Per- and polyfluoroalkyl substances and sleep health in U.S. adults, NHANES 2005-2014

Pengfei Guo; Zhihao Jin; Giselle Bellia; Jiajun Luo; Kosuke Inoue; Krystal J Godri Pollitt; Nicole C Deziel; Zeyan Liew

doi:10.1016/j.envres.2023.117092

Per- and polyfluoroalkyl substances and sleep health in U.S. adults, NHANES 2005-2014

Environ Res. 2023 Nov 15;237(Pt 2):117092. doi: 10.1016/j.envres.2023.117092. Epub 2023 Sep 6.

Authors

Pengfei Guo¹, Zhihao Jin², Giselle Bellia³, Jiajun Luo⁴, Kosuke Inoue⁵, Krystal J Godri Pollitt⁶, Nicole C Deziel⁷, Zeyan Liew⁸

Affiliations

¹ Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA; Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, USA. Electronic address: pengfei.guo@yale.edu.
² Gangarosa Department of Environmental Health, Rollins School of Public Health, Emory University, USA. Electronic address: zhihao.jin@emory.edu.
³ Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, USA. Electronic address: giselle.bellia@yale.edu.
⁴ Institute for Population and Precision Health, University of Chicago, USA. Electronic address: jluo3@bsd.uchicago.edu.
⁵ Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Japan. Electronic address: koinoue@ucla.edu.
⁶ Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA; Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, USA. Electronic address: krystal.pollitt@yale.edu.
⁷ Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA; Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, USA. Electronic address: nicole.deziel@yale.edu.
⁸ Department of Environmental Health Sciences, Yale School of Public Health, New Haven, USA; Yale Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, USA. Electronic address: zeyan.liew@yale.edu.

PMID: 37683785
DOI: 10.1016/j.envres.2023.117092

Abstract

Background: Per- and polyfluoroalkyl substances (PFAS) are synthetic chemicals that induce oxidative inflammatory responses and disrupt the endocrine and central nervous systems, all of which can influence sleep.

Objective: To investigate the association between PFAS exposure and sleep health measures in U.S. adults.

Methods: We analyzed serum concentration data of four PFAS [perfluorooctane sulfonic acid (PFOS), perfluorooctanoic acid (PFOA), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA)] reported for 8913 adults in NHANES 2005-2014. Sleep outcomes, including trouble sleeping, having a diagnosis of sleep disorder, and recent daily sleep duration classified as insufficient or excessive sleep (<6 or >9 h/day) were examined. Weighted logistic regression was used to estimate the association between the sleep outcomes and each PFAS modeled continuously (log2) or in exposure tertiles. We applied quantile g-computation to estimate the effect of the four PFAS as a mixture on the sleep outcomes. We conducted a quantitative bias analysis to assess the potential influence of self-selection and uncontrolled confounding.

Results: We observed some inverse associations between serum PFAS and trouble sleeping or sleep disorder, which were more consistent for PFOS (e.g., per log2-PFOS (ng/ml) and trouble sleeping OR = 0.93, 95%CI: 0.89, 0.98; sleep disorder OR = 0.89, 95%CI: 0.83, 0.95). Per quartile increase of the PFAS mixture was inversely associated with trouble sleeping and sleep disorder. No consistent associations were found for sleep duration across analyses. Our bias analysis suggests that the finding on sleep disorder could be explained by a moderate level of self-selection and negative confounding effects.

Conclusions: We found no evidence to suggest exposure to four legacy PFAS worsened self-reported sleep health among U.S. adults. While some inverse associations between specific PFAS and sleep disorder were observed, self-selection and uncontrolled confounding biases may play a role in these findings.

Keywords: Endocrine disruptors; Environmental pollution; Perfluorochemicals; Sleep wake disorders.