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El papel potencial del vaping como factor de riesgo en el desarrollo o exacerbación de cefaleas, insomnio, ansiedad y depresión en la población adulta joven

El papel potencial del vaping como factor de riesgo en el desarrollo o exacerbación de cefaleas, insomnio, ansiedad y depresión en la población adulta joven

Autora principal: María Hinojosa Andonegui

Vol. XIX; nº 16; 605

Potential role of vaping as a risk factor in the onset or exacerbation of cephalalgia, insomnia, anxiety, and depression among the young adult population

Fecha de recepción: 19/07/2024

Fecha de aceptación: 16/08/2024

Incluido en Revista Electrónica de PortalesMedicos.com Volumen XIX. Número 16 Segunda quincena de Agosto de 2024 – Página inicial: Vol. XIX; nº 16; 605

Autores:

María Hinojosa Andonegui1, Natalia Coello Niembro2, Rodrigo Martínez Espinosa3 y Gisselle Vanessa González Hernández4.

1,2,3 Facultad Mexicana de Medicina, Universidad La Salle. Ciudad de México, México.

4Doctorante en ciencias de la salud, Universidad Anáhuac Norte, Estado de México, México

Los autores de este manuscrito declaran que:

Todos ellos han participado en su elaboración y no tienen conflictos de intereses.

La investigación se ha realizado siguiendo las Pautas éticas internacionales para la investigación relacionada con la salud con seres humanos elaboradas por el Consejo de Organizaciones Internacionales de las Ciencias Médicas (CIOMS) en colaboración con la Organización Mundial de la Salud (OMS).

El manuscrito es original y no contiene plagio.

El manuscrito no ha sido publicado en ningún medio y no está en proceso de revisión en otra revista.

Han obtenido los permisos necesarios para las imágenes y gráficos utilizados.

Han preservado las identidades de los pacientes.

Abstract

The use of vaping as an alternative to quitting tobacco smoking has remained a controversial issue. Not only has vaping popularity increased, but also the occurrence of cephalalgia, insomnia, anxiety, and depression.

Objective: The objective of this study is to investigate a potential association between vaping and specific neuropsychiatric symptoms among the young adult population, considering the concurrent rise in both vaping and neuropsychiatric entities.

Material and methods: A cross-sectional study was made, that included 102 individuals aged between 18 and 30, comprising both vape smokers and non-smokers, individuals with and without a history of tobacco use, and people exhibiting and not exhibiting cephalalgia, insomnia, anxiety, and depression symptoms. The research was made through a survey of 20 questions that collected demographic data, information associated with vape and tobacco consumption, and data related to neuropsychiatric symptoms.

Results: The majority of the participants were aged 21-23, with 68 females and 34 males. The 47.1% of the surveyed were vape smokers. Daily vape consumption varied, but the predominant percentage of nicotine was 4-5%. For non-vapers, 66.7% experienced cephalalgia monthly of which 70.2% reported mild intensity, and 46.3% reported sleep disturbances. Among vapers, 52.2% had monthly cephalalgia of which almost a third classify it as moderate intensity, and 63% experienced insomnia or somnolence. Both groups showed varying neuropsychiatric symptoms, however vapers showed higher prevalence of certain symptoms.

Conclusions: Vaping use has increased dramatically in recent years paralleled by a notable rise in the occurrence of neuropsychiatric conditions. It is important to research the potential correlation between these phenomena, since it can offer valuable insights for the development of guiding regulations and influencing society perspectives on vaping.

Keywords: vape, cephalalgia, insomnia, anxiety, depression.

Resumen

El uso del vape como alternativa del tabaco es un tema controvertido. Actualmente, no sólo ha aumentado la popularidad del vape, sino también la incidencia de cefaleas, insomnio, ansiedad y depresión.

Objetivo: Investigar una asociación potencial entre el vapeo y síntomas neuropsiquiátricos en la población adulta joven, considerando el aumento simultáneo de ambos.

