The impact of adverse childhood experiences (ACEs) on sleep adequacy for children with special health care needs (CSHCN) in the United States

Background: Adverse childhood experiences (ACEs), are associated with poor mental and physical health, risky behaviors, chronic diseases in adulthood, and premature death. ACEs are also associated with poor sleep among children and adults. It is not clear if this association is true for children with special health care needs (CSHCN).

Objective: To explore the impact of ACEs on sleep duration among CSHCN, adjusting for demographic, family, and health characteristics.

Methods: This study used a subsample of 17,049 CSHCN from the 2019-2020 National Survey of Children's Health between 4 months and 17 years. Multivariable logistic regression was used to examine if the number of ACEs experienced by a child is associated with a child sleeping the recommended number of hours for their age while controlling for demographic, family, and health characteristics. There was no sign of multicollinearity among the variables of interest.

Results: CSHCN without adequate sleep had a higher prevalence of ACEs. When adjusting for demographic characteristics, children with 1 ACE (aOR: 0.81, 95% CI: 0.69-0.96) or at least 2 ACEs (aOR: 0.60, 95% CI: 0.51-0.71) were less likely to sleep the adequate number of hours. That association was no longer significant when adjusting for family characteristics or BMI. Other significant predictors in the adjusted models include race, poverty level, the highest level of education in households, and caregiver mental health.

Conclusion: Results demonstrate an inverse relationship between the number of ACEs and the odds of sleep adequacy for CSHCN and highlight racial and economic disparities in sleep adequacy.