cultural and geographical differences have been observed in the prevalence of sleep disorders , sleep schedule , and the reasons that lead to daytime sleepiness among children . although the sleep disorders are common , still it has been found that many a times , parents remain oblivious of their child 's sleep problems . it has been reported that children from the asian countries sleepless as compared to western countries . sleep deprivation has also been reported among children , especially with relation to the homework schedule . diagnosis of sleep disorders and sleep deprivation is important in children as they have been found to be associated with daytime napping , cardiovascular morbidity , attention deficit hyperactivity disorder ( adhd ) , and obesity . indian data using the sleep questionnaires suggests that around 13% of toddlers have sleep problems , most common being the night awakenings . another study reported that among 310 years old children , 43% had some kind of sleep disorder . the most common disorder has been the nocturnal enuresis followed by sleep talking and bruxism . these include children report of sleep habits ( crsh ) , children 's sleep habits questionnaire ( cshq ) , and pediatric sleep questionnaire ( psq ) . among these , crsh is the self - reporting questionnaire , while the latter two are to be responded by the parents . a review of various sleep questionnaires has reported that psq - sleep disordered breathing subscale is a validated tool and possess ' all psychometric properties . hence , the objective of this study was to assess sleep disorders among children falling in the age group of 49 years , especially the obstructive sleep apnea ( osa ) using hindi translation of psq . it had two parts first , the translation of psq in hindi and second , assessment of sleep disorders in children using the hindi version . it has 69 items that address various issues related to child 's sleep that range from sleep onset difficulty , insomnia , restless legs syndrome ( rls ) , snoring , excessive daytime sleepiness , parasomnias , and daytime behavioral symptoms of hyperactivity and inattention . most of the items are to be scored on three points - yes / no or do not know by the parents . one of its subscales for sleep related breathing disorder ( srbd ) has been validated for the diagnosis of sleep apnea . the 22-item srbd subscale has been found to correctly classify 85% cases with sensitivity of 85% and specificity of 87% . this scale has been translated into many languages including malay , spanish , portuguese , and turkish . the translation of the questionnaire was done according to the standard guidelines . after obtaining the permission from the author of original instrument , then , two bilingual translators translated it into hindi independently ( v1 and v2 ) . both the hindi versions were compared with each other , and a common hindi version was reached ( v3 ) . this was back - translated into english by two independent english translators ( v4 and v5 ) . this was compared with the original version ( v0 ) for the gross inconsistencies by the team if any . wherever gross technical inconsistencies were found , this was tested in a small set of parents ( n = 7 ) who had children falling between 3 and 12 years for the ease of understanding . they were asked to provide information regarding sleep of their children and also to report any difficulty in understanding the questionnaire . if they suggested any difficulty in understanding any item / word , it was discussed with them , and necessary changes in terminology were made , wherever required . this leads to a hindi version that was then considered as a final version - v8 . finalized hindi version ( v8 ) was tested in a small set of bilingual parents ( 22 in number ) . first , they were asked to provide information regarding sleep of their child according to final hindi version ( v8 ) . list of schools located in the area was prepared , and from this list , schools were selected randomly . one of the authors reached the school authorities and explained them the rationale of the study . after obtaining permission from the competent authority , this was distributed in the classes starting from lower kindergarten to class iv , i.e. , the children falling in the age group of 49 years . a page for obtaining parent 's informed consent was attached that was to be signed by the parents . , kappa was calculated for each item comparing the agreement between english and hindi version . for the data gathered from the school children , it has 69 items that address various issues related to child 's sleep that range from sleep onset difficulty , insomnia , restless legs syndrome ( rls ) , snoring , excessive daytime sleepiness , parasomnias , and daytime behavioral symptoms of hyperactivity and inattention . most of the items are to be scored on three points - yes / no or do not know by the parents . one of its subscales for sleep related breathing disorder ( srbd ) has been validated for the diagnosis of sleep apnea . the 22-item srbd subscale has been found to correctly classify 85% cases with sensitivity of 85% and specificity of 87% . this scale has been translated into many languages including malay , spanish , portuguese , and turkish . the translation of the questionnaire was done according to the standard guidelines . after obtaining the permission from the author of original instrument , then , two bilingual translators translated it into hindi independently ( v1 and v2 ) . both the hindi versions were compared with each other , and a common hindi version was reached ( v3 ) . this was back - translated into english by two independent english translators ( v4 and v5 ) . this was compared with the original version ( v0 ) for the gross inconsistencies by the team if any . wherever gross technical inconsistencies were found , this was tested in a small set of parents ( n = 7 ) who had children falling between 3 and 12 years for the ease of understanding . they were asked to provide information regarding sleep of their children and also to report any difficulty in understanding the questionnaire . if they suggested any difficulty in understanding any item / word , it was discussed with them , and necessary changes in terminology were made , wherever required . this leads to a hindi version that was then considered as a final version - v8 . finalized hindi version ( v8 ) first , they were asked to provide information regarding sleep of their child according to final hindi version ( v8 ) . list of schools located in the area was prepared , and from this list , schools were selected randomly . one of the authors reached the school authorities and explained them the rationale of the study . after obtaining permission from the competent authority , this was distributed in the classes starting from lower kindergarten to class iv , i.e. , the children falling in the age group of 49 years . a page for obtaining parent 's informed consent was attached that