Environmental tobacco smoke and sleep fragmentation in children with suspected sleep apnea.

Authors

Noga Arwas, Iris Etzion, Sari Greenberg Dotan, Ariel Tarasiuk, Aviv D Goldbart

Published in

Scientific reports. Volume 16. Issue 1. Jul 13, 2026. Epub Jul 13, 2026.

Abstract

Most studies in children using questionnaires or home polygraphy indicate that exposure to environmental tobacco smoke (ETS) is a significant risk factor for insomnia, snoring, and sleep-disordered breathing (SDB); however, objective polysomnographic evidence in suspected SDB is limited. We prospectively assessed ETS-sleep associations using urinary cotinine and overnight polysomnography in 30 children (mean age 5.8 ± 2.4 years; range 1-12; 73% boys) referred for SDB. Parents completed validated questionnaires on sleep and household ETS, and an Enzyme-Linked Immunosorbent Assay measured urinary cotinine. 46% had at least one smoking parent. Cotinine correlated with reported ETS exposure (r = 0.55, p = 0.03), supporting questionnaire validity. ETS exposure was not associated with apnea-hypopnea or oxygen desaturation indices, but exposed children had a 67% higher arousal index (p = 0.03), reflecting greater sleep fragmentation. Higher cotinine levels correlated with shorter sleep duration (r = - 0.36, p = 0.02) and lower sleep efficiency (r = - 0.43, p = 0.02). These findings indicate that ETS adversely affects sleep independent of respiratory events, highlighting a modifiable risk with measurable biomarker-linked impacts on pediatric sleep. Reducing ETS exposure may improve sleep quality even in children with SDB.

PMID:
42443283
Bibliographic data and abstract were imported from PubMed on 14 Jul 2026.

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