Unexpected association between ambient ozone and adult insomnia outpatient visits: A large-scale hospital-based study.

Growing evidence indicates that short-term ozone (O) exposure has substantial health consequences, but the relationship between short-term ambient O and insomnia, a common sleep disorder, is not clear. This study aimed to investigate the short-term effects of ambient O exposure on outpatient visits for adult insomnia and to explore the potential modifiers. A large-scale multihospital-based study was carried out in Chongqing, the largest city in Southwest China. Daily data on outpatient visits for adult insomnia, average concentrations of ambient air pollutants and meteorological factors were collected. We conducted quasi-Poisson regression with generalized additive model to assess the association between ambient O and outpatient visits for adult insomnia in varied windows of exposure. Subgroup analyses were applied to identify its modifiers. Totally, 140,159 adult insomnia outpatient visits were identified. The daily maximum 8-h average concentration of O was 69 μg/m during the study period, which greatly below the updated Chinese and WHO recommended limits (daily maximum 8-h average, O: 100 μg/m). Short-term O exposure was significantly negatively associated with outpatient visits for adult insomnia in different lag periods and the greatest decrease of outpatient visits for adult insomnia was found at lag 02 [0.93% (95% CI: 0.48%, 1.38%)]. Additionally, stronger links between O and adult insomnia outpatient visits were presented in cool seasons, and we did not observe any significant modified effects of gender and age. Moreover, the negative O-insomnia association remained robust after controlling for other common air pollutants and comorbidities. In summary, short-term exposure to lower level of ambient O, was associated with reduced daily outpatient visits for adult insomnia and such association showed to be more obvious in cool seasons.