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However, the effects of fluoride on sleep regulation remain unknown. This population-based study examined whether chronic low-level fluoride exposure is associated with sleep patterns and daytime sleepiness among older adolescents in the United States (US).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Method<\/jats:title>\n                <jats:p>This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (2015\u20132016). We analyzed data from adolescents who had plasma fluoride (<jats:italic>n<\/jats:italic>\u2009=\u2009473) and water fluoride (<jats:italic>n<\/jats:italic>\u2009=\u2009419) measures and were not prescribed medication for sleep disorders. Relationships between fluoride exposure and self-reported sleep patterns or daytime sleepiness were examined using survey-weighted linear, binomial logistic or multinomial logistic regression after covariate adjustment. A Holm-Bonferroni correction accounted for multiple comparisons.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The average age of adolescents was 17\u2009years (range\u2009=\u200916\u201319). Median (IQR) water and plasma fluoride concentrations were 0.27 (0.52) mg\/L and 0.29 (0.19) \u03bcmol\/L respectively. An IQR increase in water fluoride was associated with 1.97 times higher odds of reporting symptoms suggestive of sleep apnea (95% CI: 1.27, 3.05; <jats:italic>p<\/jats:italic>\u2009=\u20090.02), a 24\u2009min later bedtime (B\u2009=\u20090.40, 95% CI: 0.10, 0.70; <jats:italic>p<\/jats:italic>\u2009=\u20090.05), a 26\u2009min later morning wake time (B\u2009=\u20090.43, 95% CI: 0.13, 0.73; <jats:italic>p<\/jats:italic>\u2009=\u20090.04), and among males, a 38% reduction in the odds of reporting snoring (95% CI: 0.45, 0.87, <jats:italic>p<\/jats:italic>\u2009=\u20090.03).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Fluoride exposure may contribute to changes in sleep cycle regulation and sleep behaviors among older adolescents in the US. Additional prospective studies are warranted to examine the effects of fluoride on sleep patterns and determine critical windows of vulnerability for potential effects.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12940-019-0546-7","type":"journal-article","created":{"date-parts":[[2019,12,9]],"date-time":"2019-12-09T17:03:31Z","timestamp":1575911011000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Fluoride exposure and sleep patterns among older adolescents in the United States: a cross-sectional study of NHANES 2015\u20132016"],"prefix":"10.1186","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4104-0960","authenticated-orcid":false,"given":"Ashley J.","family":"Malin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonali","family":"Bose","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefanie A.","family":"Busgang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chris","family":"Gennings","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Thorpy","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert O.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosalind J.","family":"Wright","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manish","family":"Arora","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2019,12,9]]},"reference":[{"key":"546_CR1","unstructured":"Water Fluoridation Basics. 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