American Journal of Epidemiology Advance Access originally published online on July 7, 2006
American Journal of Epidemiology 2006 164(6):529-537; doi:10.1093/aje/kwj231
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Original Contribution |
Cigarette Smoking and Nocturnal Sleep Architecture
1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
2 Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
3 Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
Reprint requests to Dr. Naresh M. Punjabi, Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, 5501 Hopkins Bayview Circle, Baltimore, MD 21224 (e-mail: npunjabi{at}jhmi.edu).
Cigarette smoking has been associated with a high prevalence of sleep-related complaints. However, its effects on sleep architecture have not been fully examined. The primary objective of this investigation was to assess the impact of cigarette smoking on sleep architecture. Polysomnography was used to characterize sleep architecture among 6,400 participants of the Sleep Heart Health Study (United States, 1994–1999). Sleep parameters included total sleep time, latency to sleep onset, sleep efficiency, and percentage of time in each sleep stage. The study sample consisted of 2,916 never smokers, 2,705 former smokers, and 779 current smokers. Compared with never smokers, current smokers had a longer initial sleep latency (5.4 minutes, 95% confidence interval (CI): 2.9, 7.9) and less total sleep time (14.0 minutes, 95% CI: 6.4, 21.7). Furthermore, relative to never smokers, current smokers also had more stage 1 sleep (relative proportion = 1.24, 95% CI: 1.14, 1.33) and less slow wave sleep (relative proportion = 0.86, 95% CI: 0.78, 0.95). Finally, no differences in sleep architecture were noted between former and never smokers. The results of this study show that cigarette smoking is independently associated with disturbances in sleep architecture, including a longer latency to sleep onset and a shift toward lighter stages of sleep. Nicotine in cigarette smoke and acute withdrawal from it may contribute to disturbances in sleep architecture.
nicotine; polysomnography; sleep; sleep stages; smoking; tobacco
Abbreviations: RDI, respiratory disturbance index; REM, rapid eye movement; SHHS, Sleep Heart Health Study
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