Abstract
Background/Objectives: Breakfast skipping has been associated with a wide range of adverse health outcomes, including metabolic disorders, disrupted circadian rhythm, and impairments of memory and attention in adolescents and adults. Although partial associations between sleep and breakfast behaviors have been reported, few studies have examined multi-dimensional sleep health simultaneously in relation to breakfast skipping, especially comprehensive studies systematically examining this relationship, particularly under controlled social conditions, remain insufficient. Methods: We here demonstrate the association between sleep health and breakfast skipping among 2969 Japanese high school students. Participants provided between one and eight days of sleep diary data, including meal timing records; most (78.1%) completed all eight days, while the remainder contributed fewer days. Additionally, the Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality, and the Pediatric Daytime Sleepiness Scale (PDSS) was used to evaluate daytime sleepiness. Results: Later wake-up times, lower sleep quality, and stronger daytime sleepiness were each associated with a higher likelihood of breakfast skipping. In additional analyses, no significant pairwise interactions were detected among wake-up time, PSQI, and PDSS, suggesting that these factors may be separately associated with breakfast skipping. Conclusions: These findings suggest that multi-dimensional sleep health, including wake-up time, sleep quality, and daytime sleepiness, is relevant to breakfast skipping. This study offers a novel contribution by linking multiple downstream indicators influenced by sleep health to breakfast behavior.