Asian flush is a potential protective factor against COVID-19: a web-based retrospective survey in Japan.

BACKGROUND: Coronavirus disease 2019 (COVID-19), first reported in December 2019, spread worldwide in a short period, resulting in numerous cases and associated deaths; however, the toll was relatively low in East Asia. A genetic polymorphism unique to East Asians, Aldehyde dehydrogenase 2 rs671, has been reported to confer protection against infections. METHOD: We retrospectively investigated the association between the surrogate marker of the rs671 variant, the skin flushing phenomenon after alcohol consumption, and the timing of COVID-19 incidence using a web-based survey tool to test any protective effects of rs671 against COVID-19. RESULTS: A total of 807 valid responses were received from 362 non-flushers and 445 flushers. During the 42 months, from 12/1/2019 to 5/31/2023, 40.6% of non-flushers and 35.7% of flushers experienced COVID-19. Flushers tended to have a later onset (Spearman's partial rank correlation test, p = 0.057, adjusted for sex and age). Similarly, 2.5% of non-flushers and 0.5% of flushers were hospitalized because of COVID-19. Survival analysis estimated lower risks of COVID-19 and associated hospitalization among flushers (p = 0.03 and <0.01, respectively; generalized Wilcoxon test). With the Cox proportional hazards model covering 21 months till 8/31/2021, when approximately half of the Japanese population had received two doses of COVID-19 vaccine, the hazard ratio (95% confidence interval) of COVID-19 incidence was estimated to be 0.21 (0.10-0.46) for flusher versus non-flusher, with adjustment for sex, age, steroid use, and area of residence. CONCLUSIONS: Our study suggests an association between the flushing phenomenon after drinking and a decreased risk of COVID-19 morbidity and hospitalization, suggesting that the rs671 variant is a protective factor. This study provides valuable information for infection control and helps understand the unique constitutional diversity of East Asians.

Predictive factors of coronavirus disease (COVID-19) vaccination series completion: a one-year longitudinal web-based observational study in Japan.

Introduction: Addresing vaccine hesitancy is considered an important goal in management of the COVID-19 pandemic. We sought to understand what factors influenced people, especially those initially hesitant, to receive two or more vaccine doses within a year of the vaccine's release. Methods: We conducted longitudinal Web-based observational studies of 3,870 individuals. The surveys were conducted at four different time points: January 2021, June 2021, September 2021, and December 2021. In the baseline survey (January 2021), we assessed vaccination intention (i.e., "strongly agree" or "agree" [acceptance], "neutral" [not sure], and "disagree" or "strongly disagree" [hesitance]), and assumptions about coronavirus disease (COVID-19), COVID-19 vaccine, COVID-19-related health preventive behavior, and COVID-19 vaccine reliability. In subsequent surveys (December 2021), we assessed vaccination completion (i.e., ≥2 vaccinations). To investigate the relationship between predictors of COVID-19 vaccination completion, a multivariable logistic regression model was applied. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were calculated while adjusting for gender, age, marital status, presence of children, household income category, and presence of diseases under treatment. In a stratified analysis, predictors were determined based on vaccination intention. Results: Approximately 96, 87, and 72% of those who demonstrated acceptance, were not sure, or hesitated had been vaccinated after 1 year, respectively. Overall, significant factors associated with COVID-19 vaccine compliance included the influence of others close to the index participant (social norms) (AOR, 1.80; 95% CI, 1.56-2.08; p < 0.001), vaccine confidence (AOR, 1.39; 95% CI, 1.18-1.64; p < 0.001) and structural constraints (no time, inconvenient location of medical institutions, and other related factors) (AOR, 0.80; 95% CI, 0.70-0.91; p = 0.001). In the group of individuals classified as hesitant, significant factors associated with COVID-19 vaccine compliance included social norms (AOR, 2.43; 95% CI, 1.83-3.22; p < 0.001), confidence (AOR, 1.44; 95% CI, 1.10-1.88; p = 0.008), and knowledge (AOR, 0.69; 95% CI, 0.53-0.88; p = 0.003). Discussion: We found that dissemination of accurate information about vaccines and a reduction in structural barriers to the extent possible enhanced vaccination rates. Once the need for vaccination becomes widespread, it becomes a social norm, and further improvements in these rates can then be anticipated. Our findings may help enhance vaccine uptake in the future.

