Modeling the Association between Smoking and Sleep Fragmentation Using Log-Linear Models

smoking;sleep fragmentation;log-linear models;generalized estimating equations;biostatistics;Biostatistics

Norato, Gina

Johns Hopkins University

关键词: smoking;    sleep fragmentation;    log-linear models;    generalized estimating equations;    biostatistics;    Biostatistics;   

Others  :  https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/39469/NORATO-THESIS-2016.pdf?sequence=1&isAllowed=y

瑞士|英语

来源: JOHNS HOPKINS DSpace Repository

【 摘 要 】

Given that the etiology of poor sleep quality in regards to cigarette smoking is not well-defined, it is of interest to further investigate the risk of transition between various sleep stages for never, current, and former smokers. Polysomnography and clinical data from 5139 participants of the Sleep Heart Health Study were used for the current analysis. A log-linear generalized estimating equation (GEE) modeling approach was used, adjusted for demographic covariates and comorbidities. Previous literature has described the use of this approach as a computationally faster alternative to multi-state survival models. Compared to never smokers, former smokers transition more often into wake, from non-REM and REM sleep (NW: 1.05 (CI 1.02, 1.09); RW: 1.06 (CI 1.02, 1.11)). Current smokers are more likely to transition out of non-REM into wake (1.07 (CI 1.02-1.13)), and correspondingly less likely to transition into REM sleep from non-REM sleep (0.91 (CI 0.87-0.96)). Moreover, current smokers have less risk for transition out of REM sleep (RN: 0.87 (CI 0.80-0.94); RW: 0.88 (CI 0.82-0.95)). In more detailed analyses that characterized sleep into five states, former smokers again show increased transitions to wakefulness, and also seem to have highly altered stage 2 sleep. For current smokers, transitions out of stages 1 and 2 sleep were reduced, and overall they are more likely to transition to and stay in lower levels of sleep (ie, wake or stage 1), are less likely to transition into deeper levels of sleep, and are less likely to transition out of REM, likely due to REM pressure. The results of the current study show that cigarette smoking does influence sleep stage transitioning, even for former smokers. Furthermore, using models that incorporate the granularity of sleep using five states are of more utility than a simpler 3-state model.