{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:32:28Z","timestamp":1753893148964,"version":"3.41.2"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Sleep"],"abstract":"<jats:sec><jats:title>Background and purpose:<\/jats:title><jats:p>We determined the prevalence of physician-diagnosed sleep disorder and its association with tobacco smoke exposure and vitamin D deficiency.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The National Health and Nutrition Examination Survey (NHANES) of 2011\u20132012 data base was used for the study. Subjects were asked two questions: \u201cEver told your doctor you had trouble sleeping?\u201d and \u201cEver told by doctor have sleep disorder?\u201d The answer \u201cyes\u201d to the second question indicated presence of a doctor-diagnosed sleep disorder (DSD) and \u201cno\u201d indicated its absence. Tobacco smoke exposure was defined by serum cotinine levels while vitamin D levels were measured by serum 25(OH) D. Eight selected variables included in the analyses were BMI, age, gender, smoking exposure, vitamin D levels, income, insurance, and race. Univariate and multivariate analyses were conducted to determine if tobacco smoke exposure and Vitamin D were each predictive of DSD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 5,470 subjected aged 16 to 80+ years about 9% had doctor-diagnosed sleep disorder (DSD). In a multiple regression analysis, active tobacco smoking was predictive of DSD (OR 1.92; 95% CI = 1.38\u20132.69), while passive smoke exposure was not, even after controlling for all the other significant variables (OR 0.93; 95% CI = 0.57\u20131.52). The other variables significantly associated with DSD were by order of importance BMI (<jats:italic>P<\/jats:italic> &amp;lt; 0.001), Age (<jats:italic>P<\/jats:italic> &amp;lt; 0.001) and race (<jats:italic>P<\/jats:italic> \u2264 0.001). Vitamin D deficiency was not predictive of DSD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The prevalence of physician-diagnosed DSD was about 9%. Active smoking but not passive smoking as defined by cotinine levels was significantly associated with DSD. Vitamin D was not predictive of DSD. Future studies are therefore needed to demonstrate whether smoking cessation could help reduce DSD.<\/jats:p><\/jats:sec>","DOI":"10.3389\/frsle.2023.1113946","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T05:18:03Z","timestamp":1680499083000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Doctor-diagnosed sleep disorders in the United States: Prevalence and impact of tobacco smoke exposure and vitamin D deficiency. A population-based study"],"prefix":"10.3389","volume":"2","author":[{"given":"Philip","family":"Kum-Nji","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Taylor","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bah","family":"Tanwi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"volume-title":"American Academy of Sleep Medicine, International Classification of Sleep Disorders","year":"2014","key":"B1"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2744","DOI":"10.1093\/eurheartj\/ehi608","article-title":"Association between obesity and obstructive sleep apnoea","volume":"26","author":"Arias","year":"2005","journal-title":"Eur Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e022427","DOI":"10.1161\/JAHA.121.022427","article-title":"American heart association athero, hypertension and obesity in the young committee of the council on lifelong congenital heart disease and heart health in the young. sleep-disordered breathing and cardiovascular disease in children and adolescents: a scientific statement from the american heart association","volume":"10","author":"Baker-Smith","year":"2021","journal-title":"J. Am. Heart Assoc"},{"key":"B4","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1007\/978-3-540-69248-5_2","article-title":"Nicotine chemistry, metabolism, kinetics and biomarkers","volume":"192","author":"Benowitz","year":"2009","journal-title":"Handb. Exp. Pharmacol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"654","DOI":"10.1093\/sleep\/20.8.654","article-title":"Respiratory arousal from sleep: mechanisms and significance","volume":"20","author":"Berry","year":"1997","journal-title":"Sleep"},{"key":"B6","doi-asserted-by":"publisher","first-page":"608","DOI":"10.1164\/ajrccm.163.3.9911064","article-title":"Prevalence of sleep-disordered breathing in women: effects of gender","volume":"163","author":"Bixler","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"B7","unstructured":"Centers for Disease Control and Prevention: Biomonitoring Summary for Cotinine2017"},{"key":"B8","doi-asserted-by":"publisher","first-page":"877","DOI":"10.5665\/sleep.4732","article-title":"Racial\/ethnic differences in sleep disturbances: the multi-ethnic study of atherosclerosis (MESA)","volume":"38","author":"Chen","year":"2015","journal-title":"Sleep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1705","DOI":"10.1080\/10826084.2019.1608250","article-title":"The