Electronic cigarettes (e-cigarettes) are devices that vaporize a liquid containing nicotine, flavorings, and other chemicals, simulating a smoking-like experience without combustion (1). Initially marketed as a safer alternative to traditional tobacco products, e-cigarettes have gained significant popularity (2, 3). However, increasing evidence suggests that their use may be associated with various health issues. Research has highlighted potential risks associated with exposure to e-cigarette aerosols, including impacts on pulmonary function, cardiovascular well-being, and sleep quality (4–7).

Research indicates that nicotine, a primary component in most e-cigarettes, disrupts sleep patterns due to its stimulating properties, leading to difficulty falling asleep and maintaining restful sleep (8, 9). In addition, inhaling e-cigarettes may affect lung function and cause oxidative stress, further contributing to impaired sleep quality (10, 11). Research indicates that e-cigarette use is associated with negative sleep outcomes, including inadequate sleep duration and trouble sleeping. The use of e-cigarettes has been linked to negative effects on sleep health, including increased odds of inadequate sleep duration and trouble sleeping. Research indicates that both current and former e-cigarette users experience significant sleep disturbances compared to non-users. Current e-cigarette users are 1.82 times more likely to experience shorter sleep durations than non-users (12). Among young adults, exclusive e-cigarette users have an increased odds of inadequate sleep duration after adjusting for various co-variates (13). Dual users of e-cigarettes and conventional tobacco report increased sleep latency, taking longer to fall asleep (14). In addition to that, e-cigarette users have reported greater sleep difficulties and a higher reliance on sleep medications compared to non-users (15).

The association between e-cigarette use and poor sleep health is explored by some studies with varying results (16). However, some research suggests that individual factors may influence this relationship, highlighting the complexity of interactions between e-cigarette use and sleep health (15, 16). Despite their growing use, the long-term impact of e-cigarettes on sleep remains understudied, and further research is needed to understand the extent of these disturbances.

A systematic review on this topic has not yet been conducted. Therefore, this systematic review and meta-analysis aim to bridge this research gap by examining the existing literature on the link between e-cigarette use and sleep disturbances. Through the synthesis of findings from various studies, the analysis seeks to offer a detailed understanding of this association. The findings are anticipated to offer valuable insights into the potential psychosocial risks associated with e-cigarette use, laying the groundwork for further studies and informing policymakers and healthcare providers in mitigating the harmful effects of e-cigarette usage.

This systematic review and meta-analysis complied with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to guarantee both clarity and comprehensiveness in its reporting methodology (Supplementary Table S1). The primary goal was to systematically evaluate and consolidate the current evidence on the correlation among e-cigarette usage, sleep duration, sleep disturbances, and insomnia. Additionally, this review has been pre-registered in the PROSPERO.

The results of this study offer substantial documentation of a strong link between e-cigarette use and an increased risk of sleep disturbances, including shorter sleep duration, extended sleep latency, and reduced sleep quality. This is particularly concerning given the growing popularity of e-cigarettes, especially among adolescents and young adults. Our analysis shows that e-cigarette users are 39.1% more likely to suffer from inadequate sleep duration. These findings were consistently observed across studies involving both the general population and younger groups, suggesting that the connection between e-cigarette use and sleep problems is widespread and not limited to specific subpopulations.

Sleep is critical for both the physical and mental health of individuals, influencing nearly all aspects of a person’s life either directly or indirectly. Sleep has been given equal importance as healthy diet and physical workout for the better health of individuals (30). Researchers have emphasized the need of promoting importance of sleep health at community level globally (31). Inadequate sleep can affect the immune system thus making sleep deprived individuals more prone to various disease and infections (32, 33). Inadequate sleep for a longer duration can affect mental health of an individual leading to more depression and other related problems (34) Sleep is vital to maintain optimal health and proper day to day functions in our life. As proper sleep is crucial to maintain good health and functioning of body, any sleep related disturbance can not only effect normal physiological functioning of body but also affect various other aspects of individual’s life. Deficiency of sleep can affect productivity and economic growth of individual as well as the nation (35). Lack of adequate sleep can also lead fatigue and thus more road traffic accidents (36). The amount of sleep required for optimal health varies between individuals and is influenced by factors such as age and sociodemographic characteristics. Generally, 7 or more hours of sleep per night is considered necessary for maintaining good health (37). Insufficient sleep can lead to depression and physical activities/health is also affected (28, 38).

