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

Emily Oken; Sheryl L Rifas-Shiman; Hadine Joffe; JoAnn E Manson; Primavera Alessandra Spagnolo; Suzanne M Bertisch; Elizabeth B Klerman; Jorge E Chavarro

doi:10.1016/j.sleh.2023.09.003

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

Sleep Health. 2023 Dec;9(6):860-867. doi: 10.1016/j.sleh.2023.09.003. Epub 2023 Nov 1.

Authors

Emily Oken¹, Sheryl L Rifas-Shiman², Hadine Joffe³, JoAnn E Manson⁴, Primavera Alessandra Spagnolo³, Suzanne M Bertisch⁵, Elizabeth B Klerman⁶, Jorge E Chavarro²

Affiliations

¹ 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. Electronic address: emily_oken@hphci.harvard.edu.
² Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA.
³ 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.
⁴ 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.
⁵ Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Division of Sleep Medicine, Harvard Medical School, Boston, MA, USA.
⁶ 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.

PMID: 37923668
PMCID: PMC10840935 (available on 2024-12-01)
DOI: 10.1016/j.sleh.2023.09.003

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.

Keywords: Abuse; Adverse childhood experiences; Hardship; Midlife; Sleep; Women’s health.

MeSH terms

Anxiety
Child
Child Abuse*
Female
Humans
Pregnancy
Sleep
Sleep Quality
Sleep Wake Disorders* / epidemiology

Abstract

MeSH terms

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