title: Adverse childhood experiences and sleep disturbances in adults.
abstract: BACKGROUND
  Sleep disturbances are associated with an increased risk for many chronic diseases and unhealthy behaviors. A history of adverse childhood experiences (ACEs) is also associated with similar adult health outcomes. We studied the relationship between multiple ACEs and the likelihood of experiencing self-reported sleep disturbances in adulthood.
  
  
  METHODS
  We used data from the adverse childhood experiences (ACE) study, a retrospective cohort study of 17,337 adult health maintenance organization members in California who completed a survey about eight ACEs, which included childhood abuse and growing up with various forms of household dysfunction. The self-reported sleep disturbances measured included ever having trouble falling or staying asleep and feeling tired after a good night's sleep. We used an integer count of the number of ACEs (the ACE score) to assess the cumulative impact of these experiences on the likelihood of self-reported sleep disturbances.
  
  
  RESULTS
  Thirty-three percent of the cohort reported trouble falling or staying asleep, while 24% reported feeling tired after sleeping. All eight ACE categories were associated with an increased likelihood of self-reported sleep disturbances (p<0.05). Compared to persons with an ACE score of 0, those with an ACE score ≥ 5 were 2.1 (95% CI: 1.8-2.4) times more likely to report trouble falling or staying asleep and 2.0 (95% CI: 1.7-2.3) times more likely to report feeling tired even after a good night's sleep. The trend for increasing odds for both types of self-reported sleep disturbance with increasing ACE scores was statistically significant (p<0.0001).
  
  
  CONCLUSIONS
  Adverse childhood experiences were associated with self-reported sleep disturbances in adulthood, and the ACE score had a graded relationship to these sleep disturbances. A history of ACEs should be obtained for patients with self-reported sleep disturbances to coordinate services that ameliorate the long-term effects of these events.
authors.affiliation: Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, United States. DChapman@cdc.gov
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Chapman
authors.forename: Anne G
authors.initials: AG
authors.lastname: Wheaton
authors.forename: Robert F
authors.initials: RF
authors.lastname: Anda
authors.forename: Janet B
authors.initials: JB
authors.lastname: Croft
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Edwards
authors.forename: Yong
authors.initials: Y
authors.lastname: Liu
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Sturgis
authors.forename: Geraldine S
authors.initials: GS
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002650:Child Abuse, Sexual / Q000706:statistics & numerical data*; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology*; D055815:Young Adult