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Volume 15 No. 10
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Accepted Papers

Scientific Investigations

Cumulative Childhood Lead Levels in Relation to Sleep During Adolescence

Erica C. Jansen, PhD, MPH1,2; Galit Levi Dunietz, PhD, MPH2; Aleena Dababneh, BS2; Karen E. Peterson, ScD1; Ronald D. Chervin, MD, MS2; Jonggyu Baek, PhD3; Louise O’Brien, PhD, MS2; Peter X.K. Song, PhD4; Alejandra Cantoral, ScD5; Howard Hu, ScD, MS, MPH, MD6; Martha M. Téllez-Rojo, ScD7
1Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan; 2Division of Sleep Medicine, Department of Neurology, University of Michigan, Ann Arbor, Michigan; 3Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; 4Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; 5CONACYT, National Institute of Public Health, Cuernavaca, Mexico; 6Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, Washington; 7Center for Research on Nutrition and Health, National Institute of Public Health, Cuernavaca, Mexico

Study Objectives:

Lead exposure has been linked to adverse cognitive outcomes among children, and sleep disturbances could potentially mediate these relationships. As a first step, whether childhood lead levels are linked to sleep disturbances must be ascertained. Prior studies of lead and sleep are scarce and rely on parent-reported sleep data.


The study population included 395 participants from the Early Life Exposure in Mexico to Environmental Toxicants project, a group of sequentially enrolled birth cohorts from Mexico City. Blood lead levels measured from ages 1 to 4 years were used to calculate a cumulative measure of early childhood lead levels. Average sleep duration, sleep fragmentation, and movement index were assessed once between the ages of 9 and 18 years with wrist actigraphs worn for a continuous 7-day interval. Linear regression models were fit with average sleep duration, fragmentation, or movement as the outcome and cumulative lead levels divided into quartiles as the exposure, adjusted for age, sex, and maternal education.


Mean (standard deviation) age at follow-up was 13.8 (1.9) years, and 48% of participants were boys. Median (interquartile range) cumulative childhood lead level was 13.7 (10.8, 18.0) μg/dL. Patients in the highest quartile of the cumulative childhood lead group had on average 23 minutes less sleep than those in the first quartile in adolescence (95% confidence interval [7, 39]; P, trend = .02). Higher cumulative lead level was associated with higher sleep fragmentation in younger adolescents (younger than 14 years) only (P, interaction = .02).


Shorter sleep duration may represent an as-yet unrecognized adverse consequence of lead exposure in youth.


Jansen EC, Dunietz GL, Dababneh A, Peterson KE, Chervin RD, Baek J,O'Brien L, Song P, Cantoral A, Hu H, Téllez-Rojo MM. Cumulative childhood lead levels in relation to sleep during adolescence. J Clin Sleep Med. 2019;15(10):1443–1449.

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