The Lasting Effects of Adverse Childhood Experiences on Sleep Health Among Latinx Adults Living in the US

Background and Purpose: Adverse childhood experiences (ACEs) has been consistently associated with poor mental and physical health across the life course. Examples of these experiences include physical, emotional, or sexual abuse, parental incarceration, substance abuse in the household, among others. Although Latinx individuals are at an increased risk of experiencing ACEs (e.g., parental incarceration) and their risk factors (e.g., poverty) than their non-Latinx White counterparts, they remain underrepresented in ACEs research. Recently, ACEs have been positively associated with poor sleep in adulthood. Because poor sleep increases the risk of depression, anxiety, and cardiovascular diseases, which already affect a large percentage of Latinx adults in the US, examining ACEs as risk factors for poor sleep in this population is warranted. This study examines the association between ACEs and poor sleep among a US-based community sample of Latinx adults. Additionally, social support reduces the negative impact of ACEs on health in adulthood, therefore, we tested its moderating effects in this relationship.

Methods: Using survey data from the Hispanic Community Health Study/Study of Latinos (n=881), we conducted weighted linear unadjusted and adjusted regression analyses to test the association between ACEs and two sleep dimensions: insomnia symptoms and sleep duration. We also conducted moderation analysis to examine the effects of social support on this association using cross products. Validated scales were used to assess ACEs (CDC 10-item questionnaire) and insomnia symptoms (Insomnia Severity Index (ISI)). The self-reported number of hours participants usually sleep determined sleep duration. Social support was assessed with the Interpersonal Support Evaluation List. Models were progressively adjusted for sociodemographic factors. A final adjustment for depressive symptoms (CESD-10 scores), was made.

Results: Participants had Mage=41.47 years (SD=12.89). About half of participants identified as men (52.02%), were married or living with a partner (48.50%), and were unemployed (52.12%). Most participants were immigrants (64.82%) and preferred to speak in Spanish (72.31%). Participants’ average depressive symptoms score was 6.97 (SD=5.44). The average ACE score was 2.45 (SD=2.31). Participants reporter a mean ISI of 6.93 (SD=6.17). Average sleep duration was 8.02 hours (SD=1.34). A unit increase in ACEs was associated with a 0.08 unit increase in ISI (b=0.08, SE=0.02, p=0.001) in adjusted models. This relationship was not statistically significant when adjusting for depressive symptoms. ACEs were not statistically significantly associated with sleep duration. Social support was a statistically significant moderator in unadjusted models (b=-0.08, SE=0.003, p<0.01) with ACEs being only statistically significantly associated with increased ISI among those reporting low social support. These moderating effects were not statistically significant in adjusted models.

Conclusion and Implications: Increased ACEs were associated with worsening insomnia symptoms among Latinx adults. Future studies should replicate this study with objectively measured sleep outcomes and examine mechanisms driving this association, such as increased sleep reactivity. If replicated, Latinx adults who report exposure to childhood adversity should be evaluated for insomnia symptoms and referred to treatment. Additionally, psychological treatments for insomnia should address ACEs and seek to bolster social support among Latinx adults.