{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:32:33Z","timestamp":1753893153964,"version":"3.41.2"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T00:00:00Z","timestamp":1704672000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["NR-017435"],"award-info":[{"award-number":["NR-017435"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["HL135562"],"award-info":[{"award-number":["HL135562"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014900","name":"Sleep Research Society Foundation","doi-asserted-by":"publisher","award":["04-SRG-21"],"award-info":[{"award-number":["04-SRG-21"]}],"id":[{"id":"10.13039\/100014900","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["RCS20-191"],"award-info":[{"award-number":["RCS20-191"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sleep"],"abstract":"<jats:sec><jats:title>Study objectives<\/jats:title><jats:p>Women who experienced childhood sexual abuse have higher rates of obesity, a risk factor for obstructive sleep apnea (OSA). We assessed if prior childhood sexual abuse was more common in women with OSA vs. those in the control group, with possible mediation by obesity.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a secondary analysis of a larger project, we studied 21 women with OSA (age mean \u00b1 <jats:italic>SD<\/jats:italic> 59 \u00b1 12 years, body mass index [BMI] 33 \u00b1 8 kg\/m<jats:sup>2<\/jats:sup>, respiratory event index [REI] 25 \u00b1 16 events\/hour, and Epworth Sleepiness Scale [ESS] score 8 \u00b1 5) and 21 women without OSA (age 53 \u00b1 9 years, BMI 25 \u00b1 5 kg\/m<jats:sup>2<\/jats:sup>, REI [in 7\/21 women] 1 \u00b1 1 events\/hour, and ESS score, 5 \u00b1 3). We evaluated four categories of trauma (general, physical, emotional, and sexual abuse) with the Early Trauma Inventory Self-Report\u2013Short Form (ETISR-SF). We assessed group differences in trauma scores with independent samples <jats:italic>t<\/jats:italic>-tests and multiple regressions. Parametric Sobel tests were used to model BMI as a mediator for individual trauma scores predicting OSA in women.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Early childhood sexual abuse reported on the ETISR-SF was 2.4 times more common in women with vs. without OSA (<jats:italic>p<\/jats:italic> = 0.02 for group difference). Other trauma scores were not significantly different between women with and without OSA. However, BMI was a significant mediator (<jats:italic>p<\/jats:italic> = 0.02) in predicting OSA in women who experienced childhood physical abuse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Childhood sexual abuse was more common in women with vs. without OSA. BMI was a mediator for OSA of childhood physical but not sexual abuse. This preliminary hypothesis-generating study suggests that there may be physiological impacts of childhood trauma in women that predispose them to OSA.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frsle.2023.1281425","type":"journal-article","created":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T05:42:20Z","timestamp":1704692540000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A first look at childhood abuse in women with obstructive sleep apnea"],"prefix":"10.3389","volume":"2","author":[{"given":"Amrita","family":"Pal","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"Martinez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer","family":"Wagman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ravi S.","family":"Aysola","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ari","family":"Shechter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Mysliwiec","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jennifer L.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul M.","family":"Macey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,1,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"26","DOI":"10.5664\/jcsm.27075","article-title":"Validation of a self-applied unattended monitor for sleep disordered breathing","volume":"4","author":"Ayappa","year":"2008","journal-title":"J. Clin. Sleep Med."},{"key":"B2","doi-asserted-by":"publisher","first-page":"A186","DOI":"10.1093\/sleep\/zsz067.462","article-title":"0463 Validation of a home sleep apnea testing device for the diagnosis of sleep disordered breathing based on AASM 2012 guidelines","volume":"42","author":"Berry","year":"2019","journal-title":"Sleep."},{"key":"B3","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1097\/01.nmd.0000243824.84651.6c","article-title":"Psychometric properties of the early trauma inventory-self report","volume":"195","author":"Bremner","year":"2007","journal-title":"J. Nerv. Ment. Dis."