摘要：Introduction: A majority of studies on tobacco smoke exposure and sleep quality haverelied on self-reported smoking, resulting in potential exposure misclassification andbiases related to self-report. The objective of this study was to investigate associationsbetween urinary cotinine, a biological marker of tobacco smoke exposure, and sleepquality measures, including sleep duration, sleep continuity or efficiency, sleep satisfactionand alertness during normal waking hours.Methods: Using data on a national sample of 10 806 adults (aged 18–79 years) from theCanadian Health Measures Survey (2007–2013), we performed binary logistic regressionanalyses to estimate associations between urinary cotinine concentrations and sleepquality measures, while controlling for potential confounders. Additionally, we performedordinal logistic regression to assess the association between urinary cotinineconcentrations and increased number of sleep problems.Results: Overall, 28.7% of adult Canadian survey respondents had urinary cotinineconcentrations above the limit of detection (LOD), and the prevalence of each sleepproblem ranged from 5.5% to 35.6%. Elevated urinary cotinine concentrations (quartile4 vs. < 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 amongfemales compared to males.Conclusion: Using a biological marker of tobacco smoke exposure, our study contributesto the body of literature of toxic environmental exposures on sleep quality by supportingan association between tobacco smoke exposure and poorer sleep quality. Toaddress the limitations of a cross-sectional study design and to better assess the temporalityof tobacco smoke exposure and sleep quality, longitudinal studies arerecommended.
