This investigation indicates that ACEs experienced before age 18 are positively associated with frequent insufficient sleep in adult community dwellers. As previously noted, these results are similar to those from prior research examining the association between ACEs and two forms of disturbed sleep in a managed care patient population
. The current findings thus extend this association of ACEs with sleep impairment to specifically include frequent insufficient sleep within the domain of a population-based sample.
Although associations between childhood sexual abuse and sleep disturbance have been previously reported
[22–24], this research has largely been restricted to investigations featuring relatively brief follow-up intervals
, or only gauging childhood sexual abuse
[22–24]. However, related investigation has found both childhood sexual abuse and childhood physical abuse to be positively associated with difficulties falling asleep, staying asleep, or early awakening among a cohort of individuals with a median age of 47 years
. This finding is consistent with the results of previous research revealing these forms of childhood abuse were associated with sleep disturbance decades after their occurrence
In an investigation assessing the frequency of self-reported childhood physical, emotional, and sexual abuse, Greenfield, Lee, Friedman, and Springer
 analyzed data from 835 respondents in the National Survey of Midlife Development in the United States. Specifically, these investigators examined the association of these three forms of abuse with global sleep pathology, as measured by the Pittsburgh Sleep Quality Inventory, as well as with a variety of specific sleep characteristics, such as subjective sleep quality, sleep duration, and habitual sleep efficiency in adulthood. Consistent with the results of the present investigation, that study reported that all three types of childhood abuse examined were associated with global sleep pathology, as well as with specific sleep problems
. Additionally, related investigation has revealed that childhood adversities such as parental divorce, long-term financial difficulties, and frequent fear of a family member were associated with poor self-reported sleep quality in adulthood
Notably, the results of our investigation are similar to those obtained among a clinical sample. Bader, Shafer, Schenkel, Nissen, and Schwander
 examined the association of ACEs with actigraphic and polysomnographic sleep parameters. These investigators found that patients who reported moderate to severe ACEs exhibited a significantly greater number of both awakenings and movement arousals relative to patients reporting few or no ACEs.
The present study further addressed the effects of smoking and FMD on the associations between ACEs and frequent insufficient sleep. These relationships were slightly attenuated by smoking status and moderately attenuated by FMD. Our study findings are consistent with the results of research indicating that smoking is significantly associated with insufficient sleep
[13, 15, 29]. Further, smoking is associated with short and long sleep durations, both of which have been linked to risk for excess mortality
The attenuation of the association between ACEs and frequent insufficient sleep by FMD is consistent with psychiatric nomenclature featuring sleep disturbance as a criterion for the diagnosis of depression
. Early detection of and intervention regarding ACEs thus appear particularly warranted as insomnia symptoms
 and sleep disturbance
 have been reported to persist even after depression has improved or remitted. Notably, childhood abuse has also been associated with posttraumatic stress disorder (PTSD) symptoms
, with recent evidence suggesting that the nightmares and insomnia characteristic of PTSD may compromise the consolidation of fear extinction memory and, ultimately, recovery
. This further suggests the potentially lasting impact of ACEs, although PTSD was not assessed in this investigation.
This investigation is subject to several limitations. First, our data on both sleep and ACEs were obtained by self-report, with the former assessed by a single item not corroborated by actigraphy, polysomnography, or medical records, Specifically, relative to data garnered by objective measures, sleep difficulties are frequently overreported
. However, previous research examining potential biases in the elicitation of ACEs concluded that retrospective self-reports of childhood abuse or neglect are apt to be conservative
, thereby biasing the results towards the null. Second, our results are cross-sectional thereby prohibiting any inference of causality. Moreover, the presence of ACEs might also increase the risk of adverse events after age 18 years, which this data set does not permit assessment of. Additonally, given that the definition of FMD describes behavioral characteristics not inconsistent with those associated with ACEs, the association between these phenomena could be circuitous. This study was also limited to participants with landline telephones. Subsequent research has indicated that, relative to adults with landlines, adults with only cell phones are more likely to be binge drinkers and current smokers, to engage in regular physical activity and to have an unmet medical care need due to cost, and to be less likely to be use preventive healthcare services, and to be obese
. Finally, the generalizability of our findings may be limited, as data were collected from five states.