},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s11325-018-1628-4","article-title":"Comorbid insomnia and sleep apnea: a prevalent but overlooked disorder","volume":"22","author":"Brock","year":"2018","journal-title":"Sleep Breath."},{"key":"B5","doi-asserted-by":"publisher","first-page":"2203","DOI":"10.2147\/NSS.S343721","article-title":"High-fat diet-induced mitochondrial dysfunction promotes genioglossus injury - a potential mechanism for obstructive sleep apnea with obesity","volume":"13","author":"Chen","year":"2021","journal-title":"Nat. Sci. Sleep."},{"key":"B6","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1136\/thoraxjnl-2014-205361","article-title":"Effects of CPAP on body weight in patients with obstructive sleep apnoea: a meta-analysis of randomised trials","volume":"70","author":"Drager","year":"2015","journal-title":"Thorax."},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1201\/9780429246593","author":"Efron","year":"1994","journal-title":"An Introduction to the Bootstrap"},{"key":"B8","doi-asserted-by":"publisher","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods."},{"key":"B9","doi-asserted-by":"publisher","first-page":"732","DOI":"10.1097\/00007611-199307000-00002","article-title":"Childhood sexual abuse, depression, and family dysfunction in adult obese patients: a case control study","volume":"86","author":"Felitti","year":"1993","journal-title":"South Med. J."},{"key":"B10","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1111\/j.1467-9280.2007.01882.x","article-title":"Required sample size to detect the mediated effect","volume":"18","author":"Fritz","year":"2007","journal-title":"Psychol. Sci."},{"key":"B11","doi-asserted-by":"publisher","first-page":"3879","DOI":"10.1111\/ejn.14727","article-title":"Midbrain control of breathing and blood pressure: the role of periaqueductal gray matter and mesencephalic collicular neuronal microcircuit oscillators","volume":"52","author":"George Zaki Ghali","year":"2020","journal-title":"Eur. J. Neurosci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.smrv.2010.11.004","article-title":"Functional somatic syndromes, anxiety disorders and the upper airway: a matter of paradigms","volume":"15","author":"Gold","year":"2011","journal-title":"Sleep Med. Rev."},{"key":"B13","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.chiabu.2015.08.005","article-title":"Exposure to violence in childhood is associated with higher body mass index in adolescence","volume":"50","author":"Gooding","year":"2015","journal-title":"Child Abuse Negl."},{"key":"B14","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s12160-011-9285-x","article-title":"Childhood abuse as a risk factor for sleep problems in adulthood: evidence from a US national study","volume":"42","author":"Greenfield","year":"2011","journal-title":"Ann. Behav. Med."},{"key":"B15","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1080\/08039488.2018.1498127","article-title":"Early trauma inventory self-report short form (ETISR-SF): validation of the Swedish translation in clinical and non-clinical samples","volume":"73","author":"H\u00f6rberg","year":"2019","journal-title":"Nord. J. Psychiatry."},{"key":"B16","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1513\/AnnalsATS.201407-299FR","article-title":"Sleep-disordered breathing in patients with post-traumatic stress disorder","volume":"12","author":"Jaoude","year":"2014","journal-title":"Ann. Am. Thorac. Soc."},{"key":"B17","doi-asserted-by":"publisher","first-page":"00019","DOI":"10.15406\/smdij.2017.01.00019","article-title":"Obstructive sleep apnea and obesity: implications for public health","volume":"1","author":"Jehan","year":"2017","journal-title":"Sleep Med. Disord."},{"key":"B18","doi-asserted-by":"publisher","first-page":"256","DOI":"10.5664\/jcsm.27823","article-title":"Increased neck soft tissue mass and worsening of obstructive sleep apnea after growth hormone treatment in men with abdominal obesity","volume":"6","author":"Karimi","year":"2010","journal-title":"J. Clin. Sleep. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/S0010-440X(00)90131-7","article-title":"Sleep breathing and sleep movement disorders masquerading as insomnia in sexual-assault survivors","volume":"41","author":"Krakow","year":"2000","journal-title":"Compr. Psychiatry."},{"key":"B20","doi-asserted-by":"publisher","first-page":"647","DOI":"10.1023\/A:1013029819358","article-title":"The relationship of sleep quality and posttraumatic stress to potential sleep disorders in sexual assault survivors with nightmares, insomnia, and PTSD","volume":"14","author":"Krakow","year":"","journal-title":"J. Trauma Stress."