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Do cigarette smokers sleep worse than nonsmokers in central China?

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Among 26,282 Hunan residents, smokers (25.3%) scored worse on almost every PSQI domain and more often had sleep disturbance (32.7% vs 24.5%).

Source

Sleep quality in cigarette smokers and nonsmokers: findings from the general population in central China

Liao Y, Xie L, Chen X, et al. · BMC public health · 2019

doi.org/10.1186/s12889-019-6929-4Read the full paper ↗70 citationscc by

Study at a glance

Design
Cross-sectional — Population-based multi-stage sample of rural and urban Hunan, China (Sep–Oct 2012); PSQI among smokers vs nonsmokers.
N
N=26282 · 27,300 sampled; 26,282 (97.3%) completed smoking self-report (6,650 smokers; 19,632 nonsmokers); PSQI n=26,035.
Population
General-population residents of Hunan province, China, ages 12–99.
Outcome
PSQI global score and sleep disturbance (PSQI >5), plus smoking-characteristic correlates among smokers.

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What they did

Used multi-stage sampling in rural and urban Hunan (Sep–Oct 2012), defined current smokers as ≥100 lifetime cigarettes and smoking in the last 28 days, and compared Pittsburgh Sleep Quality Index scores, with regressions among smokers for cigarettes/day, years smoked, quit attempts, and craving.

What they found

Smoking prevalence was 25.3% (45% of men, 3% of women). Smokers had worse subjective sleep quality, latency, duration, efficiency, and disturbances, and more daytime dysfunction. Among smokers, poor sleep tracked more years smoked, quit attempts, and craving, but fewer cigarettes per day.

The limits

What it doesn't show

A cross-section cannot prove smoking caused insomnia; reverse causation (poor sleep prompting smoking) and residual confounding (alcohol was much more common in smokers) remain possible.

Key terms

PSQI
Pittsburgh Sleep Quality Index; disturbance defined as global score >5.
Current smoker
≥100 lifetime cigarettes and smoked during the last 28 days.
Sleep disturbance
PSQI >5; 32.7% of smokers vs 24.5% of nonsmokers.
Smoking craving
Self-rated craving associated with higher odds of poor sleep among smokers.
Quit attempts
28.3% of smokers reported quit attempts; also linked to worse sleep.

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Completed smoking questionnaires numbered about:

Common questions

How large was the completed sample?

26,282 of 27,300 sampled (97.3%).

Smoking prevalence?

25.3% overall (45% of men, 3% of women).

PSQI>5 rates?

32.7% of smokers vs 24.5% of nonsmokers.

Which smoking traits tracked worse sleep?

More years smoked, quit attempts, and craving; cigarettes/day was inversely associated.

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