University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
University of Pennsylvania School of Nursing, Philadelphia, PA, USA.
Environ Pollut. 2020 Jul;262:114263. doi: 10.1016/j.envpol.2020.114263. Epub 2020 Feb 24.
An increasing number of epidemiological studies have examined air pollution as a possible contributor to adverse sleep health, but results are mixed. The aims of this systematic review are to investigate and summarize the associations between exposures to air pollutants and various sleep measures across the lifespan. PubMed, CINAHL, Cochrane, Scopus, Web of Science, and PsycInfo were searched through October 2019 to identify original data-based research examining direct epidemiological associations between ambient and indoor air pollution exposures and various sleep health measures, including sleep quality, sleep duration, sleep disturbances, and daytime sleepiness. Twenty-two articles from 2010 to 2019 were selected for inclusion in this review, including a wide range of study populations (from early childhood to elderly) and locations (10 Asian, 4 North American, 3 European, 5 other). Due to variation in both exposure and outcome assessments, conducting a meta-analysis was not plausible. Twenty-one studies reported a generally positive association between exposure and poor sleep quality. While most studies focused on ambient air pollutants, five assessed the specific effect of indoor exposure. In children and adolescents, increased exposure to both ambient and indoor pollutants is associated with increased respiratory sleep problems and a variety of additional adverse sleep outcomes. In adults, air pollution exposure was most notably related to sleep disordered breathing. Existing literature generally shows a negative relationship between exposures to air pollution and sleep health in populations across different age groups, countries, and measures. While many associations between air pollution and sleep outcomes have been investigated, the mixed study methods and use of subjective air pollution and sleep measures result in a wide range of specific associations. Plausible toxicological mechanisms remain inconclusive. Future studies utilizing objective sleep measures and controlling for all air pollution exposures and individual encounters may help ameliorate variability in the results reported by current published literature.
越来越多的流行病学研究已经探讨了空气污染作为不良睡眠健康的可能影响因素，但结果存在差异。本系统综述的目的是调查和总结暴露于空气污染物与整个生命周期中各种睡眠测量指标之间的关联。通过 2019 年 10 月之前的 PubMed、CINAHL、Cochrane、Scopus、Web of Science 和 PsycInfo 检索，以确定基于原始数据的研究，这些研究直接调查了环境和室内空气污染暴露与各种睡眠健康指标（包括睡眠质量、睡眠时间、睡眠障碍和白天嗜睡）之间的流行病学关联。从 2010 年到 2019 年，选择了 22 篇文章纳入本综述，包括广泛的研究人群（从儿童早期到老年）和地点（10 个亚洲、4 个北美、3 个欧洲、5 个其他地区）。由于暴露和结果评估的差异，进行荟萃分析是不可行的。21 项研究报告了暴露与睡眠质量差之间的一般正相关。虽然大多数研究都集中在环境空气污染物上，但有 5 项研究评估了室内暴露的具体影响。在儿童和青少年中，暴露于环境和室内污染物增加与呼吸睡眠问题增加以及各种其他不良睡眠结果有关。在成年人中，空气污染暴露与睡眠呼吸障碍最相关。现有文献普遍表明，在不同年龄组、国家和测量指标的人群中，暴露于空气污染与睡眠健康之间存在负相关关系。虽然已经研究了空气污染与睡眠结果之间的许多关联，但研究方法的差异以及使用主观的空气污染和睡眠测量结果导致了具体关联的广泛差异。合理的毒理学机制仍不确定。未来的研究可以利用客观的睡眠测量指标，控制所有的空气污染暴露和个体接触，从而有助于缓解当前发表文献报告结果的变异性。
