Association between exposure to heavy metals in atmospheric particulate matter and sleep quality: A nationwide data linkage study

Abstract

Background: Recent studies have demonstrated that long-term exposure to particulate matter (PM) is associated with poor sleep quality. However, no studies have linked PM constituents, particularly heavy metals, to sleep quality. Objective: This study investigated the association between exposure to heavy metals in PM and sleep quality. Methods: We obtained nationwide data from the Korean Community Health Survey conducted in 2018 among adults aged 19-80 years. Sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI). Poor sleep quality was defined as PSQI >= 5. One-year and three-month average concentrations of heavy metals (lead, manganese, cadmium, and aluminum) in PM with diameter <= 10 mu m were obtained from nationwide air quality monitoring data and linked to the survey data based on individual district-level residential addresses. Logistic regression analyses were performed after adjusting for age, gender, education level, marital status, smoking status, alcohol consumption, history of hypertension, and history of diabetes mellitus. Results: Of 32,050 participants, 17,082 (53.3%) reported poor sleep quality. Increases in log-transformed oneyear average lead (odds ratio, 1.14; 95% confidence interval, 1.08-1.20), manganese (1.31; 1.25-1.37), cadmium (1.03; 1.00-1.05), and aluminum concentrations (1.17; 1.10-1.25) were associated with poor sleep quality. Increases in log-transformed three-month average manganese (odds ratio, 1.13; 95% confidence interval, 1.09-1.17) and aluminum concentrations (1.28; 1.21-1.35) were associated with poor sleep quality. Conclusion: We showed for the first time that exposure to airborne lead, manganese, cadmium, and aluminum were associated with poor sleep quality. This study may be limited by self-reported sleep quality and districtlevel exposure data.