E-cigarette use, commonly referred to as vaping, has gained popularity over the past decade, particularly among adolescents and young adults. Recent research has begun to explore the potential health impacts of vaping, including its association with sleep disturbances. Electronic cigarettes, initially promoted as an alternative to conventional cigarettes, have been repeatedly shown to pose significant risks to physical, physiological and mental health (6, 26, 39). Nicotine, the primary addictive component of most e-cigarettes, is a stimulant that affects sleep quality. Nicotine activates β2-containing nAChRs, which are crucial for regulating sleep–wake cycles and micro-arousals. This activation can lead to increased wakefulness and disrupted sleep patterns (40, 41). In studies, nicotine exposure has been shown to diminish protective arousal responses during sleep, exacerbating conditions like sleep-disordered breathing (42). Smokers exhibit higher nocturnal hypoxia indices, indicating that e-cigarette use may similarly impair oxygen saturation during sleep, potentially leading to sleep apnea (43). The correlation between smoking intensity and decreased nocturnal oxygen saturation suggests that e-cigarette users may experience similar respiratory disturbances (44). While causality has yet to be fully established, the data suggest that the stimulant effects of nicotine combined with the other potential irritants in e-cigarette vapor may play a role in negatively affecting sleep. A dose–response relationship exists, where increased smoking correlates with heightened sleep disturbances, including snoring and short sleep (45, 46).

Our study demonstrates that e-cigarette use is associated with various sleep-related disturbances, including reduced sleep duration, increased sleep latency, poor sleep quality, and insomnia. The findings reveal a notable association between e-cigarette use and reduced or insufficient sleep duration, comparable to the harmful effects associated with traditional cigarette smoking (15). Even irregular e-cigarette users experience negative impacts on sleep, including shortened sleep duration and altered sleep quality. Sleep quality encompasses four key attributes: sleep efficiency, sleep latency, sleep duration, and wakefulness after sleep onset. Multiple studies have consistently reported decreased sleep duration and overall poorer sleep quality among e-cigarette users sleep (15, 47). Furthermore, e-cigarette users are more likely to use medications to aid sleep, and conditions such as insomnia and parasomnias are more prevalent in this group compared to non-users (22, 24, 48). Given the critical role of sleep in maintaining overall health, these findings emphasize the need for targeted interventions to reduce e-cigarette use and raise awareness about its impact on sleep health.

A key strength of our study is that significant associations were observed between e-cigarette use and sleep disturbances for most outcomes, with the exception of OSA, where findings were inconclusive. The consistency of the included studies is homogenous. Most of the included studies are of good quality. Our study has some limitations. A key limitation of this review is the reliance on cross-sectional studies, which limits the ability to establish temporality or causality between e-cigarette use and sleep disturbances. The cross-sectional nature of the included studies limits the ability to fully account for these confounders. While some studies adjusted for covariates like age, sex, and smoking status, residual confounding from unmeasured factors, such as psychological conditions or socioeconomic disparities, may persist. The absence of experimental studies in the literature highlights a critical gap, and future research should consider longitudinal or, where ethically feasible, experimental designs to better elucidate the causal pathways. Most of the studies are based in the United States, which may restrict the applicability of the results to populations in other regions. The potential for publication bias also raises concerns regarding the validity of the results. Our analysis might have overlooked important demographic factors that might impact the link between e-cigarette use and sleep disturbances, factors like economic background or underlying psychological conditions.

E-cigarettes are often considered as an alternative to conventional cigarettes; however, they are not devoid of harmful effects. Our study clearly highlighted the association between use of e-cigarettes and sleep related disturbances. Adequate sleep is fundamental to overall health and influences various aspects of life, both professional and personal. The use of e-cigarettes should be regulated, with increased public health initiatives and policy interventions aimed at reducing their consumption. Future longitudinal and, where feasible, experimental studies are warranted to establish temporality and causality, addressing the current reliance on observational data accounting for potential confounders, sociodemographic and lifestyle factors.