A point system to predict the future risk of obesity in 10-year-old children.

BACKGROUND: A 4-year longitudinal study was conducted to develop a model and a point system for predicting childhood obesity. METHODS: This study included 1,504 Japanese 10-year-old children who underwent health check-ups between 2011 and 2015. Multivariable logistic regression analysis was conducted using the explanatory variables overweight and lifestyle. Obesity was defined as percentage overweight (POW) ≥ 20% calculated by the following equation: (actual weight - standard weight by height and sex)/standard weight by height and sex × 100 (%). The model was validated using the Hosmer-Lemeshow test on 10-year-olds. RESULTS: Our prediction model for development of childhood obesity was based on seven binary variables: sex, lack of sleep, ≥2-h use of television/ games/ smartphone, hypertension, dyslipidemia, hepatic dysfunction, and being overweight. The area under the curve of the receiver operating characteristic curve was 0.803 (95% confidence interval, 0.740 to 0.866). When validated in non-obese children (n = 415), there was no significant difference between actual and predicted numbers of children with obesity (Hosmer-Lemeshow chi-square = 7.90, p = 0.18). CONCLUSIONS: The validated prediction model and point score for obesity development were shown to be useful tools for predicting the future 4-year risk of developing obesity among 10 years-old children. The point system may be useful for reducing the occurrence of childhood obesity and promoting better health.

Variant Allele of ALDH2, rs671, Associates with Attenuated Post-Vaccination Response in Anti-SARS-CoV-2 Spike Protein IgG: A Prospective Study in the Japanese General Population.

Uncovering the predictors of vaccine immunogenicity is essential for infection control. We have reported that the most prevalent polymorphism of the aldehyde dehydrogenase 2 gene (ALDH2), rs671, may be associated with an attenuated immune system. To test the inverse relationship between rs671 and antibody production after COVID-19 vaccination, the levels of anti-SARS-CoV-2 Spike protein S1 subunit (S1) IgG were repeatedly measured for four months before and after vaccination with BNT162b2 or mRNA-1273, in 88 Japanese workers and students (including 45 females, aged 21-56 years, with an rs671 variant allele frequency of 0.3). The mixed model including fixed effects of the vaccine type, weeks post vaccination (categorical variable), sex, age, height, smoking status, ethanol intake, exercise habit, perceived stress, steroid use, allergic diseases, and dyslipidemia, indicated an inverse association between log-transformed anti-S1 IgG levels and the number of rs671 variant alleles (partial regression coefficient = -0.15, p = 0.002). Our study indicated for the first time that the variant allele of ALDH2, rs671, is associated with the attenuated immunogenicity of COVID-19 mRNA vaccines. Our finding may provide a basis for personalized disease prevention based on a genetic polymorphism that is prevalent among East Asians.

Acceptance of Booster COVID-19 Vaccine and Its Association with Components of Vaccination Readiness in the General Population: A Cross-Sectional Survey for Starting Booster Dose in Japan.

The Japanese government approved COVID-19 vaccine booster doses in November 2021. However, intentions and readiness for booster vaccines among the general population were unknown. This survey measured the intentions for COVID-19 booster vaccination. Among 6172 participants (53.2% female), 4832 (78.3%) accepted booster doses; 415 (6.7%) hesitated. Vaccination intention was associated with higher age, marital status, having children, underlying diseases, and social norms. To evaluate the readiness for vaccination, the seven component (7C) vaccination readiness scale was employed, comprising "Confidence", "Complacency", "Constraints", "Calculation", "Collective responsibility", "Compliance", and "Conspiracy". Participants with acceptance showed significantly higher 7C scores (p < 0.001) than those who hesitated or were unsure. Multivariable logistic regression analysis revealed that the "social norms" predictor was the strongest predictor of acceptance (adjusted odds ratio (AOR) 4.02, 95% confidence interval (CI): 3.64−4.45). "Constraints" (AOR: 2.27, 95% CI: 2.11−2.45) and "complacency" (AOR: 2.18, 95% CI: 2.03−2.34) were also strongly associated with acceptance, but "compliance" (AOR: 1.24, 95% CI: 1.18−1.31) and "conspiracy" (AOR: 1.42, 95% CI: 1.33−1.52) were weakly associated. The "7C vaccination readiness scale" is useful for measuring vaccine acceptance in the Japanese population. However, "social norms" might be more suitable than "compliance" and "conspiracy" for measuring vaccine acceptance in Japan.

