Psychological medicine · 2026
Adverse childhood experiences and risk of chronic sleep disturbances: A population-based cohort study from a Chinese national survey.
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Lu Hong, Wen Yi, Yu Hegao, Wu Chujun, Zhao Dizhou
Аннотация
BACKGROUND: Adverse childhood experiences (ACEs) have long-lasting effects in Chinese older adults. Using China Health and Retirement Longitudinal Study (CHARLS) data, we examined ACEs' impact on chronic sleep disturbances combining poor sleep quality and abnormal duration in China's aging population.
METHODS: We analyzed 20,450 CHARLS participants (2014 baseline). After excluding those with missing ACEs data (n = 11,006), incomplete sleep data, or aged <45 years and with psychiatric conditions, the final sample comprised 5,533 individuals. ACE exposure was categorized into: Class 1 (0 ACEs, n = 1,382), Class 2 (1 ACE, n = 1,769), Class 3 (2 ACEs, n = 1,264), and Class 4 (≥3 ACEs, n = 1,118). Composite sleep disturbances were defined by CES-D-10 self-reported sleep quality (4-point scale item ≥3) and abnormal duration (<6 or >9 hours). Multivariable logistic regression adjusted for age, sex, education, marital status, smoking, drinking, and chronic diseases, with trend tests modeling ACEs ordinally.
RESULTS: A graded association emerged: adjusted ORs increased from 1.30 (95% CI: 1.05-1.59) for 1 ACE to 2.1 (1.69-2.62) for ≥3 ACEs (Ptrend < 0.001). Five ACE types showed significant associations: household mental illness showed the strongest association (OR = 1.77, 1.53-32.06, P < 0.001). Subgroup analyses revealed consistent associations between ACE exposure (≥1) and increased risk of Chronic Sleep Disturbances across most population strata (OR range: 1.27-1.81, P < 0.05).
CONCLUSIONS: Childhood adversity, particularly household mental illness, was significantly associated with sleep disturbances in older adults. The observed 2.1-fold prevalence difference suggests that older adults with high ACE exposure may benefit from targeted screening and early intervention.
METHODS: We analyzed 20,450 CHARLS participants (2014 baseline). After excluding those with missing ACEs data (n = 11,006), incomplete sleep data, or aged <45 years and with psychiatric conditions, the final sample comprised 5,533 individuals. ACE exposure was categorized into: Class 1 (0 ACEs, n = 1,382), Class 2 (1 ACE, n = 1,769), Class 3 (2 ACEs, n = 1,264), and Class 4 (≥3 ACEs, n = 1,118). Composite sleep disturbances were defined by CES-D-10 self-reported sleep quality (4-point scale item ≥3) and abnormal duration (<6 or >9 hours). Multivariable logistic regression adjusted for age, sex, education, marital status, smoking, drinking, and chronic diseases, with trend tests modeling ACEs ordinally.
RESULTS: A graded association emerged: adjusted ORs increased from 1.30 (95% CI: 1.05-1.59) for 1 ACE to 2.1 (1.69-2.62) for ≥3 ACEs (Ptrend < 0.001). Five ACE types showed significant associations: household mental illness showed the strongest association (OR = 1.77, 1.53-32.06, P < 0.001). Subgroup analyses revealed consistent associations between ACE exposure (≥1) and increased risk of Chronic Sleep Disturbances across most population strata (OR range: 1.27-1.81, P < 0.05).
CONCLUSIONS: Childhood adversity, particularly household mental illness, was significantly associated with sleep disturbances in older adults. The observed 2.1-fold prevalence difference suggests that older adults with high ACE exposure may benefit from targeted screening and early intervention.