The associations between gas cooking stoves, indoor NO2 concentrations and adverse sleep outcomes in a pediatric sample.

Study objectives: To investigate whether gas cooking stove exposure and elevated indoor NO2 concentration were associated with adverse sleep outcomes in a pediatric sample.

Methods: Children from urban neighborhoods in Boston, Massachusetts underwent in-home sleep assessments. Indoor NO2 concentrations were measured continuously over 7 days by devices placed in the participants' living areas. Primary outcomes were short sleep duration (average 7-day sleep duration <8 hours by wrist actigraphy), and sleep-disordered breathing (SDB; ≥5 events/hour with >3% desaturation by a home sleep monitor). Associations between gas cooking stove exposure and elevated NO2 (≥ 69.48 ppb) with each sleep outcome were assessed through logistic regression models, adjusting for demographic and socioeconomic factors and season. Sensitivity analyses further adjusted for health conditions, kitchen ventilation, and various sources of indoor NO2.

Results: Of the 242 children, 74% (n=178) were exposed to gas cooking stoves. The median (interquartile range) of the average daily 95th percentile indoor NO2 was 41.1 (38.4) ppb. Children exposed to elevated indoor NO2 level were at a 2.88 increased adjusted odds (95% CI: 1.27, 6.55, p=0.012) of short sleep duration compared to children exposed to lower levels. A positive but insignificant relationship between indoor NO2 exposure and SDB was found (OR=1.23, 0.61, 2.47). Gas cooking stove exposure was unassociated with any sleep outcome.

Conclusions: Exposure to elevated indoor NO2 was associated with higher odds of short sleep duration in children. Interventions targeting indoor air quality may provide a novel approach for improving sleep health and reducing pediatric sleep disparities.