Comparison of CLEIA and ELISA for SARS-CoV-2 Virus Antibodies after First and Second Dose Vaccinations with the BNT162b2 mRNA Vaccine.

The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has required rapid action to control its spread and vaccines are a fundamental solution to this pandemic. The development of rapid and reliable serological tests to monitor the antibody response to coronavirus disease vaccines is necessary for post-vaccination immune responses. Therefore, in this study, anti-SARS-CoV-2 antibody titers after the first and second doses were monitored using two different measurement systems, a highly sensitive analytical platform of chemiluminescent enzyme immunoassay (CLEIA) and an enzyme-linked immunosorbent assay (ELISA). Our study included 121 participants who received two doses of the BNT162b2 vaccine. Both methods show significant increase in anti-spike protein IgG antibody levels one week after the first vaccination, and then reached at a plateau at week five (week two after the second dose), with a 3.8 × 103-fold rise in CLEIA and a 22-fold rise in ELISA. CLEIA and ELISA showed a good correlation in the high titer range, >10 binding antibody unit (BAU)/mL. Both methods detected higher IgG antibody levels in females compared with male participants after the second vaccination, while CLEIA exhibits the sex difference after the first dose. Thus, our study showed better performance of CLEIA over ELISA in sensitivity, especially in the low concentration range, however ELISA was also useful in the high titer range (>10 BAU/mL) corresponding to the level seen several weeks after the first vaccination.

Association of Vaccine Confidence and Hesitancy in Three Phases of COVID-19 Vaccine Approval and Introduction in Japan.

Understanding vaccine hesitancy, considering the target region and phase, is an urgent issue to quell the coronavirus disease (COVID-19) pandemic. This study aimed to monitor COVID-19 vaccine hesitancy in the Japanese population during the three phases of vaccine approval and introduction, and evaluate the association of vaccine hesitancy with vaccine confidence and literacy. We conducted web-based cross-sectional surveys during the three phases of COVID-19 vaccine introduction: January 2021, before approval; June, start of vaccination of the elderly; and September, when about 70% of the target population was vaccinated with at least one dose. There were 7210 participants, aged 20−80 years. We evaluated the association of vaccine hesitancy with vaccine confidence and literacy in the three phases using multivariate logistic regression analysis. The proportion of hesitancy in January, June, and September was 17.5%, 65.3%, and 19.4%, respectively. In any phase, lower vaccine confidence and literacy showed a higher adjusted odds ratio (AOR) of vaccine hesitancy in most items (AOR > 1, p < 0.001). Vaccine hesitancy in June had a different trend in perception of COVID-19 compared to that in the January and September surveys. The findings suggested that hesitancy increases transiently during vaccination introduction phases, and changes as the vaccination program progressed or waves of epidemic. Careful risk communication to increase vaccine confidence and literacy is essential to reduce vaccine hesitancy, especially in the introduction phase.

A cross-sectional epidemiological study of the relationship between sleep duration, quality, and rhythm and presenteeism in workers.

This study aims to examine the relationship of sleep (sleep duration, sleep quality, and sleep rhythm) with presenteeism in workers while controlling for other confounding factors. A total of 2375 workers of six Japanese companies received self-administered questionnaires from June to November 2018. Information on sleep duration was used to evaluate sleep quantity, the Athens Insomnia Scale (AIS) was used to evaluate sleep quality, and workers' engagement in shift work was used to determine their sleep rhythms. We used the World Health Organization Health and Work Performance Questionnaire to evaluate presenteeism. Information on lifestyle (exercise, smoking, etc.), sex, and age was also collected. We conducted a logistic regression analysis with high absolute/relative presenteeism as an objective variable, sleep duration, AIS, and shift work as dependent variables, and basic attributes and lifestyle factors as adjustment factors. Completed questionnaires were collected from 1992 workers (aged 18-79 years; 25.2% women; response rate: 83.9%). Logistic regression analysis showed that high absolute presenteeism was significantly associated with poor sleep quality (high AIS score; P < 0.001) but not with sleep duration (P = 0.326) and shift work (P = 0.177). High relative absenteeism was significantly associated with poor sleep quality (high AIS score; P = 0.001) but not with sleep duration (P = 0.461) or shift work (P = 0.245). We showed that poor sleep quality is significantly associated with a high level of presenteeism. This suggests focusing on improving sleep quality is important for reducing presenteeism among workers.

