Mediation Effects of Sleep Efficiency and Total Sleep Time of PSG and Apathy in Cognitively Unimpaired Older Adults With Childhood Trauma: A Community-Based Study

Background: Childhood trauma is linked to sleep quality and mental health in adults. However, there is limited research exploring their connections in older adults. We aimed to investigate whether childhood trauma leads to a higher occurrence of adverse sleep patterns and mental problems and whether sleep mediates these effects. Methods: This cross-sectional study included participants aged ≧ 60 in Taiwan from September 2019 to October 2020. Individuals with dementia, major depressive disorder, or significant organ system abnormalities were excluded. Sleep patterns were evaluated using the Pittsburgh Sleep Quality Index and polysomnography. The participants completed the Childhood Trauma Questionnaire (CTQ) and underwent comprehensive assessments of apathy, cognitive function and mood symptoms. Results: In the study of 89 participants (average age 73.35 years; 56.1% women), higher CTQ scores correlated with longer sleep latency, reduced sleep efficiency as measured by polysomnography. It was also associated with increased severity of apathy, aberrant cognitive function and mood symptoms, even after adjusting for age and gender. Moreover, sleep efficiency mediated the relationship between childhood trauma and apathy, while apathy fully mediated the link between childhood trauma and both sleep efficiency and total sleep time. Conclusions: These novel findings showed that sleep efficiency mediated the effect of childhood trauma on apathy in older adults, and apathy fully mediates childhood trauma on sleep efficiency and total sleep time bidirectionally. Furthermore, our results revealed an association between childhood trauma and apathy, cognitive function and mood symptoms, emphasizing the importance of sleep quality by addressing apathy in older adults who had experienced childhood trauma.