Late Breaking Abstract - The impact of electronic cigarette use on sleep disorders: Asystematic review and meta-analysis of novel data

<bold>Background:</bold> The prevalence of electronic cigarette (EC) usage has surged globally, raising concerns about its potential health impacts, including sleep disorders. <bold>Objective:</bold> To review systematically the relationship between EC use and sleep disorders, with a focus on sleep insufficiency and quality among EC and dual (EC and traditional cigarette) users. <bold>Methods:</bold> This study followed a registered protocol (PROSPERO ID: CRD42023413379). We conducted systematic searches in MEDLINE, EMBASE, PubMed, and LILACS up to December 21, 2023. We included randomized controlled trials and observational studies involving individuals aged 12-70 years who used ECs. Primary outcomes included objectively diagnosed sleep disorders (SD), while secondary outcomes assessed sleep quality via validated tools like the Pittsburgh Sleep Quality Index. Meta-analyses were performed using Review Manager 5.4.3, with odds ratios (ORs) as the primary measure of effect. Heterogeneity and publication bias were evaluated using I² statistics and Egger's test. <bold>Results:</bold> Seventeen studies, comprising 466,005 individuals, were included. Our meta-analysis found a significant association between EC use and increased prevalence of sleep insufficiency (SI) (OR=545.02, 95% CI: 498.24 to 596.19, P<0.001). Sensitivity analysis, excluding a large study, adjusted the OR to 17.05 (95% CI: 12.95 to 23.65, P<0.001) with reduced heterogeneity (I²=70%). Dual users also showed heightened SI (OR=66.92, 95% CI: 53.33 to 83.97, P<0.001). The GRADE assessment indicated moderate to high quality for most studies. <bold>Conclusions:</bold> The findings highlight the need for targeted interventions to address sleep health in EC users.