Psychometric Properties of a New Simplified Scale to Assess the Quality of Workers' Rest and Recreation on Their Days Off.

BACKGROUND: In this study, we developed and tested the validity and reliability of the 12-item Rest and Recreation Quality Scale (RRQ-Scale) for Workers as a new scale capable of conveniently assessing the quality of workers' days off, that is, their rest and recreation. METHODS: Participants included 756 employees (694 men, 62 women, mean age ± SD= 44.7 ± 13.5, age range = 18-81) of 26 manufacturing-related companies located in Oita Prefecture, Japan. We analyzed the factorial validity of the scale's score distribution and its criterion-related validity and reliability (Cronbach's coefficient α), compared to MOS 36-Item Short-Form Health Survey version 2.0 (SF-36v2) and the generalized self-efficacy scale. Participants responded to the 12 questions on 4-point scales; these were summed to calculate the total score (score range: 12-48 points). RESULTS: The smallest and largest mean ± SD of the questions were 2.53 ± 0.89 and 3.21 ± 0.74, respectively, which are within the possible score range (1-4, implying the absence of floor and ceiling effects). A confirmatory factor analysis indicated that the goodness of fit of the higher-order factor analysis model was satisfactory (GFI = 0.955), confirming factorial validity. In addition, consistent with the theoretical predictions, the total score exhibited statistically significant positive correlations with the components of the SF-36v2; physical component summary (PCS): rs = 0.193, P < 0.001, mental component summary (MCS): rs = 0.369, P < 0.001, and role/social Component Summary (RCS): rs = 0.115, P = 0.002. This confirmed criterion-related validity. Further, the overall reliability of the scale was high; α = 0.877. CONCLUSION: In sum, the score distribution, validity, and reliability of the RRQ-Scale for workers were good, indicating a high degree of practicality.

Relationship between internet addiction and sleep disturbance in high school students: a cross-sectional study.

BACKGROUND: The increase in the number of Internet users has increased Internet dependence worldwide. In adolescents, this dependence may interfere with sleep, which is important for the development of psychophysiological capabilities. However, few large-scale surveys have described the relationship between Internet addiction (IA) and sleep disturbance using standardized questionnaires. We conducted a survey in one prefecture in Japan to determine the relationship between sleep disturbance and IA in adolescents based on the categories of the Young Diagnostic Questionnaire (YDQ). METHODS: In 2016, high school students (N = 10,405, age range: 15-16 years) in all 54 daytime high schools in the selected prefecture were surveyed using a self-administered questionnaire. Participants with scores > 5.5 points on the Japanese version of the Pittsburgh Sleep Quality Index were defined as having a sleep disturbance. IA was evaluated using the YDQ: Participants with five to eight YDQ items present were classified as having IA; those with three or four items present were classified as "at risk of IA"; and those with two or less YDQ items were classified as "non-IA". Multiple logistic regression analysis was performed with sleep disturbance as the dependent variable, IA as the explanatory variable, and adjustments for eight other variables. RESULTS: High YDQ scores were associated with a high prevalence of sleep disturbance in boys and girls. These findings persisted after controlling for other factors in the multiple regression model. CONCLUSIONS: Among Japanese adolescents, there was a significant independent relationship between IA and sleep disturbance.

Relationship between Internet Addiction and Poor Mental Health among Japanese Adolescents.

BACKGROUND: Internet addiction and poor mental health are two pervasive problems during adolescence. This study aimed to determine whether Internet addiction and poor mental health status exhibited a bidirectional relationship in which either variable could become a risk factor for the onset of the other. METHODS: Longitudinal school-based survey with a baseline sample of 1547 students among 8 schools (10th graders) in Japan surveyed in 2015 and followed up 1 year later. The schools are located in the middle city. We assessed internet addiction using the Japanese version of the Diagnostic Questionnaire developed by Young and mental health status using the 12-item General Health Questionnaire. Regression analyses including the covariates tested whether Internet addiction was related to the onset of poor mental health among youth who had never internet addiction, and poor mental health was related to the onset of internet addiction. RESULTS: The incidence for Internet addiction and poor mental health during one year were 22.0% and 8.8%, respectively. Multiple regression analyses showed that poor mental health (adjusted odds ratio: 2.17 [95%CI: 1.45-3.25]) promoted new onset of Internet addiction and Internet addiction (adjusted odds ratio: 2.39 [95%CI: 1.36-4.20]) also promoted new onset of poor mental health. CONCLUSION: Internet addiction and poor mental health status each increased the risk of onset of the other. Adolescents, their parents and schools need to take policies to use properly Internet.

