity. We also examined associations between race/ethnicity and sleep stratified by pregnancy status. We used average marginal predictions from fitted logistic regression models to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for each sleep dimension, adjusting for sociodemographic and health characteristics. Pregnant women were less likely than non-pregnant women to report short sleep (PR_Overall  = 0.75; 95% CI, 0.68-0.82) and more likely to report long sleep (PR_Overall  = 2.06; 95% CI, 1.74-2.43) and trouble staying asleep (PR_Overall  = 1.34; 95% CI, 1.25-1.44). The association between pregnancy and sleep duration was less pronounced among women aged 35-49 years compared to those <35 years. Among white women, sleep medication use was less prevalent among pregnant compared to non-pregnant women (PR_White  = 0.45; 95% CI, 0.31-0.64), but this association was not observed among black women (PR_Black  = 0.98; 95% CI, 0.46-2.09) and was less pronounced among Hispanic/Latina women (PR_{Hispanic/Latina}  = 0.82; 95% CI, 0.38-1.77). Compared to pregnant white women, pregnant black women had a higher short sleep prevalence (PR_Black  = 1.35; 95% CI, 1.08-1.67). Given disparities in maternal/birth outcomes and sleep, expectant mothers (particularly racial/ethnic minorities) may need screening followed by treatment for sleep disturbances. Our findings should be interpreted in the historical and sociocultural context of the USA.