Sleep it off? Exploring sleep duration and bedtime regularity as potential moderators of early adversity’s impact on mental health in infancy, childhood and adolescence

Abstract Introduction: Adverse Childhood Experiences (ACEs) are known to increase the risk of mental health challenges, and sleep is known to decrease risk. We investigated whether adequate sleep duration and sleep regularity would moderate the impact of ACE exposure on mental health risk. Methods: We conducted secondary cross-sectional analyses on the 2020–2021 waves of the National Survey of Children’s Health (NSCH; N = 92,669). Logistic and ordinal regressions explored the impact of ACEs (total, household, community and single) and sleep (duration and irregularity) and related interactions on mental health diagnosis and symptom severity. Results: Known main effects of ACEs and sleep on mental health were replicated. Interactions between ACE exposure and sleep factors were not clinically significant, although some were statistically significant due to the large sample, such that adequate duration was associated with marginally increased risk of mental health diagnosis (Omnibus B = 0.048, p < 0.0001) and greater bedtime irregularity was associated with marginally decreased risk (Omnibus B = –0.030, p < 0.001). Discussion: Dichotomous and categorical assessments of sleep health may not be sensitive to interaction effects, compared with continuous data. Examining mental health symptoms (rather than diagnosis status) may also allow for a nuanced understanding of potential interactions.