Materiales y métodos: Se realizó un estudio transversal que incluyó a 102 personas con edades comprendidas entre los 18 y 30 años, incluyendo fumadores y no fumadores de vapeo, personas con y sin antecedentes de consumo de tabaco, y personas con o sin síntomas de cefalea, insomnio, ansiedad o depresión. El estudio se realizó a través de una encuesta de 20 preguntas en la que se recopilaron datos demográficos, información asociada al consumo de vape, y datos relacionados con síntomas neuropsiquiátricos.

Resultados: La mayoría de los participantes tenían entre 21 y 23 años. 68 fueron mujeres y 34 hombres. El 47,1% de los encuestados eran fumadores de vape. El consumo diario de vape varió, pero el porcentaje predominante de nicotina fue de 4-5%. En los no vapeadores, 66,7% experimentó cefalalgia mensual, de los cuales 70,2% la clasifica de intensidad leve, y 46,3% informó alteraciones del sueño. Entre los vapeadores, 52,2% padecía cefalalgia mensual de los cuales un tercio la clasifica como intensidad moderada, y 63% experimentaba insomnio o somnolencia. Ambos grupos mostraron síntomas neuropsiquiátricos variables; sin embargo, los vapeadores mostraron una mayor prevalencia de ciertos síntomas.

Conclusiones: El uso del vape ha aumentado drásticamente en los últimos años, en paralelo con un aumento notable de afecciones neuropsiquiátricas. Es importante investigar una posible correlación entre estos fenómenos, ya que puede ofrecer información valiosa para el desarrollo de regulaciones gubernamentales e influir en las perspectivas de la sociedad sobre el vapeo.

Palabras clave: vape, cefalea, insomnio, ansiedad, depresión.

Introduction

The use of vaping as a substitute for quitting tobacco smoking has been a subject of controversy for years. Electronic cigarettes entered the market in 2003 in China, and later entered the market in other countries. (1) At first, they were regarded as a safer alternative to tobacco, as there has been no conclusive evidence establishing a direct link between vaping and cancer (2). Nevertheless, various studies have demonstrated harmful effects of vaping consumption in several systems including the lungs, the central nervous system, and the immune system. The prevalence of vaping consumption has dramatically increased in recent years, and the prevalence is highest among young adults, aged 18 to 24 years. (3)

Electronic cigarettes

Electronic cigarettes, also known as vapes, are nicotine delivery systems composed of a cartridge, liquid, an atomizer, and a battery; when the smoker draws, the atomizer heats the liquid which creates an aerosol that mimics tobacco smoke. (4)  The number of draws someone can get from a device before it runs out of liquid, battery power or both is known as puff, hit or toke count. (4) The liquid in most electronic cigarettes contains nicotine, flavorings and propylene glycol or glycerol. (5,6).

Many chemical substances can be contained in these devices that have a potential negative impact on the health of those who inhale them, but nothing can be concluded because of the variety of flavoring options and brands that contain different chemical substances. However, a meta-analysis of forty-four articles on the health effects of electronic cigarettes found that propylene glycol and glycerol can cause mouth and throat irritation, dry cough, and impact the immune system by increasing lymphocyte and granulocyte counts, as well as levels of interleukins, epidermal growth factor, and tumor necrosis factor alpha. (7)

Because these smoking devices haven’t been present as long as cigarettes, the information regarding the impact on different body systems and carcinogenesis is extremely limited (8, 9). They may provide a less harmful source of nicotine than traditional cigarettes, but evidence of decreased harm with long-term use is not available, and nicotine itself has shown to have significant adverse health effects. (7).

Pathophysiological effects of nicotine

Nicotine is an alkaloid obtained from different types of plants, including the tobacco plant, and binds to the nicotinic cholinergic receptors. Many people turn to electronic cigarettes as a ‘healthier’ alternative to traditional cigarettes, but they still contain nicotine and therefore, their health effects should be considered.

