Heated tobacco product (HTP) use and sleep disturbance among Japanese workers: Findings from the J-ECOH Study

Heated tobacco products have expanded rapidly, especially in Japan, and are marketed as less harmful than cigarettes. Although combustible cigarette smoking is associated with impaired sleep, evidence on sleep-related effects of heated tobacco products remains limited. We assessed associations of heated tobacco product use with sleep latency, sleep duration, and sleep disturbance.

We conducted a cross-sectional study among 12,026 workers aged 20 to 69 years in the Japan Epidemiology Collaboration on Occupational Health (J-ECOH) Study (2018-2021). Smoking status was classified as never, former, exclusive heated tobacco product use, dual use, or exclusive cigarette smoking. Sleep outcomes included sleep latency, duration, and indicators of sleep disturbance (≥3/week)-difficulty initiating sleep, early morning awakening, and restless sleep. Multilevel Poisson regression estimated prevalence ratios for sleep disturbance, and multilevel linear regression estimated sleep latency and sleep duration, adjusting for sociodemographic, lifestyle, occupational, and physical factors.

Compared with never smokers, exclusive heated tobacco product users, dual users, and exclusive cigarette smokers had higher adjusted prevalence ratios (95% CIs) for difficulty initiating sleep: 1.59 (1.06-2.37), 1.63 (1.36-1.95), and 1.27 (1.03-1.57), respectively. For restless sleep, prevalence ratios were 1.47 (1.20-1.80), 1.33 (1.03-1.72), and 1.13 (0.87-1.45). Exclusive heated tobacco product users, dual users, and exclusive cigarette smokers had longer adjusted mean sleep latency (20.7, 21.9, 20.9 vs. 18.0 minutes, respectively). Sleep duration differed little across smoking groups.

Exclusive heated tobacco product use and dual use were associated with longer sleep latency and greater indicators of sleep disturbance among workers. Heated tobacco products may not represent a less harmful alternative for sleep.