Associations of cooking fuel types and daily cooking duration with sleep quality in rural adults: Effect modification of kitchen ventilation

Associations of combined different cooking fuel types and cooking duration with sleep quality were scarcely reported. This study aimed to explore the associations of exposure to household air pollution (HAP) from different cooking fuel types and cooking duration with sleep quality and examine the effect modification of kitchen ventilation on these associations.A total of 28,135 eligible participants were obtained from the Henan rural cohort study. Sleep quality was assessed by the Pittsburgh sleep quality index (PSQI), and participants with a PSQI score > 5 were identified as having poor sleep quality. A questionnaire was used to collect the cooking fuel types, cooking frequency, cooking duration, and kitchen ventilation. The average daily cooking duration was calculated as the cooking frequency per week multiplied by the cooking duration for each meal divided by 7.Both domestic fuel use and cooking duration were positively related to poor sleep quality. The solid fuel users with a cooking duration ≥1.5 h/day had a higher prevalence of poor sleep quality (OR: 1.390, 95% CI: 1.233, 1.567), relative to those who never cooked. Notably, the estimated OR and 95% CI for poor sleep quality of clean fuel users with a cooking duration <1.5 h/day plus mechanical or natural ventilation versus those who never cooked was 1.05 (0.933, 1.187) or 1.306 (1.163, 1.466) and these associations were modified by kitchen ventilation.Positive associations of combined different cooking fuel types and cooking duration with the prevalence of poor sleep quality were attenuated by kitchen ventilation, implying that installing mechanical ventilation may be an effective measure to improve sleep quality in low- and middle-income countries. These results need to be confirmed by future studies, which measure HAP more accurately using personal monitoring devices or behavior diaries.