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Environmental tobacco smoke exposure and risk of habitual snoring in children: a meta-analysis
  1. Ke Sun,
  2. Yue Zhang,
  3. Yue Tian,
  4. Xiubo Jiang
  1. Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao, China
  1. Correspondence to Professor Xiubo Jiang, Department of Epidemiology and Health Statistics, The School of Public Health of Qingdao University, Qingdao 266021, China; jiangxiubo2005{at}


Background The association between environmental tobacco smoke (ETS) exposure and habitual snoring (HS) risk in children remains controversial. Therefore, a meta-analysis was carried out to evaluate and compare the effect of ETS by different family members and prenatal smoke exposure on the risk of HS in children.

Methods Relevant studies published in English were identified by a search of PubMed, Embase and Web of Science up to December 2017. Random effect model and fixed effect model were used to pool the findings. Restricted cubic splines were used to assess the dose-response relationship.

Results A total of 24 studies with 87 829 participants were included in the present meta-analysis. When comparing ETS exposed with non-ETS exposed, the pooled OR of HS were 1.46 (95% CI, 1.29 to 1.65) for household smoking exposure, 1.45 (95% CI, 1.27 to 1.65) for paternal smoking exposure, 1.87 (95% CI, 1.56 to 2.23) for maternal smoking exposure and 1.95 (95% CI, 1.63 to 2.34) for prenatal tobacco smoke exposure. For dose-response analysis, evidence of a linear association was found between household smoking exposure and HS, and the risk of HS increased by 2.1% (OR=1.02, 95% CI, 1.00 to 1.04, p=0.022) for every 1 cigarette/day increment of smoking by people living with children.

Conclusions This meta-analysis of observational studies indicates that exposure to ETS, in particularly prenatal tobacco smoke exposure and maternal smoking, is associated with an increased risk of HS.

  • meta analysis
  • child health
  • tobacco
  • environmental epidemiology
  • sleep

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  • Contributors KS and XJ had full access to the data and takes responsibility for the integrity and accuracy of the analysis. All authors approved the final version of the article to be published. KS and YZ designed the study and wrote the protocol. KS wrote the search strategy and undertook the literature searches and wrote the draft of the manuscript. KS and YZ undertook study screening, data extraction and quality assessment. KS and YT undertook all data analysis. All authors contributed to the interpretation of the findings. XJ provided critical revisions to the article.

  • Funding This study was supported by grants from the Natural Science Foundation of Shandong Province (ZR2015HM029).

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.