Porcelain Publishing / HNP / Volume 2 / Issue 2 / DOI: 10.47297/ppihnp2026020203
ARTICLE

Association Between Adverse Childhood Experiences and Sleep Quality Among Chinese Adults: A Cross-Sectional Study

Shuang Zang1# Kunshuo Du1# Jiayi Xu1 Yuqi Yang2* Aiping Wang1*
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1 School of Nursing Medical University, Shenyang 110122, Liaoning, China
2 School of Nursing, Henan University of Science and Technology, Luoyang 471003, Henan, China

# These authors share the first authorship on this work.

Published: 28 July 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/)
Abstract

Adverse childhood experiences (ACEs) are cognized to have long-term association with on health, including sleep quality. However, the association of ACEs with sleep quality in Chinese adults remains understudied. In 2023, a cross-sectional survey was performed on participants in China, which included 29916 individuals. The association of ACEs with sleep quality was analyzed using generalized linear models, adjusting for potential confounders. In addition, subgroup analysis and interaction tests were used to examine possible interactions between ACEs and sleep quality. Subsequently, E-value analysis suggested unmeasured confounding. In this study, individuals with a history of ACEs exhibited a significantly higher prevalence of poor sleep quality. Compared with participants without ACE exposure, those reporting one ACE had a 0.27-point higher BPSQI score, whereas those reporting two or more ACEs had a 0.55-point higher score, indicating poorer sleep quality. Subgroup analyses revealed stronger associations among individuals with no spouse, a history of smoking, higher household income, higher education levels, and those with chronic diseases. The findings of our study highlight a significant association of ACEs with sleep quality in Chinese adults. Strategies for prevention and intervention targeting individuals with a history of ACEs may help mitigate sleep-related problems and improve overall health outcomes.

Keywords
Adverse childhood experiences
Childhood adversity
Pittsburgh sleep quality index
China
Adults
Funding
Social Science Foundation Project of Liaoning Province (No. L20BGL059)
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