relationship between tobacco smoking, cortisol secretion, and sleep continuity","volume":"54","author":"Cohen","year":"2019","journal-title":"Subst. Use Misuse"},{"key":"B10","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1183\/09031936.93.03050509","article-title":"The relationship between neck circumference, radiographic pharyngeal anatomy, and the obstructive sleep apnoea syndrome","volume":"3","author":"Davies","year":"1990","journal-title":"Eur. Respir. J"},{"key":"B11","doi-asserted-by":"publisher","first-page":"685","DOI":"10.1164\/ajrccm.163.3.2005065","article-title":"Obstructive sleep apnea-hypopnea and related clinical features in a population-based sample of subjects aged 30 to 70 yr","volume":"163","author":"Dur\u00e1n","year":"2001","journal-title":"Am. J. Respir. Crit. Care Med"},{"key":"B12","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1016\/j.sleep.2009.10.006","article-title":"Who gets the best sleep?Ethnic and socioeconomic factors related to sleep complaints","volume":"11","author":"Grandner","year":"2010","journal-title":"Sleep Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"310","DOI":"10.1016\/S2213-2600(15)00043-0","article-title":"Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study","volume":"3","author":"Heinzer","year":"2015","journal-title":"Lancet Respir. Med"},{"key":"B14","doi-asserted-by":"publisher","first-page":"1442","DOI":"10.1093\/aje\/kwt159","article-title":"Racial disparities in short sleep duration by occupation and industry","volume":"178","author":"Jackson","year":"2013","journal-title":"Am. J. Epidemiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"293","DOI":"10.5665\/sleep.5430","article-title":"Serum vitamin D is significantly inversely associated with disease severity in caucasian adults with obstructive sleep apnea syndrome","volume":"39","author":"Kerley","year":"2016","journal-title":"Sleep"},{"key":"B16","doi-asserted-by":"publisher","first-page":"1673","DOI":"10.1378\/chest.14-0772","article-title":"Where there is smoke\u2026there is sleep apnea: exploring the relationship between smoking and sleep apnea","volume":"146","author":"Krishnan","year":"2014","journal-title":"Chest"},{"key":"B17","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1177\/0884533609351532","article-title":"Sleep-disordered breathing and obesity: pathophysiology, complications, and treatment","volume":"24","author":"Leinum","year":"2009","journal-title":"Nutr Clin Pract."},{"key":"B18","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/j.smrv.2013.07.001","article-title":"The link between vitamin D metabolism and sleep medicine","volume":"18","author":"McCarty","year":"2014","journal-title":"Sleep Med. Rev"},{"key":"B19","doi-asserted-by":"publisher","first-page":"681","DOI":"10.3275\/8923","article-title":"Obstructive sleep apnea syndrome and its association with vitamin D deficiency","volume":"36","author":"Mete","year":"2013","journal-title":"J Endocrinol Invest"},{"key":"B20","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1080\/10705500801929577","article-title":"Association of active and passive smoking with sleep disturbances and short sleep duration among japanese working population","volume":"15","author":"Nakata","year":"2008","journal-title":"Int. J. Behav. Med"},{"key":"B21","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1007\/s11920-014-0519-z","article-title":"Sleep-disordered breathing and psychiatric disorders","volume":"16","author":"Naqvi","year":"2014","journal-title":"Curr. Psychiatry Rep"},{"key":"B22","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1378\/chest.97.1.27","article-title":"Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients","volume":"97","author":"Partinen","year":"1990","journal-title":"Chest"},{"key":"B23","doi-asserted-by":"publisher","first-page":"1006","DOI":"10.1093\/aje\/kws342","article-title":"Increased prevalence of sleep-disordered breathing in adults","volume":"177","author":"Peppard","year":"2013","journal-title":"Am. J. Epidemiol"},{"key":"B24","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1001\/jama.1996.03530400021033","article-title":"Exposure of the US population to environmental tobacco smoke: the third national health and nutrition examination survey, 1988 to 1991","volume":"275","author":"Pirkle","year":"1996","journal-title":"JAMA"},{"key":"B25","doi-asserted-by":"publisher","first-page":"568","DOI":"10.1097\/MCP.0b013e328358be05","article-title":"Roles of gender, age, race\/ethnicity, and residential socioeconomics in obstructive sleep apnea syndromes","volume":"18","author":"Ralls","year":"2012","journal-title":"Curr. Opin. Pulm. Med."