Longitudinal Epidemiologic Study of Poor Mental Health Status in Japanese Adolescents: Incidence of Predictive Lifestyle Factors.

OBJECTIVE: To clarify the incidence of predictive risk factors for poor mental health status in Japanese adolescents. METHODS: In 2010, baseline surveys of first-year junior and senior high school students were conducted at 10 randomly selected junior high schools and 14 senior high schools in Japan. After 2 years, follow-up surveys were conducted on the same students. For both surveys, a self-administered questionnaire about mental health status and lifestyle, General Health Questionnaire-12 (GHQ-12), was provided to the students. RESULTS: In total, 1,304 junior and 4,383 senior high school students were enrolled at the start of the study, and 776 junior and 2,697 senior high school students responded to both surveys. The new incidence of poor mental health status (GHQ-12 ≥ 4 points), determined by changes between the baseline and follow-up surveys, was 17.1% (95% CI, 13.9% to 20.3%) of junior high school students and 22.6% (95% CI, 20.5% to 24.7%) of senior high school students. According to the multiple logistic regression analysis, in junior high school students, factors associated with the onset of poor mental health were not participating in sports activities (adjusted odds ratio, 3.13; P = .035) and spending ≥ 2 hours per day studying outside of school (2.18; P = .010). In senior high school students, factors associated with the onset of poor mental health were female sex (2.51; P < .001), difficulty initiating sleep (3.38; P < .001), poor sleep quality (1.83; P = .034), poor appetite (3.43; P = .011), spending less than 2 hours per day watching television (1.37; P = .038), being a victim of bullying (2.46; P = .011), and not having a sympathetic supporter (1.72; P = .006). CONCLUSIONS: The findings of this study are valuable for formulating approaches aimed at addressing adolescent mental health.

Short sleep duration, shift work, and actual days taken off work are predictive life-style risk factors for new-onset metabolic syndrome: a seven-year cohort study of 40,000 male workers.

BACKGROUND: This longitudinal study investigated the effects of various lifestyle-related factors - including sleep duration, shift work, and actual days taken off work - on new-onset metabolic syndrome (MetS). METHODS AND RESULTS: A total of 39,182 male employees (mean age 42.4 ± 9.8 years) of a local government organization in Japan were followed up for a maximum of seven years, between 1999 and 2006. Multivariate analysis (Cox proportional hazard method) identified seven high-risk lifestyle factors that were significantly associated with new-onset MetS or a range of metabolic factors (obesity, hypertension, hyperglycemia, dyslipidemia): (1) short sleep duration (<5 h/day), (2) shift work, (3) insufficient number of days off work, (4) always eating until satiety, (5) not trying to take every opportunity to walk, (6) alcohol intake ≥60 g/day, and (7) smoking. In addition, a higher number of these high-risk lifestyle factors significantly promoted the onset of MetS. The hazard ratio for MetS associated with 0-1 high-risk lifestyle parameters per subject at the baseline was set at 1.00. Hazard ratios associated with the following numbers of high-risk lifestyle parameters were: 1.22 (95% CI 1.15-1.29) for 2-3 of these parameters; and 1.43 (1.33-1.54) for 4-7. CONCLUSION: An increase in the number of high-risk lifestyle factors - such as short sleep duration, shift work, and an insufficient number of days off work - increased the risk of MetS onset. Comprehensive strategies to improve a range of lifestyle factors for workers, such as sleep duration and days off work, could reduce the risk of MetS onset.

Predictors of insomnia onset in adolescents in Japan.