When nicotine is inhaled through tobacco or vape, it binds to cholinergic receptors in the lungs. The activation of these can inhibit CFTR ion channels, producing denser mucus and therefore causing stasis, inflation, and lung damage. (10) Furthermore, chronic nicotine consumption increases the destruction of neutrophils, leading to the release of their intracellular proteases which also damage the lungs, contributing to inflammation, chronic cough, bronchiectasis, and emphysema. After inhalation, nicotine is systemically absorbed and can cross the blood-brain barrier. When entering the brain, it forms connections with neurons within the mesolimbic system, triggering the nucleus accumbens to release dopamine. This nucleus role is to categorize sensations as either positive or negative. (11)

In an opposite way, the chronic consumption of nicotine has shown an inverse effect in dopamine production. Studies carried out in rodents have shown that chronic nicotine consumption decreases the release of dopamine, and therefore, it decreases the brain reward system, resulting in symptoms such as depression, reduced responsiveness to stimuli, disruptions in sleep patterns, heightened activity in the locomotor system, and a decrease in body temperature. (11)

Material and methods:

A cross-sectional study was conducted; it includes 102 individuals aged between 18 and 30, comprising both vape smokers and non-smokers, individuals with and without a history of tobacco use, and people exhibiting or lacking symptoms associated with cephalalgia, insomnia, anxiety, and depression. The research was made through an electronic survey consisting of 20 questions distributed across three blocks.

The first block included 4 questions with basic demographic inquiries such as age, biological sex and occupation.

The second block consisted of 4 questions, and was exclusive to individuals who had engaged in vape smoking at any point in their lives. This section delved into details concerning concurrent or past tobacco use (previously smoked, currently smokes or has never smoked tobacco), how many years has the user consumed vaping products (less than a year, 1-5, years, 5-10 years or over 10 years), the nicotine vape percentage (0%, 1-3%, 4-5% or over 5%), and the approximate daily puff consumption (less than 10, 10-30, 30-50 or greater than 50).

The last block comprised 10 questions focused on neuropsychiatric symptoms. Concerning cephalalgia, participants were asked about existing medical diagnoses (migraine, tensional cephalalgia or no previous diagnoses), frequency in days per month (3-5, 5-10, 10-20 or more than 20) and intensity (mild: doesn’t interfere with my daily activities, moderate: interferes with my daily activities but does not stop me from doing them, or severe: stops me from doing my daily activities). For insomnia, it was asked the average daily sleep duration (less than 6 hours, 6-8 hours or more than 8 hours), difficulties in initiating or maintaining sleep (takes longer than 30 minutes to fall asleep, wakes up mid-sleep and is able to go back to sleep, or wakes up mid-sleep and is unable to go back to sleep), and the frequency of these symptoms per week (0-2 times per week or over 3 times per week). (12) Depression symptoms were investigated by asking participants to select, from a provided list, symptoms experienced daily or almost daily over the past two weeks. This list included a feeling of sadness for most of the day, lack of interest in activities that were previously pleasant, changes in appetite, insomnia or excessive sleepiness, agitation, fatigue, a, excessive feeling of uselesness or guilt, difficulty making decisions, lack of concentration or ability to think and recurring thoughts of death, suicidal ideas, planning suicide or a suicide attempt. Finally, to assess anxiety symptoms, participants were asked if they have difficult-to-control worries (yes or no answer), the weekly frequency of such worries (3 or less or 4-7), and the presence of three or more symptoms from a designated anxiety related list, which included agitation, nervousness, easy fatigability, difficulty focusing, irritability, muscular tension and sleep disorders. (13) Importantly, all neuropsychiatric symptom questions were structured based on the diagnostic criteria outlined in the DSM-V. (14) It is crucial to emphasize that this study does not aim to establish a link between vaping and punctual neuropsychiatric diagnoses, but rather seeks to explore the relationship between the symptoms of these four entities with vape consumption.

Results

A total of 102 subjects were enrolled in this study, of which the age distribution was the following: 15.7% of individuals are aged 18 to 20 years, 63.7% are aged 21 to 23 years, 14.7% are aged 23 to 25, 3.9% are aged 26 to 28 and 2% are aged 29 to 30. The majority of the sample is constituted by females (66.7%). 80.4% of participants listed their occupation as students, whilst 10.8% of individuals are employed and 8.8% are both students and employed. The population of vape smokers represented 47.1% of the sample.

