Tobacco smoke exposure and sleep: estimating the association of urinary cotinine with sleep quality

Abstract

Introduction A majority of studies on tobacco smoke exposure and sleep quality have relied on self-reported smoking, resulting in potential exposure misclassification and biases related to self-report. The objective of this study was to investigate associations between urinary cotinine, a biological marker of tobacco smoke exposure, and sleep quality measures, including sleep duration, sleep continuity or efficiency, sleep satisfaction and alertness during normal waking hours. Methods Using data on a national sample of 10 806 adults (aged 18–79 years) from the Canadian Health Measures Survey (2007–2013), we performed binary logistic regression analyses to estimate associations between urinary cotinine concentrations and sleep quality measures, while controlling for potential confounders. Additionally, we performed ordinal logistic regression to assess the association between urinary cotinine concentrations and increased number of sleep problems. Results Overall, 28.7% of adult Canadian survey respondents had urinary cotinine concentrations above the limit of detection (LOD), and the prevalence of each sleep problem ranged from 5.5% to 35.6%. Elevated urinary cotinine concentrations (quartile 4 vs. $lt;LOD) were associated with significantly higher odds of short or long sleep duration (OR = 1.41; 95% CI: 1.02–1.95; p-trend = .021), trouble falling or staying asleep (OR = 1.71; 95% CI: 1.28–2.27; p-trend = .003), sleep dissatisfaction (OR = 1.87; 95% CI: 1.21–2.89; p-trend = .011), and increased number of sleep problems (OR = 1.64; 95% CI: 1.19–2.26; p-trend = .001). Stronger associations were observed among females compared to males. Conclusion Using a biological marker of tobacco smoke exposure, our study contributes to the body of literature of toxic environmental exposures on sleep quality by supporting an association between tobacco smoke exposure and poorer sleep quality. To address the limitations of a cross-sectional study design and to better assess the temporality of tobacco smoke exposure and sleep quality, longitudinal studies are recommended.

The relationship between poor sleep quality measured by the Pittsburgh Sleep Quality Index and smoking status according to sex and age: an analysis of the 2018 Korean Community Health Survey

“…Another noteworthy point in this study is that the ORs for poor sleep quality related to smoking status in female were greater than those for male in all age groups. Differences by sex concerning the sensitivity and metabolization rate of nicotine may explain the stronger association between tobacco smoke exposure and poorer sleep quality among female [ 13 ]. In a study that included twins as the subjects, the clearance of nicotine and cotinine, the nicotine-to-cotinine clearance ratio, and the ratio of trans-3 ′-hydroxycotinine to cotinine were significantly higher in female than in male.…”

“…Given the strong effect of psychological factors on sleep quality, the results of 2 models (2 types of adjusted odds ratios [aORs]) were presented depending on whether these factors were included. Because of the differences in the metabolic processes related to nicotine and cotinine and in the relationship between sleep quality and tobacco smoking according to sex and age [ 10 , 13 , 20 ], we performed separate analyses stratified by sex and age group to explore the potential effects on the association between cigarette smoking and sleep quality. An interaction model was used to estimate the effect of smoking on sleep quality according to age.…”

“…Sex differences in the sensitivity and metabolization rate of nicotine can explain the stronger association between tobacco smoke exposure and poorer sleep quality among females [13].…”

“…These associations were not observed in male and female participants in other age groups [ 12 ]. Stronger associations were observed among female in a Canadian nationwide study, in which elevated urinary cotinine concentrations were found to be associated with a significantly higher likelihood of short or long sleep duration, trouble falling or staying asleep, sleep dissatisfaction, and an increased number of sleep problems [ 13 ]. In a study on Japanese workers, the likelihood of difficulty waking up in the morning for male and female smokers was significantly higher than for non-smokers, while increased difficulty initiating sleep and decreased early morning awakening were observed in female smokers only [ 14 ].…”

The association between cotinine-measured smoking intensity and sleep quality

“…Only a few studies used biomarkers for differentiating smoking exposure, and those using biomarkers for evaluating smoking intensity reported inconsistent results. A Canadian national survey reported that increasing urinary cotinine levels were associated with higher odds of disturbed sleep quality 7 . In contrast, a German study using the Pittsburgh Sleep Quality Index (PSQI) showed no significant associations between smoking intensity measured by biological indicators (i.e.…”