Associations of adverse childhood experiences and sleep in adulthood and older age: A nationwide cohort study.

BACKGROUND Longitudinal evidence on the association between adverse childhood experiences (ACEs) and sleep in Chinese middle-aged and older adults is limited.

METHOD Data were derived from five waves (2011-2020) of China Health and Retirement Longitudinal Study (CHARLS), comprising 12363 participants aged ≥45 years at baseline. ACEs occurring before age 18 were retrospectively assessed, while sleep duration and quality were measured across five waves over 9-year follow-up. Latent class analysis (LCA) identified clustering patterns of ACEs. Group-Based Multivariate Trajectory Modeling (GBMT) identified sleep trajectory patterns. Multivariable-adjusted models, including Cox regression, linear mixed-effects, and ordinal logistic regression were used to estimate the associations between ACEs and sleep outcomes. Restricted cubic spline (RCS) regression was used to assess potential nonlinear associations.

RESULT 12,363 participants were included (mean age: 58.0 ± 8.96 years; 47.43 % male). LCA identified ACEs exposure patterns. Each additional ACE was associated with higher risk of incident inadequate sleep (HR= 1.08, 95 %Cl: 1.06-1.10) and sleep disturbance (HR= 1.10, 95 %Cl: 1.08-1.12) over the 9-year follow-up. ACE was associated with poorer sleep quality (OR = 1.18, 95 %Cl: 1.16-1.20) and shorter sleep duration (β=-0.11, 95 %Cl: -0.13 to -0.09). Among five sleep trajectories identified by GBMT, ≥4 ACEs were more likely to belong to "Severely Restless Short Sleep" (OR= 2.23, 95 %Cl: 1.69-2.96). RCS supported a linear dose-response relationship between ACEs and adverse sleep outcomes. Certain ACEs clusters showed stronger links with adverse sleep.

CONCLUSION ACEs are associated with shorter sleep duration and poorer sleep quality in middle-aged and older adults. The associations varied across ACEs exposure patterns. Assessing ACE history may guide insomnia management in later life, whereas early-life prevention of adverse experiences could protect long-term sleep health.