Background: Due to the unclear etiology of recurrent aphthous stomatitis (RAS), a painful and distressing condition with a high prevalence, the researchers have hypothesized a connection between sleep quality and RAS.

Methods: The cross-sectional study enrolled 10,138 Fasa Cohort Study participants aged 35-70 years. Various sleep quality factors were calculated and categorized based on the Pittsburgh Sleep Questionnaire.

Results: Among 9030 subjects finally included with RAS prevalence of 20.2%, adjusted logistic regression showed significant odds ratios (ORs) in subjects who sleep < 5 h (OR = 1.44, 95%CI 1.25, 1.66), have sleep latencies of more than 60 min (OR = 1.37, 95%CI 1.11, 1.69), have sleep efficiencies of 65%-75% (OR = 1.55, 95%CI 1.21, 1.98), or regularly go to bed after 11 p.m. (OR = 1.23, 95%CI 1.11, 1.37). Subgroup analyses indicated no significant associations between RAS and various sleep factors in individuals who worked night shifts, and stronger associations were observed in men than women.

Conclusion: The study found a significant positive association between RAS and sleep quality factors such as shorter duration, lower efficiency, longer latency, later bedtime, and regular sleeping pill use. Establishing early and sufficient sleep and addressing sleep onset disturbances by adhering to sleep hygiene principles should be prioritized in individuals with RAS.