E‐cigarette use and sleep‐related complaints among youth

Abstract

Introduction: E-cigarette use is highly prevalent among adolescents. However, little research has examined the relationship between e-cigarette use and sleep-related complaints in this population. The objective of this study was to assess whether exclusive e-cigarette, exclusive combusted cigarette, and dual-product use are associated with sleep-related complaints among adolescents. Methods: Participants were 9,588 U.S. adolescents from the Population Assessment of Tobacco and Health Study, a nationally representative cohort, followed from 2013 through 2015. Using logistic regression, we examined the cross-sectional association between past-year e-cigarette, combusted cigarette, or dual-product use and past-year sleep-related complaints (bad dreams, sleeping restlessly, or falling asleep during the day), both measured at Wave 2. We controlled for Wave 1 demographic characteristics, emotional and behavioral health, and prior history of ecigarette use, combusted cigarette use, and sleep-related complaints. Results: In unadjusted analyses, e-cigarette, combusted cigarette, and dual-product use were significantly associated with greater odds of sleep-related complaints, compared to use of neither product (e-cigarettes: OR = 1.61, 95% CI 1.34-1.94; combusted cigarettes: OR = 1.62, 95% CI 1.26-2.09; dual-product use: OR = 2.00, 95% CI 1. 63-2.46). Associations between e-cigarette and dual-product use and sleep-related complaints remained significant in fully adjusted analyses (e-cigarettes: aOR = 1.29, 95% CI 1.05-1.59; dual-product use: aOR = 1.57, 95% CI 1.24-1.99), whereas associations with combusted cigarette use were significant in all models except the fully adjusted model (aOR = 1.30, 95% CI 0.98-1.71).Conclusions: E-cigarette and dual-product use are significantly associated with greater odds of reporting sleep-related complaints among adolescents. Future research should evaluate whether this association may be causal.

Main and Interactive Effects of Nicotine Product Type on Sleep Health Among Dual Combustible and E‐Cigarette Users

“…Specifically, we observed a significant interaction between e‐cigarette and combustible cigarette frequency in predicting global sleep quality, such that high CPD was associated with worse global sleep quality scores, whereas high e‐cigarette use was not. This finding echoes previous research reporting that dual users were most at‐risk for worse overall sleep quality, 29,30 but high use of different cigarette types appears to have differential effects.…”

“…A key assumption is that nicotine disrupts the sleep/wake cycle through its stimulating properties; thus, there is a need to understand the nuanced association between frequency of nicotine intake and sleep health. Second, many studies examining sleep have relied on either a single sleep question 29,31 or used a global metric of sleep quality, such as the total score of the Pittsburgh Sleep Quality Index 32 . Despite the strengths of the PSQI global sleep quality index, it does not provide an understanding of unique facets of subjective sleep quality, including next‐day tiredness and nightly awakenings 33 .…”

“…Dual combustible and e‐cigarette use may confer even worse sleep outcomes via simple dose‐response relationships 26‐28 . Limited work has evaluated the potential multiplicative effect of concurrent dual use on sleep, but one study found dual‐product users to have the greatest odds of sleep‐related complaints compared with single‐product users and nonusers 29 . Boddu et al 30 observed worse overall sleep quality and increased sleep onset latency among dual users relative to e‐cigarette users, combustible smokers, and nonusers, though this pattern was restricted to females.…”

Association Between Substance Use and Insufficient Sleep in U.S. High School Students

“…For example, the use of marijuana and tobacco was significantly associated with greater sleep problems among adolescents (Zhabenko et al, 2016). In addition, teens with more consumption of alcohol experienced later sleep schedules and more sleep on weekends compared with weekdays (Singleton & Wolfson, 2009), while those who used e-cigarettes tended to have shorter total sleep time on weekends (Dunbar et al, 2017) and had increased complaints related to sleep (e.g., bad dreams, sleeping restlessly, or falling asleep during the daytime; Riehm et al, 2019) compared to the nonusers. The association between sleep and substance use has been an interest among researchers for a long period of time, but relatively limited studies exist for adolescents.…”

Deleterious Association of Inhalant Use on Sleep Quality during the COVID-19 Pandemic

“…Only one study did not find a difference in sleep duration or quality in e-cigarette users; however, this study design had concerning limitations using unvalidated methods for assessing sleep [5]. The remaining nine articles had findings supportive of a relationship between e-cigarette use and decreased sleep quality including sleep duration, onset, latency or regularity [6][7][8][9][10][11][12][13][14]. In summary, although the articles all had unique limitations from study design to generalizability of findings, the vast majority of the articles concluded that e-cigarette or dual use leads to alterations in sleep that need further investigation.…”