OBJECTIVE: The objective of this study was to clarify the incidence rate and predictive factors of insomnia in Japanese junior and senior high school students. METHODS: We conducted a baseline survey on first year junior and senior high school students (seventh and 10th graders) throughout the nation. A follow-up survey was then conducted two years later. For both surveys, we used self-administered questionnaires inquiring about sleep, mental health status, lifestyle, participation in club activities, and study hours. RESULTS: A total of 3473 students (776 junior high and 2697 senior high) were suitable for analysis. During the two years leading to the follow-up study, the incidence rate of newly developed insomnia was 7.8% among junior high and 9.2% among senior high school students. Multiple logistic regression analyses revealed that factors associated with new insomnia onset were 'sleep paralysis experience' and 'poor mental health status' in junior high school students, and 'being woken by a nightmare', 'poor mental health status', '≥2 h of extracurricular learning per day' and 'mobile phone use for ≥2 h per day' in senior high school students. CONCLUSIONS: In junior and senior high school students, parasomnias such as nightmares and sleep paralysis, and mental health status can be predictors of insomnia onset. For senior high school students, longer use of mobile phones can be a predictor of insomnia onset. The present findings suggest that sleep health must be promoted among junior and senior high school students in the future.

Nationwide epidemiological study of insomnia in Japan.

BACKGROUND: This study was a nationwide epidemiological study of insomnia in Japan. It was conducted because very few studies on this topic have previously been performed for the general Japanese population. METHODS: An interview survey on symptoms of insomnia (difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep) and daytime dysfunction was conducted on the general nationwide population in the winter (February) and summer (August) of 2008. Data from 2614 participants who provided valid responses (age range 20-95 years, valid response rate 54.2%) were analyzed. RESULTS: The prevalence of difficulty initiating sleep, difficulty maintaining sleep with difficulty resuming sleep, and early morning awakening with difficulty resuming sleep was 8.3%, 5.8%, and 5.8%, respectively, in men, and 11.0%, 8.1%, and 7.4%, respectively, in women. The prevalence of insomnia was 12.2% in men and 14.6% in women, and the prevalence of insomnia with daytime dysfunction was 3.2% in men and 4.2% in women. The results of logistic regression analyses indicated that the factors aggravating insomnia for men were unemployment and having mental health issues, and for women they were being aged ≥70 years, completing fewer years of schooling, and having mental health issues. Seasonality and regionality in association with insomnia were also examined, but no significant associations were found. CONCLUSION: In the present survey, insomnia was defined by using criteria that were closer to the clinical diagnostic criteria (eg, coexistence of both difficulty resuming sleep and daytime dysfunction was considered). Therefore, it is believed that the results of this study were representative of the clinical actuality of insomnia in Japan.

Development and evaluation of an electromagnetic hypersensitivity questionnaire for Japanese people.

The purpose of the present study was to evaluate the validity and reliability of a Japanese version of an electromagnetic hypersensitivity (EHS) questionnaire, originally developed by Eltiti et al. in the United Kingdom. Using this Japanese EHS questionnaire, surveys were conducted on 1306 controls and 127 self-selected EHS subjects in Japan. Principal component analysis of controls revealed eight principal symptom groups, namely, nervous, skin-related, head-related, auditory and vestibular, musculoskeletal, allergy-related, sensory, and heart/chest-related. The reliability of the Japanese EHS questionnaire was confirmed by high to moderate intraclass correlation coefficients in a test-retest analysis, and high Cronbach's α coefficients (0.853-0.953) from each subscale. A comparison of scores of each subscale between self-selected EHS subjects and age- and sex-matched controls using bivariate logistic regression analysis, Mann-Whitney U- and χ(2) tests, verified the validity of the questionnaire. This study demonstrated that the Japanese EHS questionnaire is reliable and valid, and can be used for surveillance of EHS individuals in Japan. Furthermore, based on multiple logistic regression and receiver operating characteristic analyses, we propose specific preliminary criteria for screening EHS individuals in Japan. Bioelectromagnetics. 37:353-372, 2016. © 2016 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

[Summary of The Sleep Guidelines 2014 for health promotion].

The current understanding is that sleep associates profoundly with mental and physical health and life style-related diseases. Under the Ministry of Health, Labour and Welfare "The Sleep Guidelines for health promotion" was devised in 2003 and revised it in 2014. It is to promote that a citizen carries out a better sleep behavior in every life stage from infancy to old age. We comment on the 12 clauses of "The Sleep Guidelines" in this report. It shows the concrete methods for sleep well and the sleep disorder-related disease. We hope the 12 clauses will contribute to reducing a citizen troubled with daytime sleepiness. The night pleasant sleep is important in keeping mental and physical health.