},{"key":"B26","doi-asserted-by":"publisher","first-page":"186","DOI":"10.1164\/ajrccm.155.1.9001310","article-title":"Racial differences in sleep-disordered breathing in African-Americans and Caucasians","volume":"155","author":"Redline","year":"1997","journal-title":"Am. J. Respir. Crit Care Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1080\/15402002.2010.509251","article-title":"Sleep disorders in African Americans and Caucasian Americans: a meta-analysis","volume":"8","author":"Ruiter","year":"2010","journal-title":"Behav. Sleep Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1093\/qjmed\/hcu029","article-title":"Obesity and sleep-disordered breathing\u2013when two 'bad guys' meet","volume":"107","author":"Ryan","year":"2014","journal-title":"QJM"},{"key":"B29","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.sleep.2010.09.002","article-title":"The association between active smoking, smokeless tobacco, second-hand smoke exposure and insufficient sleep","volume":"12","author":"Sabanayagam","year":"2011","journal-title":"Sleep Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1513\/pats.200708-137MG","article-title":"Obesity and obstructive sleep apnea: pathogenic mechanisms and therapeutic approaches","volume":"5","author":"Schwartz","year":"2008","journal-title":"Proc. Am. Thorac. Soc"},{"key":"B31","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1172\/JCI117640","article-title":"Physiologic, metabolic, and muscle fiber type characteristics of musculus uvulae in sleep apnea hypopnea syndrome and in snorers","volume":"95","author":"Series","year":"1995","journal-title":"J. Clin. Invest"},{"key":"B32","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1016\/j.smrv.2017.06.010","article-title":"Sleep disturbances increase the risk of dementia: A systematic review and meta-analysis","volume":"40","author":"Shi","year":"2018","journal-title":"Sleep Med. Rev"},{"key":"B33","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1046\/j.1365-2796.1997.63889000.x","article-title":"Visceral fat accumulation as an important risk factor for obstructive sleep apnoea syndrome in obese subjects","volume":"241","author":"Shinohara","year":"1997","journal-title":"J. Intern. Med"},{"key":"B34","doi-asserted-by":"publisher","first-page":"362","DOI":"10.4104\/pcrj.2012.00096","article-title":"Body mass index and obstructive sleep apnoea","volume":"21","author":"Shneerson","year":"2012","journal-title":"Prim Care Respir J"},{"key":"B35","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1093\/sleep\/zsy015","article-title":"Sleep-disordered breathing in epilepsy: epidemiology, mechanisms, and treatment","volume":"41","author":"Sivathamboo","year":"2018","journal-title":"Sleep"},{"key":"B36","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1016\/j.annepidem.2007.07.096","article-title":"Short sleep duration across income, education, and race\/ethnic groups: population prevalence and growing disparities during 34 years of follow-up","volume":"17","author":"Stamatakis","year":"2007","journal-title":"Ann. Epidemiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1289\/ehp.9084173","article-title":"Cotinine analytical workshop report: consideration of analytical methods for determining cotinine in human body fluids as a measure of passive exposure to tobacco smoke","volume":"84","author":"Watts","year":"1990","journal-title":"Environ Health Perspect"},{"key":"B38","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1161\/01.HYP.0000101686.98973.A3","article-title":"Obesity, sleep apnea, and hypertension","volume":"42","author":"Wolk","year":"2003","journal-title":"Hypertension"},{"key":"B39","doi-asserted-by":"publisher","first-page":"2030S","DOI":"10.3945\/jn.110.121483","article-title":"NHANES monitoring of serum 25-hydroxyvitamin D: a roundtable summary","volume":"140","author":"Yetley","year":"2010","journal-title":"J Nutr."},{"key":"B40","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1056\/NEJM199304293281704","article-title":"The occurrence of sleep-disordered breathing among middle-aged adults","volume":"328","author":"Young","year":"1993","journal-title":"N. Engl. J. Med"},{"key":"B41","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1152\/japplphysiol.00587.2005","article-title":"Excess weight and sleep-disordered breathing","volume":"99","author":"Young","year":"2005","journal-title":"J. Appl. Physiol"},{"key":"B42","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1001\/archinte.162.8.893","article-title":"Sleep heart health study research group. predictors of sleep-disordered breathing in community-dwelling adults: the sleep heart health study","volume":"162","author":"Young","year":"2002","journal-title":"Arch. Int. Med"}],"container-title":["Frontiers in Sleep"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2023.1113946\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T05:18:08Z","timestamp":1680499088000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/frsle.2023.1113946\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,4,3]]},"references-count":42,"alternative-id":["10.3389\/frsle.2023.1113946"],"URL":"https:\/\/doi.org\/10.3389\/frsle.2023.1113946","relation":{},"ISSN":["2813-2890"],"issn-type":[{"type":"electronic","value":"2813-2890"}],"subject":[],"published":{"date-parts":[[2023,4,3]]},"article-number":"1113946"}}