Exploring the Interplay of Sleep and Nicotine Vaping in Adolescents: An Evidence-Based Narrative Review

Although adolescent use of combustible cigarettes (CC) has decreased, the rise of nicotine electronic vaping products (EVPs) presents new public health concerns. Nicotine vaping devices, with appealing packaging and flavors, are now the most commonly used nicotine delivery method among adolescents. While the long-term effects remain unclear, short-term effects include tachycardia, coughing, and wheezing. This review explores the relationship between nicotine vaping and sleep disturbances in adolescents.

A PubMed search (2006-2024) using keywords "nicotine sleep adolescents," "vaping sleep adolescents," and "e-cigarette sleep adolescents" identified 159 articles. Filters for "Humans," "English," and "Age-Birth-18 years" narrowed the list to 124. Abstracts were independently screened for cross-sectional studies describing sleep disturbances, yielding nine articles. Outcome measures included insufficient sleep (< 7-8 hours/night) and sleep latency, assessed through self-reported hours and the Pittsburgh Sleep Quality Index (PSQI).

Data from 106,628 adolescents (12-18 years; males = females) revealed e-cigarette (most common vaping device used) and dual users (e-cigs + CC) reported significantly more insufficient sleep on school nights than non-users. Dual users exhibited increased sleep latency, particularly in males. Two studies suggested chronic insufficient sleep might lead to initiation or increased use of vaping devices, highlighting a bidirectional relationship.

Many survey studies indicate vaping nicotine is associated with sleep disturbances in adolescents. Other studies determined sleep disturbances were associated with an initiation or increase in vaping nicotine indicating a cause-and-effect conundrum. Further investigation through longitudinal studies are needed to determine factors such as the causal relationship, dose-response and product-specific effects.