Abstract
BackgroundPrevious studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children.MethodsIn this cross-sectional study, children were recruited from elementary and middle schools in Liaoning Province, China between April 2012 and January 2013. We assessed early-life SHS exposure (pregnancy and the first 2 years of life) via questionnaires. Sleep problems and different types of sleep-related symptoms were measured based on the validated tool of the Sleep Disturbance Scale for Children (SDSC). Generalized linear mixed models were applied to estimate the associations of early-life SHS exposure with sleep problems.ResultsWe included a total of 45,562 children (22,657 [49.7%] males; mean [SD] age, 11.0 [2.6] years) and 6167 of them (13.5%) were exposed to early-life SHS during both pregnancy and the first 2 years of life. Compared with unexposed counterparts, children exposed to early-life SHS had higher total T-scores of SDSC (β = 4.32; 95%CI: 4.06, 4.58) and higher odds of increased sleep problems (OR = 2.14; 95%CI: 1.89, 2.42). When considering different sleep-related symptoms, the associations between early-life SHS exposure and symptom of sleep-wake transition disorders (i.e., bruxism) were the strongest in all analyses.ConclusionsEarly-life SHS exposure was associated with higher odds of global sleep problems and different sleep-related symptoms in children aged 6–18 years. Our findings highlight the importance to strengthen efforts to support the critical importance of maintaining a smoke-free environment especially in early life.
Highlights
Previous studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children
To verify the robustness of the results, sensitivity analyses were performed: (1) we examined the associations by excluding children with parent-reported asthma (n = 2257, 4.95%) since previous studies have found strong associations between second-hand smoke (SHS) exposure and sleep problems in asthmatic children [16]; (2) we grouped SHS exposure into more detailed categories of exposure by considering pregnancy and the first 2 years of life separately and re-analyzed the data; (3) we used current SHS exposure derived from the questionnaires to confirm the associations between current SHS exposure and simultaneous sleep problems since most of previous studies have confirmed the above association
Associations between early‐life SHS exposure and sleep problems In the adjusted model (Table 2), compared with unexposed counterparts, children ever exposed during pregnancy or the first 2 years of life had higher total T-scores of Sleep Disturbance Scale for Children (SDSC) (β = 2.69; 95%confidence interval (CI): 2.40, 2.98), and children ever exposed during both pregnancy and the first 2 years of Exposure to SHS during early life
Summary
Previous studies have revealed that current secondhand smoke exposure showed highly suggestive evidence for increased risk of simultaneous sleep problems in children. Data on the associations between early-life exposure to SHS with subsequent sleep problems in children were scarce. We aimed to evaluate the associations of early-life SHS exposure with sleep problems in children. There are over 341 million smokers in China and the prevalence of smoking in Chinese men has reached 49.7% [1], indicating one important issue of exposure to second-hand smoke (SHS) in Chinese children [2]. Recent studies have linked SHS exposure to sleep problems in children, which has emerged as another public health issue due to the increasing prevalence worldwide [6]. Since good sleep quality is a well-recognized predictor of physical and mental health during childhood and adolescence [8], it’s of importance to understand the associations between SHS exposure and sleep problems in children especially in China
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