was to be signed by the parents . kappa was calculated for each item comparing the agreement between english and hindi version . for the data gathered from the school children , translation process of the scale in hindi was made difficult by various cultural issues . in hindi , we did not have expression for some of the phrases mentioned in original english version . for example , original version mentions  growing pains  in item numbers a13a and a13b . since this did not have adequate translation in hindi , after the consensus , another term which is given in original instrument  unexplained leg pains  was used , and it was translated as  akaaran dard . the kappa suggested a perfect agreement for most of the items of the scale [ table 2 ] . item a15 had worst agreement , and hence , it was revised in the hindi translation after consultation with participants . hindi translation of english terminologies in pediatric sleep questionnaire - hindi version kappa values of items of pediatric sleep questionnaire - hindi version a total of 560 forms were distributed ; out of which , 482 were returned ( response rate = 86% ) . out of these 482 forms , 47 forms had missing responses on 5 or more items , hence , they were excluded from the study . none of the forms that were returned disclosed any medical condition among any of the participants . two or more awakenings in the night were reported in 3.01% children , and 1.94% had difficulty in falling asleep again . frequent change in bedtime was reported in 5.49% and a frequent change in wake time was observed by parents of 4.95% children . prevalence of various sleep disorders and their symptoms in children of 4 - 9 years ( n=435 ) srbd was reported in approximately 8% children , and at least , one out of three children was wetting the bed . restless legs  and  growing pains  were reported in 6% and 10% children , respectively . among parasomnias , thus , this study underlines the need for focusing our attention to the sleep of children . earlier studies have reported that sleep disorders are not uncommon among school children . at the age of 4 years , 19% children have been found to suffer from sleep disorders with insomnia being the most prevalent of all , reported in 17% of the subjects . another study has reported that insomnia and nightmares were the most prevalent sleep disorder among children who have just joined the school , having reported by 15% and 14% study sample . an indian study involving children falling between 1 and 3 years suggested that 81% had 13 awakenings at night and 13% were suffering from various sleep disorders . our results are more or less comparable with the data from other studies except the snoring , which has been reported by small group in the present study . earlier it has been found that around 39% children snore with 4% having habitual snoring . that study reported that habitual snoring was associated with restless sleep , witnessed pauses in breath during sleep and mouth breathing , and hyperactivity during the daytime . furthermore , sleep disorders and poor sleep have been found to impair academic performance and to produce symptoms similar to adhd . adenotonsillar hypertrophy and obesity are the important predictors of osa among children , and most of the time they are coexistent . in addition to mimicking adhd , osa has been found to have multiple metabolic and cardiovascular complications among children . studies have reported that osa among children leads to lipid peroxidation ; increment of proinflammatory markers in body , for example , interleukin 6 , interleukin 18 , plasminogen activating factor , high - sensitivity - c reactive protein ; insulin resistance ; endothelial dysfunction ; and an increase in blood pressure . however , resolution of osa by adenotonsillectomy or any other method has been reported to improve all consequences of osa among children including adhd and systemic inflammation . considering the high prevalence of osa in this study among indian children and multiple adverse consequences which are reversible , there is a need for improving the awareness among pediatricians regarding sleep disorders . worsening of growing pains at night was reported by parents of 3.22% subjects with repeated kicking in bed by 2.14% . earlier studies have suggested a rls has a prevalence of approximately 2% in chinese children and 3% among turkish children and adolescents ; figures that are close to the prevalence found in this study . however , it should be noted that we did not assess the rls by face - to - face interview . in addition , a number of children in this study had growing pains , and growing pains may be initial presentation of rls among children . considering the impact of rls on the daytime performance of children , sleep quality at night and considering the prevalence of iron deficiency in india , it would be worthwhile to assess the children for rls . first , sample size was small ; second , this was a questionnaire - based study , and third , sleep and sleep disorders were not examined using objective measures . however , the strengths of the study lie in the fact that a hindi translated version of a valid instrument was used that had earlier been found to have good correlation with objective measures . in future , further studies with improved methodology are required to assess the extent of the problem among children and to analyze the effect of sleep disorder on scholastic performance , behavior , and health . this study shows that a significant proportion of children aging between 4 and 9 years suffer from sleep disorders such as srbd and rls . we are thankful to swami rama himalayan university extending the financial support for the data collection . we are thankful to swami rama himalayan university extending the financial support for the data collection .
objective : the objective of this study is to assess the prevalence of sleep disorders among children aging between 4 and 9 years using hindi version of pediatric sleep questionnaire ( psq).methods : this study had two parts first , translation and validation of psq into hindi language , and second , assessment of the prevalence of sleep disorders using psq hindi version . 
 hindi psq was distributed in randomly chosen primary schools in a semi - urban area . 
 the children were requested to get them filled by their parents . 
 when the questionnaires were returned , responses were analyzed.results:most of the items of the hindi version had perfect agreement with original questionnaire in a bilingual population (  = 1 ) . 
 totally , 435 children were included in the field study having average age of 6.3 years . 
 obstructive sleep apnea was reported in 7.5% children ; symptoms suggestive of restless legs syndrome were reported by 2%3% ; teeth grinding by 13.9% and sleep talking by 22.6% children.conclusion:psq hindi version is a validated tool to screen for sleep disorders among children . 
 sleep disorders are fairly prevalent among young children in india .