Sleep Difficulties and Their Associations With Smoking Abstinence Among Adults Seeking Tobacco Cessation Treatment.

Abstract

In prior studies, sleep difficulties have been associated with lower likelihood of smoking cessation, although little is known about this relationship among people trying to quit smoking. This study aimed to examine the associations between pre-existing sleep difficulties and smoking cessation outcomes in adults seeking tobacco cessation treatment. Participants in a New Jersey statewide cessation program between November 2019 and July 2022 provided self-reported smoking abstinence at 1-month (n=2,919) and/or 7-month (n=1,471) follow-ups. Participants completed 3 items on sleep difficulties at baseline: difficulty sleeping (past and present) and insomnia as a withdrawal symptom. Multivariable logistic regression models estimated the associations between sleep difficulties and smoking cessation at each follow-up, controlling for sex, age, household income, ethnicity, and baseline heaviness of smoking index in 2024. At baseline, 3.6% of participants reported difficulty sleeping in the past, 20.1% reported difficulty sleeping in the present, and 14.6% experienced insomnia as a withdrawal symptom. Lower income, depression, anxiety, excessive alcohol and caffeine use, dual use, and identifying as male or Hispanic were associated with higher odds of pre-existing sleep difficulties (e.g., OR=4.30, 95% CI=3.66, 5.04). Sleep difficulty in the past was positively associated with nonabstinence at 1-month follow-up (AOR=2.95, 95% CI=1.28, 6.79) and 7 months (AOR=4.64, 95% CI=1.06, 20.23). There were no associations between the other 2 measures of sleep difficulties and cessation outcomes. Pre-existing sleep difficulties may be associated with lower short-term smoking abstinence among adults seeking tobacco cessation treatment. Addressing pre-existing sleep difficulties in smoking cessation interventions may enhance the chances of successful smoking cessation.