Is there an association between anthropogenic heat flux and sleep problems among children? Findings from a multicity study in China

As a significant factor in climate change, the negative impact of anthropogenic heat flux (AHF) on human health has garnered considerable attention. However, evidence of the associations between AHF and sleep problems is limited. This study aims to explore the associations between AHF and sleep problems in children. We conducted a cross-sectional investigation involving 187,448 children aged 6-18 years across 14 cities in China from April 2012 to May 2018. We utilized the Sleep Disturbance Scale for Children adapted for Chinese children to assess sleep problems. Socio-economic data, remote sensing of nighttime light and vegetation, and energy consumption were utilized to evaluate participants' exposure to AHF. Mixed-effects models were employed to explore the associations. After adjusting for social demographic and behavioral factors, each standard deviation (SD) increase in total AHF was associated with a β (95% confidence interval) of 3.27 (3.21, 3.33) for total t-score and an odds ratio (95% confidence interval) of 1.90 (1.84, 1.95) for sleep disorders. In addition, these associations were stronger in girls, children not exclusively breastfed, those engaging in less daily exercise, or residing in proximity to major roads. We concluded that AHF was significantly associated with increased risk of sleep problems.