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Abstract

Introduction: Sleep is essential for children’s neurocognitive and physiological development, yet environmental factors like air pollution may contribute to sleep disturbances. While adult studies suggest such associations, research on pediatric populations remains limited. Given the rising global concern over air quality and the growing body of evidence linking environmental exposures to health outcomes, it is essential to describe the potential impacts of air pollution on children’s sleep, particularly in the context of climate change. The purpose of this SPAR project was to conduct a scoping review to explore and summarize the existing literature on the sleep outcomes of children 12 years of age and younger exposed to climate-related air pollution. Methods: A scoping review was conducted following the methodologies outlined by Arksey & O’Malley and Levac et al. A comprehensive search was performed across three databases: Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycInfo, along with relevant reference lists to identify studies that examine sleep outcomes in children under 12 years of age exposed to air pollution associated with climate change. Additionally, Google Scholar was searched for gray literature. Results: Fourteen studies published between 2008 and 2024 were included, with sample sizes ranging from 36 to 185,428 participants of predominantly school-aged children (12 years of age or younger). All studies employed quantitative methods, including questionnaires, healthcare databases, and air quality data, to investigate the association between air pollutants and sleep outcomes. Most studies were cross-sectional, with a mix of sampling techniques, and were conducted in both developed and developing countries. The review found consistent evidence linking ambient air pollution, particularly particulate matter (PM), ozone (O₃), and nitrogen dioxide (NO₂), with sleep disturbances in children, including disorders of initiating and maintaining sleep, disorders of excess somnolence, sleep-disordered breathing (SDB), and global sleep dysfunction. PM1, PM₂.₅, and O₃ were most strongly associated with impaired global sleep quality and disruptions across multiple sleep domains, with PM1 exposure increasing the risk for global sleep quality impairment by 53%. Gaseous compounds exposure, such as NO₂ and O₃, was also significantly associated with SDB symptoms in children. NO₂ increased the risk of SDB by 30%, while O₃ raised the risk of nocturnal wheeze by 69%. Moreover, combined pollutants, particularly from traffic emissions, were linked to SDB, with urban environments showing the most significant associations. Conclusions: Findings highlight strong associations between air pollution exposure and various sleep disturbances in children. While causality remains unclear, gaps in the literature suggest the need for further research using more rigorous methods, particularly regarding long-term impacts, subgroup analyses, and multi-pollutant exposures. The findings emphasize the importance of climate-informed nursing practices and policy reforms to reduce harmful emissions and protect children’s sleep health.