Concerning vape- smoking participants, 22.9% stated that they smoke tobacco as well as vape, 41.7% declared that they smoked tobacco but currently only smoke vape, and 22.9% have never smoked tobacco. The majority of the vape-consuming sample, representing 81.3% of said study group, started smoking vape between 1 and 5 years ago; the next most popular answer, representing 14.6%, started smoking vape less than a year ago, and only 4.2% started smoking 5 to 10 years ago. The most common percentages of nicotine that the participants consume while vaping are 4 to 5% and 1 to 3%, representing 64.6% and 33.3%, respectively. There was quite an even distribution regarding how many hits people consume on a daily basis: 29.2% estimate that they smoke 30 to 50 hits per day, 25% smoke less than 10 hits , 22.9% smoke 10 to 30 and 22.9% smoke over 50 hits per day.

Demographic data and vape and tobacco consumption habits are summarised in tables 1 and 2, respectively (shown at the end of the article).

Neuropsychiatric symptoms in people who don’t consume vape

Study results indicate that 66.7% of participants experience cephalalgia once or less than once a month, followed by 24.6% who experience this symptom 3 to 5 times per month. The remaining percentage was distributed between 5 to 10, 10 to 20 and more than 20 times per month. 70.2% refer to the intensity of the cephalalgia as mild, meaning it doesn’t interfere with their normal  activities, whereas 26.3% responded that the intensity is moderate, so it interferes with their normal activities but doesn’t stop them from completing them. Only 3.5% consider their pain to be severe, which prevents them from carrying out normal tasks. We asked our participants if they had a previous medical diagnosis regarding cephalalgia: 89.5% answered that they don’t have one and 8.8% are diagnosed with migraine. The most common response for the average hours of sleep participants get per day was 6 to 8 hours, representing 68.4%, whilst 28.1% of people sleep less than 6 hours a day and 3.5% of individuals sleep more than 8 hours per day. 75.4% of people responded that they don’t have trouble sleeping, 10.5% of individuals have trouble falling asleep, taking them over 30 minutes to fall asleep, 8.8% of individuals have trouble staying asleep and wake up during the night, and 5.3% of individuals wake up before than expected and aren’t able to fall asleep again. 93% of participants experience these sleep alterations 0 to 2 times per week and 7% experience them 3 or more times per week. The participants were asked to state which of the following symptoms they presented almost daily in the 2 weeks previous to their response, and the responses were the following: A) a feeling of sadness for the majority of the day: 22.2%, B) loss of interest in activities thay they previously enjoyed: 20.4%, C) changes in appetite: 31.5%, D) insomnia or excessive somnolence during the day: 40.7%, E) agitation: 14.8%, F) fatigue: 51.9%, G) feeling of uselessness or excessive guilt: 22.2%, H) loss of ability to concentrate or difficulty making decisions: 46.3% and I) recurring thoughts of death, suicide, planning or attempting a suicide: 5.6%. 35.1% of participants consider that they have a constant feeling of anguish that they find hard to control; 78.9% present this feeling 0 to 3 days per week and 21.1% present it 4 to 7 days per week. Finally, the participants were given the following list of symptoms, corresponding to anxiety, and answered how many of them they have presented in the 6 months previous to the survey: agitation, nervousness, excessive fatigue, difficulty concentrating, irritability, muscle tension and sleep disorders. 59.6% presented 0 to 2 symptoms and 40.4% of participants presented 3 or more symptoms.

