title: Sleep Duration, Snoring Prevalence, Obesity, and Behavioral Problems in a Large Cohort of Primary School Students in Japan.
abstract: Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey.
  
  
  
  We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics.
  
  
  
  In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school.
  
  
  
  Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school.
authors.affiliation: Department of Epidemiologic Research, Toho University, Tokyo, Japan.
authors.forename: Naoko
authors.initials: N
authors.lastname: Sakamoto
authors.affiliation: Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago,Chicago, IL.
authors.forename: David
authors.initials: D
authors.lastname: Gozal
authors.affiliation: Department of Health Sciences, University of Chicago, Chicago, IL.
authors.forename: Dale L
authors.initials: DL
authors.lastname: Smith
authors.affiliation: Medical Support Center for Japan Environment and Children's Study, Tokyo, Japan.|National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Limin
authors.initials: L
authors.lastname: Yang
authors.affiliation: National Center for Child Health and Development, Tokyo, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Morimoto
authors.affiliation: Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Wada
authors.affiliation: Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Kotatsu
authors.initials: K
authors.lastname: Maruyama
authors.affiliation: Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Ai
authors.initials: A
authors.lastname: Ikeda
authors.affiliation: Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Department of Otolaryngology and Good Sleep Center, Nagoya City University, Nagoya, Japan.
authors.forename: Meiho
authors.initials: M
authors.lastname: Nakayama
authors.affiliation: Center for Relations Strategy, Nagasaki University, Nagasaki, Japan.
authors.forename: Itsuko
authors.initials: I
authors.lastname: Horiguchi
authors.affiliation: Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Tanigawa
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000150:complications / Q000453:epidemiology*; D000066553:Problem Behavior; D012307:Risk Factors; D012574:Schools; D012890:Sleep / Q000502:physiology*; D012891:Sleep Apnea Syndromes / Q000150:complications / Q000453:epidemiology; D012913:Snoring / Q000453:epidemiology*; D013334:Students; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Japan.; behavior; children; sleep; sleep-disordered breathing