},{"key":"B21","doi-asserted-by":"publisher","first-page":"442","DOI":"10.1097\/00005053-200207000-00004","article-title":"Sleep-disordered breathing, psychiatric distress, and quality of life impairment in sexual assault survivors","volume":"190","author":"Krakow","year":"2002","journal-title":"J. Nerv. Ment Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1016\/S0006-3223(00)01087-8","article-title":"Complex insomnia: insomnia and sleep-disordered breathing in a consecutive series of crime victims with nightmares and PTSD","volume":"49","author":"Krakow","year":"","journal-title":"Biol. Psychiatry."},{"key":"B23","doi-asserted-by":"publisher","first-page":"814","DOI":"10.1016\/j.sleep.2013.02.015","article-title":"two-year prospective study on the frequency and co-occurrence of insomnia and sleep-disordered breathing symptoms in a primary care population","volume":"14","author":"Krakow","year":"2013","journal-title":"Sleep Med."},{"key":"B24","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/j.smrv.2014.11.001","article-title":"Posttraumatic stress disorder and sleep-disordered breathing: a review of comorbidity research","volume":"24","author":"Krakow","year":"2015","journal-title":"Sleep Med. Rev."},{"key":"B25","doi-asserted-by":"publisher","first-page":"317","DOI":"10.7326\/0003-4819-146-5-200703060-00004","article-title":"Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection","volume":"146","author":"Kroenke","year":"2007","journal-title":"Ann. Intern. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1177\/2470289718787107","article-title":"The persistent gender bias in the diagnosis of obstructive sleep apnea: a commentary","volume":"2","author":"Lastra","year":"2018","journal-title":"Gender Genome."},{"key":"B27","doi-asserted-by":"publisher","first-page":"198","DOI":"10.1037\/tra0000080","article-title":"An epidemiologic study of childhood sexual abuse and adult sleep disturbances","volume":"8","author":"Lind","year":"2016","journal-title":"Psychol. Trauma."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1545","DOI":"10.1111\/jsm.12908","article-title":"Changes in autonomic nervous system activity are associated with changes in sexual function in women with a history of childhood sexual abuse","volume":"12","author":"Lorenz","year":"2015","journal-title":"J. Sex Med."},{"journal-title":"OSA and Childhood Trauma, 6th Edn","year":"2023","author":"Macey","key":"B29"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsz108","article-title":"Traumatic childhood experiences and multiple dimensions of poor sleep among adult women","author":"McWhorter","year":"2019","journal-title":"Sleep"},{"key":"B31","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1097\/PSY.0b013e3181cb5c24","article-title":"Childhood abuse is associated with adiposity in midlife women: possible pathways through trait anger and reproductive hormones","volume":"72","author":"Midei","year":"2010","journal-title":"Psychosom. Med."},{"key":"B32","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.1186\/s12889-018-6044-y","article-title":"Establishing the international prevalence of self-reported child maltreatment: a systematic review by maltreatment type and gender","volume":"18","author":"Moody","year":"2018","journal-title":"BMC Public Health."},{"key":"B33","doi-asserted-by":"publisher","first-page":"e61","DOI":"10.1542\/peds.2006-3058","article-title":"Obesity risk for female victims of childhood sexual abuse: a prospective study","volume":"120","author":"Noll","year":"2007","journal-title":"Pediatrics."},{"key":"B34","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1016\/j.jsmc.2013.04.004","article-title":"Insomnia and obstructive sleep apnea","volume":"8","author":"Ong","year":"2013","journal-title":"Sleep Med. Clin."},{"key":"B35","doi-asserted-by":"publisher","first-page":"A169","DOI":"10.1093\/sleep\/zsab072.427","article-title":"428 Baroreflex sensitivity during handgrip in obstructive sleep apnea with and without CPAP","volume":"44","author":"Pal","year":"","journal-title":"Sleep."},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1093\/sleep\/zsaa124","article-title":"Functional organization of the insula in men and women with obstructive sleep apnea during Valsalva","author":"Pal","year":"","journal-title":"Sleep"},{"key":"B37","doi-asserted-by":"publisher","first-page":"989","DOI":"10.5665\/sleep.5738","article-title":"Aberrant insular functional network integrity in patients with obstructive sleep apnea","volume":"39","author":"Park","year":"2016","journal-title":"Sleep."},{"key":"B38","doi-asserted-by":"publisher","first-page":"575","DOI":"10.1016\/j.mehy.2003.12.005","article-title":"Cortisol abnormality as a cause of elevated estrogen and immune destabilization: insights for human medicine from a veterinary perspective","volume":"62","author":"Plechner","year":"2004","journal-title":"Med. Hypoth."