Neuropsychiatric symptoms in people who consume vape

Data from the survey revealed that 52.2% of participants who vape present cephalalgia once a month or less, 23.9% present this symptom 3 to 5 times per month, 19.6% present it 5 to 10 times per month and 4.3% present it 10 to 20 times per month. 65.2% of participants refer to the intensity of the pain as mild and 34.8% describe it as moderate according to the previous definitions of intensity; no participants described their pain as severe. 23.9% of participants are diagnosed with migraine, and the rest of the individuals don’t have a medical diagnosis regarding cephalalgia. 65.2% of people in this group get 6 to 8 hours of sleep per night, 28.3% sleep less than 6 hours and 6.5% sleep over 8 hours. 54.3% of individuals stated that they don’t have any sleep alterations, 30.4% have trouble falling asleep, 13% have trouble remaining asleep and 2.2% wake up earlier than expected and can’t fall back asleep. 71.7% of individuals present these alterations 0 to 2 times per week, whilst 28.3% present them 3 or more times per week. Once again, the participants were asked to state which of the following symptoms they presented almost daily in the 2 weeks previous to their response, and the responses were the following: A) a feeling of sadness for the majority of the day: 34.8%, B) loss of interest in activities thay they previously enjoyed: 39.1%, C) changes in appetite: 50%, D) insomnia or excessive somnolence during the day: 63%, E) agitation: 23.9%, F) fatigue: 43.5%, G) feeling of uselessness or excessive guilt: 43.5%, H) loss of ability to concentrate or difficulty making decisions: 52.2% and I) recurring thoughts of death, suicide, planning or attempting a suicide: 17.4%. 54.3% of participants consider that they have a constant feeling of anguish they find hard to control; 78.3% present this feeling 0 to 3 days per week and 21.7% present it 4 to 7 days per week. The participants were given the same list of symptoms corresponding to anxiety, as detailed above, and answered how many of them they have presented in the 6 months previous to the survey: 56.5% presented 0 to 2 symptoms and 43.5% of participants presented 3 or more symptoms.

The prevalence of neuropsychiatric symptoms in both the control group and the group that smokes vape is summarized in tables 2 to 5 (shown at the end of the article).

Discussion

The purpose of this study is to investigate how frequently certain neuropsychiatric symptoms are found among the young adult vaper population, considering the concurrent rise in both vaping and neuropsychiatric entities. The aim is to identify if symptoms such as cephalalgia, sleep alterations, depression, and anxiety occur more frequently among people who vape compared to those who do not. The population included only people aged 18 to 30, with no other exclusion criteria. All of the questions included in the survey in the sleep, depression and anxiety sections were based on the DSM-V criteria for these pathologies.

An increased prevalence was found regarding sleep alterations in individuals who consume vape in comparison to those who don’t, mainly concerning initial insomnia, which refers to the difficulty in falling asleep. Additionally, the frequency of these sleep alterations is significantly higher in individuals who smoke vape, as the number of people who present these alterations 3 or more times per week was four times higher than in the control group. There are other reports that indicate a notable prevalence of sleep disturbances among electronic cigarette users. A study published at Frontiers in 2020, explored a potential association between electronic cigarettes, sleep duration, and adverse cardiovascular outcomes. 253,561 participants were included, of whom 14.7% reported inadequate sleep duration, who also had a significantly higher cardiovascular risk in comparison to those smokers who did not report sleep disturbance. (15)

Furthermore, the control group presented a lower prevalence of depressive symptoms compared to those who vape. The feeling of sadness for the majority of the day, changes in appetite, insomnia or excessive somnolence and agitation were 1.5 times more prevalent in the group who consumes vape, and anhedonia and the feeling of uselessness or excessive guilt was 2 times more prevalent. Similarly, the presence of a constant feeling of anguish that is hard to control was 1.5 times more prevalent in people who consume vape. It is crucial to highlight the fact that recurring thoughts of death, suicide, planning or attempting suicide were 3 times more prevalent in the group who vapes compared to those who don’t. This could indicate an important relevance that vaping may have an impact in the psychiatric aspect of many individuals, and the need to conduct further studies to evaluate the relationship between vaping and depression, considering the effects chronic nicotine consumption has on dopamine release, a hormone crucial for mood regulation. (11)

As for frequency, intensity of cephalalgia and previous medical diagnosis for this specific condition no relevant differences were found when comparing the two study groups. Reports suggest that smoking tobacco is more common among individuals with migraines, and that those with migraines believe smoking exacerbates their attacks; however, a clear causal relationship has not been confirmed. Moreover, evidence indicates that smoking may exacerbate migraine-related outcomes, such as stroke, but few studies have thoroughly investigated this link, and there is currently no information linking migraines with electronic cigarettes. (16)

Finally, no relevant differences were found regarding the frequency of feeling of anxiety symptoms.

