Abstract
Background
Adequate sleep during childhood is an important component of overall health and wellbeing
for children. Secondhand smoke (SHS) exposure has been linked to a greater risk of
sleep-disordered breathing.
Objective
Our objective was to investigate relationships between SHS exposure and sleep-related
breathing problems in healthy toddlers aged 2 to 5 years. We hypothesized that there
is an independent relationship between objectively measured SHS exposure and presence
of sleep-related breathing problems by parental report.
Methods
A convenience sample of 149 healthy children ages 2 to 5 years was recruited from
an academic pediatric primary care center for this cross-sectional study; 138 had
complete data that were analyzed. Current SHS exposure was determined by hair nicotine
level. Presence of sleep-related breathing problems was assessed by 1 survey item.
Inflammation was determined by serum C-reactive protein (CRP) level. Analysis in Stata
15 included a series of multivariate logistic regression models, controlling for individual-level
demographics and body mass index z scores according to mediation analysis procedures
for dichotomous outcomes.
Results
Approximately 24% of parents reported their child snored, gasped, or had difficulty
breathing at night sometimes, most of the time, or almost always. Regression models
with mediation analysis indicate that SHS exposure significantly increased the odds
of reporting the child had sleep-related breathing problems, and 18% of this relationship
is explained by log serum CRP levels.
Conclusions
Although the cross-sectional nature of this study limits causality, evidence suggests
a relationship exists between SHS exposure, as measured by log hair nicotine and sleep-related
breathing problems at night.
Keywords
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References
- The association between secondhand smoke and sleep-disordered breathing in children: a systematic review.Laryngoscope. 2015; 125: 241-247
- Sleep-disordered breathing in preschool children is associated with behavioral, but not cognitive, impairments.Sleep Med. 2012; 13: 621-631
- Longitudinal cardiovascular outcomes of sleep disordered breathing in children: a meta-analysis and systematic review.Sleep. 2017; 40
- Sleep disordered breathing and academic performance: a meta-analysis.Pediatrics. 2015; 136: e934-e946
- Diagnosis and management of childhood obstructive sleep apnea syndrome.Pediatrics. 2012; 130: e714-e755
- Sleep-disordered breathing symptoms are associated with poorer cognitive function in 5-year-old children.J Pediatr. 2004; 145: 458-464
- Persistent snoring in preschool children: predictors and behavioral and developmental correlates.Pediatrics. 2012; 130: 382-389
- Health-related quality of life and sleep-disordered breathing in children.Sleep. 2002; 25: 657-666
Oxford Centre for Evidence-based Medicine. Levels of Evidence (March 2009). Available at:https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed February 15, 2019.
- Associations between secondhand smoke exposure and sleep patterns in children.Pediatrics. 2010; 125: e261-e268
- Environmental tobacco smoke exposure and risk of habitual snoring in children: a meta-analysis.J Epidemiol Community Health. 2018; 72: 1064-1070
- Predictors of obstructive sleep apnea severity in adenotonsillectomy candidates.Sleep. 2014; 37: 261-269
- Effects of passive smoking on snoring in preschool children.J Pediatr. 2013; 163: 1158-1162.e1154
- Vital signs: disparities in nonsmokers' exposure to secondhand smoke—United States, 1999–2012.MMWR Morb Mortal Wkly Rep. 2015; 64: 103-108
- Trends in exposure to secondhand smoke at home among children and nonsmoker adolescents.Sci Total Environ. 2016; 542: 144-152
- Environmental tobacco smoke exposure in children aged 3–19 years with and without asthma in the United States, 1999–2010.NCHS Data Brief. 2013; 126: 1-8
- Secondhand smoke exposure and preclinical markers of cardiovascular risk in toddlers.J Pediatr. 2017; 189: 155-161
- Method validation for measurement of hair nicotine level in nonsmokers.Biomed Chromatogr. 2009; 23: 273-279
- Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems.Sleep Med. 2000; 1: 21-32
- A general approach to causal mediation analysis.Psychol Methods. 2010; 15: 309-334
- Identification, inference, and sensitivity analysis for causal mediation effects.Stat Sci. 2010; 25: 51-71
- Causal mediation analysis using R.in: Vinod HD Advances in Social Science Research Using R. Springer, New York2009: 129-154
- Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012.JAMA Pediatr. 2014; 168: 561-566
- Prevalence of childhood and adult obesity in the United States, 2011–2012.JAMA. 2014; 311: 806-814
- C-reactive protein and carotid intima-media thickness in children with sleep disordered breathing.J Clin Sleep Med. 2013; 9: 493-498
- Utility and cutoff value of hair nicotine as a biomarker of long-term tobacco smoke exposure, compared to salivary cotinine.Int J Environ Res Public Health. 2014; 11: 8368-8382
- Assessing pediatric tobacco exposure using parent report: comparison with hair nicotine.J Expo Sci Environ Epidemiol. 2018; 28: 530-537
- Increased myocardial prevalence of C-reactive protein in human coronary heart disease: direct effects on microvessel density and endothelial cell survival.Cardiovasc Pathol. 2012; 21: 428-435
- Clinical practice policy to protect children from tobacco, nicotine, and tobacco smoke.Pediatrics. 2015; 136: 1008-1017
Article Info
Publication History
Published online: April 05, 2019
Accepted:
March 31,
2019
Received:
September 7,
2018
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2019 by Academic Pediatric Association
