Original Article

Investigating the Relation between Electronic Cigarette Use and Sleep Duration in Kentucky Using the BRFSS, 2016–2017

Authors: W. Jay Christian, PhD, MPH, Nimish R. Valvi, DrPH, MBBS, Courtney J. Walker, PhD


Objectives: Like traditional cigarettes, electronic cigarettes (e-cigarettes) contain nicotine, which is known to negatively influence sleep quality. Few studies, however, have examined the relation between e-cigarettes and sleep quality using population-based survey data because of the relatively recent appearance of these products on the market. This study investigated the relation between e-cigarette and cigarette use and sleep duration in Kentucky, a state with high rates of nicotine dependence and related chronic diseases.

Methods: Data from two consecutive years of the Behavioral Risk Factor Surveillance System survey—2016 and 2017—were analyzed using χ2 statistics and multivariable Poisson regression analyses to control for socioeconomic and demographic variables, the presence of other chronic diseases, and traditional cigarette use.

Results: This study was conducted using responses from 18,907 Kentucky adults aged 18 years and older. Overall, almost 40% reported short (<7 hours) sleep duration. After adjusting for other covariates, including the presence of chronic diseases, those who had currently or formerly used both traditional and e-cigarettes had the highest risk of short sleep duration. Those who currently or formerly smoked only traditional cigarettes also had significantly higher risk, unlike those who had only used e-cigarettes.

Conclusions: Survey respondents who used e-cigarettes were more likely to report short sleep duration, but only if they currently or formerly smoked traditional cigarettes. Those who used both products, regardless of whether current or former, were more likely to report short sleep duration than those who had used just one of these tobacco products.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Liu TZ, Xu C, Rota M, et al. Sleep duration and risk of all-cause mortality: a flexible, non-linear, meta-regression of 40 prospective cohort studies. Sleep Med Rev 2017;32:28–36.
2. Li Y, Cai S, Ling Y, et al. Association between total sleep time and all cancer mortality: non-linear dose-response meta-analysis of cohort studies. Sleep Med 2019;60:211–218.
3. Itani O, Jike M, Watanabe N, et al. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med 2017;32: 246–256.
4. Cohrs S, Rodenbeck A, Riemann D, et al. Impaired sleep quality and sleep duration in smokers—results from the German Multicenter Study on Nicotine Dependence. Addict Biol 2014;19:486–496.
5. Dugas EN, Sylvestre MP, O'Loughlin EK, et al. Nicotine dependence and sleep quality in young adults. Addict Behav 2017;65:154–160.
6. Hayley AC, Stough C, Downey LA. DSM-5 tobacco use disorder and sleep disturbance: findings from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Subst Use Misuse 2017;52: 1859–1870.
7. Wetter DW, Young TB, Bidwell TR, et al. Smoking as a risk factor for sleep-disordered breathing. Arch Intern Med 1994;154:2219–2224.
8. Zhang L, Samet J, Caffo B, et al. Cigarette smoking and nocturnal sleep architecture. Am J Epidemiol 2006;164:529–537.
9. Lavigne GL, Lobbezoo F, Rompre PH, et al. Cigarette smoking as a risk factor or an exacerbating factor for restless legs syndrome and sleep bruxism. Sleep 1997;20:290–293.
10. Wiener RC, Waters C, Bhandari R, et al. The association of sleep duration and the use of electronic cigarettes, NHANES, 2015–2016. Sleep Disord 2020;2020:8010923.
11. Tweed JO, Hsia SH, Lutfy K, et al. The endocrine effects of nicotine and cigarette smoke. Trends Endocrinol Metab 2012;23:334–342.
12. Jaehne A, Unbehaun T, Feige B, et al. Sleep changes in smokers before, during and 3 months after nicotine withdrawal. Addict Biol 2015;20: 747–755.
13. Cohen A, Ben Abu N, Haimov I. The interplay between tobacco dependence and sleep quality among young adults. Behav Sleep Med 2020;18:163–176.
14. Varol Y, Anar C, Tuzel OE, et al. The impact of active and former smoking on the severity of obstructive sleep apnea. Sleep Breath 2015;19:1279–1284.
15. Dinakar C, O'Connor GT. The health effects of electronic cigarettes. N Engl J Med 2016;375:2608–2609.
16. Basanez T, Majmundar A, Cruz TB, et al. E-cigarettes are being marketed as "vitamin delivery" devices. Am J Public Health 2019;109:194–196.
17. Centers for Disease Control and Prevention, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion. Smoking and tobacco use. About electronic cigarettes (e-cigarettes). https://www.cdc.gov/tobacco/basic_information/e-cigarettes/about-e-cigarettes.html. Published 2018. Accessed April 8, 2020.
18. Delnevo CD, Giovenco DP, Steinberg MB, et al. Patterns of electronic cigarette use among adults in the United States. Nicotine Tob Res 2016;18:715–719.
19. Herzog B, Gerberi J, Scott A. Equity research: Nielsen - Tobacco 'all channel' data. Wells Fargo. Securities 2014. July 22. Available at: http://www.c-storecanada.com/attachments/article/153/Nielsen%20C-Stores% 20-%20Tobacco.pdf. Accessed January 7, 2023.
20. Schoenborn CA, Gindi RM. Electronic cigarette use among adults: United States, 2014. NCHS Data Brief 2015;(217):1–8.
21. Berry KM, Fetterman JL, Benjamin EJ, et al. Association of electronic cigarette use with subsequent initiation of tobacco cigarettes in US youths. JAMA Netw Open 2019;2:e187794.
22. Boakye E, Osuji N, Erhabor J, et al. Assessment of patterns in e-cigarette use among adults in the US, 2017–2020. JAMA Netw Open 2022;5: e2223266.
23. Boddu SA, Bojanowski CM, Lam MT, et al. Use of electronic cigarettes with conventional tobacco is associated with decreased sleep quality in women. Am J Respir Crit Care Med 2019;200:1431–1434.
24. Dunbar MS, Tucker JS, Ewing BA, et al. Frequency of e-cigarette use, health status, and risk and protective health behaviors in adolescents. J Addict Med 2017;11:55–62.
25. Schmidt MH. The energy allocation function of sleep: a unifying theory of sleep, torpor, and continuous wakefulness. Neurosci Biobehav Rev 2014; 47:122–153.
26. Pierannunzi C, Hu SS, Balluz L. A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004–2011. BMC Med Res Methodol 2013;13:49.
27. Watson NF, Badr MS, Belenky G, et al. Joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society on the recommended amount of sleep for a healthy adult: methodology and discussion. J Clin Sleep Med 2015;11:931–952.
28. Hale J, Thompson D, Darden P. Calculating subset weighted analysis using PROC SURVEYFREQ and GENMOD. https://support.sas.com/resources/papers/proceedings13/272-2013.pdf. Published 2013. Accessed December 8, 2022.
29. Petersen MR, Deddens JA. A comparison of two methods for estimating prevalence ratios. BMC Med Res Methodol 2008;8:9.
30. Wang JB, Olgin JE, Nah G, et al. Cigarette and e-cigarette dual use and risk of cardiopulmonary symptoms in the Health eHeart Study. PloS One 2018; 13:e0198681.