Perceived stress partially mediates the association between adverse childhood experiences and sleep quality in young adults

Abstract Introduction Growing evidence suggests that Adverse Childhood Experiences (ACEs) are associated with poor sleep in young adulthood. It has also been proposed that ACEs may cause stress sensitization, and perceived stress has been linked with poor sleep. We hypothesized that the relation between ACE exposure and poor sleep is mediated by perceived stress. Methods One-hundred and twenty-five (86% Female; mean±SD, age = 22±3 y) young adults between the ages of 18 and 30 years completed the 10-item ACE questionnaire, the Perceived Stress Scale, and the Pittsburgh Sleep Quality Index to quantify ACE exposure, perceived stress (PS), and global sleep quality (GSQ), respectively. Zero-order correlations were used to examine relations among ACE exposure, PS, and GSQ. Multiple linear regression analyses were used to examine the effect of ACE exposure on PS and GSQ after adjustment for sex, age, Race, and Ethnicity. Mediation analysis was then performed using the Bootstrapped Bias-Corrected Percentile Confidence Interval method, and the variance accounted for (VAF) was calculated as the ratio of the indirect effect to total effect β-coefficients. Results ACEs were highly prevalent (69% with ≥1 ACE; 30% with ≥4 ACEs) and variable (range = 0 – 10 ACEs). ACE exposure was associated with greater PS (r=0.40; p< 0.0001) and worse GSQ (r=0.31; p< 0.0001). Higher PS was associated with worse GSQ (r=0.31; p=0.0005). After adjustment, ACE exposure remained a significant predictor of both GSQ (β=0.29; p=0.002) and PS (β=0.39; p< 0.0001). PS significantly, partially mediated the association between ACE exposure and GSQ (indirect effect standardized β-estimate = 0.035 [95% CI = 0.013 – 0.069]; VAF = 29%). Conclusion ACE exposure is associated with greater perceived stress and poorer sleep quality among young adults. Perceived stress partially mediated the association of ACE exposure with sleep quality. Studies confirming the directionality and causality of these associations (including longitudinal mediation), and subsequently whether stress reduction interventions can promote improvements in sleep among individuals with ACEs are needed. Support (if any) Research reported in this publication was supported in part by the NCATS of the NIH (UL1TR002537) and by the Injury Prevention Research Center through the CDC (R49 CE003095).