Dual use of e-cigarettes with conventional tobacco is associated with increased sleep latency in cross-sectional Study

Abstract

The health effects of e-cigarettes remain relatively unknown, including their impact on sleep quality. We previously showed in a pilot study that females who smoke both conventional tobacco and vape e-cigarettes (dual users) had decreased sleep quality (measurement of how well an individual is sleeping) and increased sleep latency (amount of time to fall asleep), suggesting an influence by gender. Cough is also known to adversely impact sleep quality and may be caused by inhalant use. As a result, we undertook this study to assess the impact of e-cigarette, conventional tobacco, and dual use on sleep quality, sleep latency, cough, and drug use. Participants (n = 1198) were recruited through online surveys posted to social media sites with a monetary incentive. Participants were grouped by inhalant use, with 8% e-cigarette users, 12% conventional tobacco users, 30% dual users, and 51% non-smokers/non-vapers. Dual use of e-cigarettes and conventional tobacco was associated with increased sleep latency relative to non-smokers/non-vapers by multivariable linear regression (mean difference of 4.08; 95% CI: 1.12 to 7.05, raw p = 0.007, adjusted p = 0.042); however, dual usage was not significantly associated with sleep quality relative to non-smokers/non-vapers (mean difference 0.22, 95%CI: (−0.36, 0.80), raw p = 0.452, adjust p = 0.542). Dual use was also associated with a higher reporting of cough (p = 0.038), as well as increased marijuana (p < 0.001) and cocaine (p < 0.001) usage. This study demonstrates that dual use is associated with longer sleep latency, and suggests that the shared component of nicotine may be a driver. Because sleep broadly impacts multiple aspects of human health, defining the associations of e-cigarettes and vaping devices on sleep is critical to furthering our understanding of their influence on the body.

Association of dual electronic cigarettes and marijuana use with sleep duration among adults from the United States, NHANES 2015–2018

“…Wiener RC et al reported that participants who currently used e-cigarettes were 1.82-fold more likely not to get their recommended sleep duration compared with participants who never used e-cigarettes ( Riehm et al, 2019 ). Other studies have found that co-users of e-cigarettes with other tobacco products may have more emotional problems and experience more harm than e-cigarette-only users ( Kang and Bae, 2021 , Abafalvi et al, 2019 , Lee and Lee, 2019 , Berlin et al, 2019 , Advani et al, 2022 ). Kang and Bae (2021) conducted a study to examine between-groups differences in depression and sleep quality based on smoking/vaping status among Korean adults and showed that dual users of e-cigarettes and traditional cigarettes had significantly higher depression scores (PHQ-9) and significantly lower sleep quality (Pittsburgh Sleep Quality Index-Korean version), respectively, than did cigarette users and non-users.…”

“… Berlin et al (2019) found that dual users of e-cigarettes and traditional cigarettes in France may have higher overall nicotine intake than exclusive e-cigarette users, but they may take in less nicotine from their e-cigarettes. A study conducted by Advani et al (2022) demonstrated that dual use of e-cigarettes and traditional cigarettes was associated with longer sleep latency, and the shared component of nicotine may be a driver. However, to date, there are no studies on the relationship between e-cigarette and cannabis co-use and sleep health in such a large age group.…”

Ocular Symptoms in Adolescents and Young Adults With Electronic Cigarette, Cigarette, and Dual Use

“…E-cigarette use has been linked to numerous adverse outcomes, including increased blood pressure, heart rate, air resistance in lungs, and immunomodulatory cytokines production . Studies examining the dual use of e-cigarettes and cigarettes have reported additional detrimental findings, such as lower general health, increased sleep latency, and higher vascular disorder risk …”