Early-life NO2 exposure and sleep disturbances in preschool children: a study from 551 cities across China
Abstract
Summary Background Ambient nitrogen dioxide (NO2) has been linked to sleep disturbances in adults, yet its impact on pediatric populations remains understudied. Methods A total of 112,471 children aged 3–7 years from the Chinese National Cohort of Motor Development were enrolled. Sleep quality was assessed using the Children's Sleep Habits Questionnaire (CSHQ), while NO2 exposure at home addresses was estimated through a satellite-based spatiotemporal model. Linear mixed-effect models and generalized estimating equations were employed to quantify the associations of NO2 exposure with CSHQ scores and sleep disturbances, with the adjustment for demographics, meteorological parameters. Findings Early-life NO2 exposure was associated with higher CSHQ scores and increased risk of sleep disturbances. Per 10 μg/m3 increase in NO2 exposure during 0–3 years and the entire pregnancy was associated with 0.23 (95% confidence interval [CI]: 0.12–0.33) and 0.18 (95% CI: 0.09–0.27) increases in CSHQ score, respectively, indicating poorer sleep quality. A 10 μg/m3 increase in NO2 exposure from ages 0–3 years and during the pregnancy was associated with a 1.1% (relative risk [RR] = 1.011, 95% CI: 1.004–1.018) and 1.0% (RR = 1.010, 95% CI: 1.004–1.016) higher risk of sleep disturbances, respectively. Higher NO2 exposure was linked to greater likelihood of sleep onset delay, sleep-disordered breathing, and daytime sleepiness. The association appeared more pronounced among children exclusively…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 112,471 participants or records.
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