This study does not establish a direct relationship between vaping and clinical symptoms of the pathologies that were evaluated. Instead, the study focuses on symptoms that can be present in these conditions. Equally, it is important to inquire if these neuropsychiatric manifestations were present prior to the start of consumption since a potential link between the personality of those who vape and the presence of these symptoms could be found. This could be an area of opportunity for future investigations as a wide range of associations between vaping and neuropsychiatric symptoms can be explored. We recommend implementing a more comprehensive evaluation of people’s lives in order to analyze if neuropsychiatric symptoms can be related to vaping, if vaping is a consequence of preexisting conditions of the individual or if vaping can trigger the development of these pathologies.

Conclusions

The use of vaping among the young population has increased dramatically in recent years, paralleled by a notable rise in the occurrence of neuropsychiatric conditions such as cephalalgia, insomnia, anxiety, and depression.

Although there is no clear relationship between the use of vaping and the clinical diagnosis of any of these four entities, the prevalence of symptoms is higher among the vape smoking population. For this reason, it is crucial to investigate the potential correlation between these two phenomena and a more thorough exploration of the impact of vaping on the central nervous system is essential, as it can offer valuable insights for the development of government guiding regulations and influencing society perspectives on vaping.

References

  1. Hájek P, Etter J, Benowitz NL, Eissenberg T, McRobbie H. Electronic cigarettes: review of use, content, safety, effects on smokers and potential for harm and benefit. Addiction [Internet]. 2014 Jul 31;109(11):1801–10. Available from: https://doi.org/10.1111/add.12659
  2. Lyzwinski LN, Naslund JA, Miller CJ, Eisenberg MJ. Global Youth Vaping and Respiratory Health: Epidemiology, Interventions, and policies. npj Primary Care Respiratory Medicine [Internet]. 11 de abril de 2022;32(1). Disponible en:https://doi.org/10.1038/s41533-022-00277-9
  3. Cornelius ME, Loretan C, Jamal A, Lynn BCD, Mayer M, Alcantara I, et al. Tobacco product use among adults – United States, 2021. Morbidity and Mortality Weekly Report [Internet]. 2023 May 5;72(18):475–83. Available from: https://doi.org/10.15585/mmwr.mm7218a1
  4. Hartmann‐Boyce J, Lindson N, Butler AR, McRobbie H, Bullen C, Begh R, et al. Electronic cigarettes for smoking cessation. The Cochrane Library [Internet]. 2022 Nov 17;2023(3). Available from: https://doi.org/10.1002/14651858.cd010216.pub7
  5. Rigotti, Reddy. Vaping and e-cigarettes [Internet]. UpToDate. 2023 [cited 2023 Nov 19]. Available from: https://www.uptodate.com/contents/vaping-and-e-cigarettes?search=pathophysiological%20effects%20of%20Electronic%20nicotine%20delivery%20system&source=search_result&selectedTitle=4~150&usage_type=default&display_rank=4#
  6. Laino T, Tuma C, Moor P, Martin E, Stolz S, Curioni A. Mechanisms of propylene glycol and triacetin pyrolysis. Journal of Physical Chemistry A [Internet]. 2012 Apr 30;116(18):4602–9. Available from: https://doi.org/10.1021/jp300997d
  7. Callahan-Lyon, P. Electronic cigarettes: human health effects. Tob Control [Internet]. Tob Control [Internet]. 2014 Apr 14;23: 36-40. Disponible en: https://doi.org/10.1136/tobaccocontrol-2013-051470
  8. Giovanni SP, Keller TL, Bryant A, Weiss NS, Littman AJ. Electronic Cigarette Use and Chronic Respiratory Symptoms among U.S. Adults. American Journal of Respiratory and Critical Care Medicine [Internet]. 2020 May 1;201(9):1157–60. Available from: https://doi.org/10.1164/rccm.201907-1460le
  9. Li D, Sundar IK, McIntosh S, Ossip DJ, Goniewicz MŁ, O’Connor RJ, et al. Association of smoking and electronic cigarette use with wheezing and related respiratory symptoms in adults: cross-sectional results from the Population Assessment of Tobacco and Health (PATH) study, wave 2. Tobacco Control [Internet]. 2019 Feb 13;tobaccocontrol-054694. Available from: https://doi.org/10.1136/tobaccocontrol-2018-054694
  10. Marklew AJ, Patel W, Moore PJ, Da Tan C, Smith A, Sassano MF, et al. Cigarette smoke exposure induces retrograde trafficking of CFTR to the endoplasmic reticulum. Scientific Reports [Internet]. 20 de septiembre de 2019;9(1). Disponible en: https://doi.org/10.1038/s41598-019-49544-9
  11. Herman MA, Tarran R. E‐cigarettes, nicotine, the lung and the brain: multi‐level cascading pathophysiology. The Journal of Physiology [Internet]. 6 de julio de 2020;598(22):5063-71. Disponible en: https://doi.org/10.1113/jp278388
  12. Kalmbach DA, Pillai V, Arnedt JT, Drake CL. DSM-5 Insomnia and Short Sleep: Comorbidity landscape and racial Disparities. SLEEP [Internet]. 1 de diciembre de 2016;39(12):2101-11. Disponible en: https://doi.org/10.5665/sleep.6306
  13. Locke AB. Diagnosis and management of generalized anxiety disorder and panic disorder in adults [Internet]. AAFP. 2015. Disponible en: https://www.aafp.org/pubs/afp/issues/2015/0501/p617.html
  14. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR). 5th ed. 2022.
  15. Xingyou, L., Zhichao, Y., Yuelong, J. The association between electronic cigarettes, sleep duration, and the adverse cardiovascular outcomes: Findings from behavioral risk factor surveillance system, 2020. Frontiers [Internet]. 06 de octubre de 2022; 9:01-11. Disponible en: https://doi.org/10.3389/fcvm.2022.909383
  16. Weinberger, A., Seng, E. The Relationship of Tobacco Use and Migraine: A Narrative Review. Current Pain and Headache Reports [Internet]. 11 de marzo de 2023; 27:39–47. Disponible en: https://doi.org/10.1007/s11916-023-01103-8

