Poor Sleep Quality Contributes to Vascular Endothelial Dysfunction in Young Adults with Adverse Childhood Experiences
Authors: West Kylee S. , Schwager Laura E. , Diesel Sara , Carlson Alyssa , Fonkoue Ida T , Thomas Emily BK , Jenkins Nathaniel D.M. 
Published: May 2024

Introduction: Adverse childhood experiences (ACEs) represent severe psychosocial stressors during the first 18 years of life that promote a dose-dependent, lifetime increase in cardiovascular disease risk. ACEs have been associated with impaired vascular endothelial function and poor sleep quality in young adults. However, whether poor sleep quality influences the association between ACEs and vascular endothelial function is unclear. We hypothesized that sleep quality would mediate the association of ACE exposure with impaired vascular function. Purpose: To examine the contribution of sleep quality to ACEs-related impairments in vascular endothelial function in young adults. Methods: We used a cross-sectional cohort study (Study 1) and a single-arm intervention (Study 2) to test our hypothesis. Sleep quality was characterized as sleep effciency (SE%) and calculated as total sleep duration relative to time-in-bed. Vascular endothelial function was assessed using the brachial artery flow mediated dilation technique (FMD). In Study 1, we examined the mediation effect of SE% in the association of ACE exposure with FMD in a cohort of young adults (n=56; age = 25 ± 5 y, BMI = 26 ± 5 kg/m2) using the bootstrapped (1,000 replications) bias-corrected percentile confidence interval method adjusted for sex, and depression and anxiety symptomology. The variance accounted for (VAF) was calculated as the ratio of the indirect effect to total effect β-coeffcients. In Study 2, with a separate sample (n=12; age = 21 ± 2 y, BMI = 23 ± 4 kg/m2) of young adults with high ACE exposure (5 ± 2 ACEs) and poor sleep quality (SE ≤ 90%), we manipulated SE% using 6-weeks of cognitive-behavioral therapy for insomnia (CBTi) and measured FMD before (PRE) and after (POST) the intervention. Change in weekly SE% from daily consensus sleep diary entries was analyzed using a one-way ANOVA with Tukey post hoc comparisons. PRE to POST change in FMD was analyzed with a paired samples t-test. The association between the change (Δ; POST-PRE) in SE% and FMD was examined using a Spearman’s correlation coeffcient (ρ). Results: In Study 1, SE% significantly, partially mediated the association between ACE exposure and FMD (indirect effect standardized β-estimate = -0.11 [95% CI = -0.29 – -0.02]; VAF = 27.4%). In Study 2, there was a treatment effect of CBTi on SE% ( p < 0.001) where SE% improved from baseline to weeks 3, 4, 5, and 6 (weekly improvement range = 8.8 – 10.1%; all p ≤ 0.002). FMD increased PRE to POST (2.85 ± 0.58 to 3.65 ± 1.0 %/SR AUC·104; p = 0.017). There was a moderate, non-significant association between ΔSE% and ΔFMD (ρ = 0.46, p = 0.13). Conclusions: Our findings provide initial evidence that poor sleep quality may contribute to the previously described impairment in vascular endothelial dysfunction observed with increasing ACE exposure in young adults. Funding provided by a grant from the Injury Prevention Research Center through the CDC (R49 CE003095; NDMJ). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.