Is Smokeless Tobacco Used To Mitigate The Daytime Sleepiness And Depression? A Case-Control Study In Tabuk City, Saudi Arabia

Background: smokeless tobacco use is prevalent worldwide, however, its association with depression and daytime sleepiness is not well-studied. The study aimed to assess the association between depression, daytime sleepiness, and smokeless tobacco use. Methodology: This case-control study was conducted among 212 male subjects (84 smokers vs. 128 controls) in Tabuk City, Kingdom of Saudi Arabia during the period from January to April 2020. Cases were matched with controls for age. A structured questionnaire based on demographic data and the Arabic versions of the Epworth Sleepiness Scale and HADS questionnaires were used to assess the daytime sleepiness and depression respectively. The statistical Package for Social Sciences (SPSS) was used for data analysis and the ethical committee of the University of Tabuk approved the research. Results: There were 84 males smokers and 128 control subjects, their ages were37.65 +/- 10.74, vs. 34.21 +/- 12.91 years with no significant statistical difference, P-value >0.05,depression was found in 38.1% of smokers and 4.7% of non-smokers and the daytime sleepiness was reported in (35.7% subjects vs. 17.2% of controls), with a significant statistical difference, P-values <0.05. It is interesting to note that 57.1% of smokers tried to quit due to illness and social factors, the main barriers were dependence and stress. Conclusion: depression and daytime sleepiness were common among smokeless tobacco users compared to their counterparts, more than half of smokers attempted quitting due to illness and they felt that smokeless tobacco is not social. Barriers to quitting were dependence and stress felt after stopping. Studies addressing barriers to quitting are recommended.