Table 1: summary of demographic data. 

Percentage distribution
Age 18-20 years: 15.7% (16/102)

21-23 years: 63.7% (65/102)

23-25 years: 14.7% (15/102)

26-28 years: 3.9% (4/102)

29-30 years: 2% (2/102)
Biological sex Female: 66.7% (68/102)

Male: 33.3% (34/102)
Occupation Student: 80.4% (82/102)

Employed: 10.8% (11/102)

Student and employee: 8.8% (9/102)

Neither student nor employed: 0% (0/102)
Vape consumption Consumes vape: 47.1% (48/102)

Doesn’t consume vape: 52.9% (54/102)

Table 2: vape and tobacco consumption habits.

Percentage distribution
Tobacco use Currently consumes tobacco: 22.9% (11/48)

Previously consumed tobacco: 41.7% (20/48)

Has never consumed tobacco: 35.4% (17/48)
Years smoking vape <1 year: 14.6% (7/48)

1-5 years: 81.3% (39/48)

5-10 years: 4.25% (2/48)

>10 years: 0% (0/48)
Percentage of nicotine in the vape that is usually consumed 0%: 0% (0/48)

1-3%: 33.3% (16/48)

4-5%: 64.6% (31/48)

>5%: 2.1% (1/48)
Number of puffs per day <10: 25% (12/48)

10-30: 22.9% (11/48)

30-50: 29.2% (14/48)

>50: 22.9% (11/48)

Table 3: comparison of prevalence of cephalalgia between non- vape smokers and vape smokers. 