},{"key":"B39","doi-asserted-by":"publisher","first-page":"A4167","DOI":"10.1183\/13993003.congress-2019.PA4167","article-title":"Weight changes after initiation of CPAP in sleep apnea patients","volume":"54","author":"Pociene","year":"2019","journal-title":"Eur. Respir. J."},{"key":"B40","doi-asserted-by":"publisher","first-page":"879","DOI":"10.3758\/BRM.40.3.879","article-title":"Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav. Res. Methods."},{"key":"B41","doi-asserted-by":"publisher","first-page":"205","DOI":"10.5664\/jcsm.27181","article-title":"Does CPAP lead to change in BMI?","volume":"4","author":"Redenius","year":"2008","journal-title":"J. Clin. Sleep Med."},{"key":"B42","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1111\/j.2047-6310.2013.00196.x","article-title":"The association between childhood sexual and physical abuse with incident adult severe obesity across 13 years of the national longitudinal study of adolescent health","volume":"9","author":"Richardson","year":"2014","journal-title":"Pediatr. Obes."},{"key":"B43","doi-asserted-by":"publisher","first-page":"920","DOI":"10.1161\/CIRCULATIONAHA.111.076877","article-title":"Physical and sexual abuse in childhood as predictors of early-onset cardiovascular events in women","volume":"126","author":"Rich-Edwards","year":"2012","journal-title":"Circulation."},{"key":"B44","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1513\/pats.200708-137MG","article-title":"Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches","volume":"5","author":"Schwartz","year":"2008","journal-title":"Proc. Am. Thorac. Soc."},{"key":"B45","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1089\/jwh.2009.1763","article-title":"Sexual abuse, sexual orientation, and obesity in women","volume":"19","author":"Smith","year":"2010","journal-title":"J. Women's Health"},{"key":"B46","doi-asserted-by":"publisher","first-page":"340","DOI":"10.1111\/j.1467-789X.2008.00478.x","article-title":"Obesity and obstructive sleep apnea-hypopnea syndrome","volume":"9","author":"Sousa","year":"2008","journal-title":"Obes Rev."},{"key":"B47","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"Brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"JAMA Intern. Med."},{"key":"B48","doi-asserted-by":"publisher","first-page":"228","DOI":"10.1038\/ijir.2012.20","article-title":"Sexual function in pre- and post-menopausal women with obstructive sleep apnea syndrome","volume":"24","author":"Stavaras","year":"2012","journal-title":"Int. J. Impot. Res."},{"key":"B49","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1016\/j.smrv.2011.01.006","article-title":"Sleep disturbances in sexual abuse victims: a systematic review","volume":"16","author":"Steine","year":"2012","journal-title":"Sleep Med. Rev."},{"key":"B50","doi-asserted-by":"publisher","first-page":"371","DOI":"10.3390\/brainsci9120371","article-title":"Co-morbid insomnia and sleep apnea (COMISA): prevalence, consequences, methodological considerations, and recent randomized controlled trials","volume":"9","author":"Sweetman","year":"2019","journal-title":"Brain Sci."},{"key":"B51","doi-asserted-by":"publisher","first-page":"e010440","DOI":"10.1161\/JAHA.118.010440","article-title":"Obstructive sleep apnea in cardiovascular disease: a review of the literature and proposed multidisciplinary clinical management strategy","volume":"8","author":"Tietjens","year":"2019","journal-title":"J. Am. Heart Assoc."},{"key":"B52","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.smrv.2012.08.002","article-title":"Obesity and obstructive sleep apnea\u2013clinical significance of weight loss","volume":"17","author":"Tuomilehto","year":"2013","journal-title":"Sleep Med. Rev."},{"key":"B53","doi-asserted-by":"publisher","first-page":"12631","DOI":"10.1038\/s41598-021-91996-5","article-title":"Stress in obstructive sleep apnea","volume":"11","author":"Wong","year":"2021","journal-title":"Sci. Rep."},{"key":"B54","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1007\/s11930-014-0034-6","article-title":"Sexual issues in treating trauma survivors","volume":"7","author":"Zoldbrod","year":"2015","journal-title":"Curr. Sex. Health Rep."}],"container-title":["Frontiers in Sleep"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2023.1281425\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,8]],"date-time":"2024-01-08T05:42:25Z","timestamp":1704692545000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2023.1281425\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,1,8]]},"references-count":54,"alternative-id":["10.3389\/frsle.2023.1281425"],"URL":"https:\/\/doi.org\/10.3389\/frsle.2023.1281425","relation":{},"ISSN":["2813-2890"],"issn-type":[{"type":"electronic","value":"2813-2890"}],"subject":[],"published":{"date-parts":[[2024,1,8]]},"article-number":"1281425"}}