Joint effects of contaminants of emerging concern (CECs) on sleep quality in Chinese elderly: A Bayesian kernel machine regression and quantile g-computation analysis

Despite their trace concentrations in the environment, contaminants of emerging concern (CECs) pose potential risks to human health, particularly for vulnerable populations like the elderly. However, current research provides limited insight into the relationship between CECs and sleep quality in older adults. The current study involved 3096 seniors aged 60 and above through face-to-face interviews. Urine samples were collected to biomonitor 50 CECs. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). To study the association between CECs and sleep quality, multivariable logistic and multi-pollutant exposure models were utilized. At least one of the 50 CECs was detected, with more than half of urine samples containing five antibiotic categories and 11 other CECs. In the multivariable logistic analysis, azithromycin, sulfamonomethoxine, lincosamides, and N, N-diethyl-m-toluamide (DEET) were positively linked with reduced sleep quality, with odds ratios (ORs) varying from 1.17 to 1.38. When all of the target CECs were elevated to the 60th percentile or above compared to median values, Bayesian kernel machine regression (BKMR) analysis revealed a significant combined association of five antibiotic categories and five other individual CECs with poor sleep quality. DEET, tetracyclines, lincosamides, acetaminophen and metformin exhibited positive risk trends, whereas other CECs showed flat or modest inverse risk trends. Quantile g-computation (Qgcomp) regression analysis identified a significant adverse combined association between the five antibiotic categories and five other CECs and sleep quality (OR=1.21, 95% CI: 1.05-1.38). DEET, tetracyclines, acetaminophen, lincosamides, macrolides, sulfonamides, metformin, and cotinine each presented positive associations with poor sleep quality, with DEET, tetracyclines, and acetaminophen contributing the higher weights (0.308, 0.229, and 0.220, respectively). Exposure to certain CECs-particularly DEET, tetracyclines, and acetaminophen-was associated with sleep disturbances in an elderly Chinese population. Public health interventions targeting environmental CECs and medication management are warranted.