The social stratification of slumber: Disentangling the intersectional effects of heterogeneous adverse childhood experiences on sleep deprivation in US children and adolescents

Sleep constitutes a fundamental pillar of pediatric development. However, sleep deprivation has emerged as a “silent epidemic” among children and adolescents all over the world. This study investigates the associations between adverse childhood experiences (ACEs) and sleep deprivation, moving beyond traditional cumulative risk models to disentangle the heterogeneity of trauma patterns and their intersectional stratification. Utilizing pooled data from the National Survey of Children's Health (2020–2022) with a nationally representative sample of school-aged children and adolescents (N = 94,257), we employed Latent Class Analysis (LCA) to identify distinct ACE typologies and Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) to quantify sleep disparities across 138 intersectional strata defined by ACE patterns, race, gender, and developmental timing. LCA identified four distinct classes: Low Adversity, Family Disruption, Peer Victimization & Discrimination, and Pervasive Adversity. While all high-risk classes predicted elevated sleep deprivation, MAIHDA revealed profound structural stratification, with race/ethnicity emerging as the largest single contributor to between-strata variance, independently explaining 31.32% of the between-strata variance. We found significant “excess intersectional heterogeneity” indicating non-additive effects, most notably a “Double Jeopardy” effect for Black male adolescents in the Pervasive Adversity, whose predicted probability of sleep deprivation approached 80%, compared to less than 20% in low-risk groups. These findings underscore that sleep disparities are not merely byproducts of individual trauma but are systematically patterned by racialized and gendered structures, suggesting that addressing the pediatric sleep epidemic requires moving beyond aggregate risk scores toward targeted interventions that address the specific “intersectional locations” of vulnerable children.