  Non- vaping participants Vape- consuming participants
Frequency of cephalalgia <1: 66.7% (38/57)

3-5: 24.6% (14/57)

5-10: 3.5% (2/57)

10-20: 3.5% (2/57)

>20: 1.8% (1/57)

 <1: 52.2% (24/46)

3-5: 23.9% (11/46)

5-10: 19.6% (9/46)

10-20: 4.3% (2/46)

>20: 0% (0/46)
Intensity of cephalalgia Mild: 70.2% (40/57)

Moderate: 26.3% (15/57)

Severe: 3.5% (2/57)

 Mild: 65.2% (30/46)

Moderate: 34.8% (16/46)

Severe: 0% (0/46)
Previous medical diagnosis specific to cephalalgia No medical diagnosis: 89.5% (51/57)

Migraine: 8.8% (4/57)

I don’t have headaches: 1.8% (1/57)

 No medical diagnosis: 76.1% (35/46)

Migraine: 23.9% (11/46)

Tensional cephalalgia: 0% (0/46)

Table 4: comparison of prevalence of sleep alterations between non- vape smokers and vape smokers. 

  Non- vaping participants Vape- consuming participants
Average hours of sleep per day <6 hours: 28.1% (16/57)

6-8 hours: 68.4% (39/57)

>8 hours: 3.5% (2/57)

 <6 hours: 28.3% (13/46)

6-8 hours: 65.2% (30/46)

>8 hours: 6.5% (3/46)
Sleep alterations None: 75.4% (43/57)

Trouble falling asleep: 10.5% (6/57)

Trouble staying asleep: 8.8% (5/57)

Early awakenings: 5.3% (3/57)

 None: 54.3% (25/46)

Trouble falling asleep: 30.4% (14/46)

Trouble staying asleep: 13% (6/46)

Early awakenings: 2.2% (1/46)
Frequency of sleep alterations 0-2 times per week: 93% (53/57)

>3 times per week: 7% (4/57)

 0-2 times per week: 71.7% (33/46)

>3 times per week: 28.3% (13/46)

Table 5: comparison of prevalence of depression symptoms between non- vape smokers and vape smokers. 

  Non- vaping participants Vape- consuming participants
Symptoms of depression A) a feeling of sadness for the majority of the day: 22.2% (12/57)

B) loss of interest in activities that they previously enjoyed: 20.4% (11/57)

C) changes in appetite: 31.5% (17/57)

D) insomnia or excessive somnolence during the day: 40.7% (22/57)

E) agitation: 14.8% (8/57)

F) fatigue: 51.9% (28/57)

G) feeling of uselessness or excessive guilt: 22.2% (12/57)

H) loss of ability to concentrate or difficulty making decisions: 46.3% (25/57)

I) recurring thoughts of death, suicide, planning or attempting a suicide: 5.6% (3/57)

 A) a feeling of sadness for the majority of the day: 34.8% (16/46)

B) loss of interest in activities that they previously enjoyed: 39.1% (18/46)

C) changes in appetite: 50% (23/46)

D) insomnia or excessive somnolence during the day: 63% (29/46)

E) agitation: 23.9% (11/46)

F) fatigue: 43.5% (20/46)

G) feeling of uselessness or excessive guilt: 43.5% (20/46)

H) loss of ability to concentrate or difficulty making decisions: 52.2% (24/46)

I) recurring thoughts of death, suicide, planning or attempting a suicide: 17.4% (8/46)

Table 6: comparison of prevalence of anxiety symptoms between non- vape smokers and vape smokers. 

  Non- vaping participants Vape- consuming participants
Constant feeling of anguish that is hard to control Yes: 35.1% (20/57)

No: 64.9% (37/57)

 Yes: 54.3% (25/46)

No: 45.7% (21/46)
Frequency of feeling of anguish 0-3 days per week: 78.9% (45/57)

4-7 days per week: 21.1% (12/57)

 0-3 days per week: 78.3% (36/46)

4-7 days per week: 21.7% (10/46)
Symptoms of anxiety 0-2 symptoms: 59.6% (34/57)

3 or more symptoms: 40.4% (23/57)

 0-2 symptoms: 56.5% (26/46)

3 or more symptoms: 43.5% (20/46)