Youth Screen Media Habits and Sleep: Sleep-Friendly Screen Behavior Recommendations for Clinicians, Educators, and Parents

Prescription Trends of Medications Used to Treat Sleep Disturbances in School-Aged Children: An Interrupted Time-Series Analysis in France, 2016-2023

OBJECTIVE

To assess rates and trends of hypnotic medication prescriptions for children and adolescents.

STUDY DESIGN

Cross-sectional study of national dispensing data between January 1, 2016, and December 31, 2023, in France. Prescriptions of hypnotic medications (hydroxyzine, alimemazine, melatonin, and Z-drugs) dispensed to children aged 6-17 years were analyzed. Monthly rates of hypnotic prescriptions per 1000 children were modeled before and after the pandemic onset (March 2020) to assess rate and trend changes. Rate ratios (RRs) were calculated between estimated and expected prescription rates.

RESULTS

Overall, 2 675 142 prescriptions were dispensed to an average yearly population of 9 963 497 children. In January 2016, prescription rate of hypnotic medications was estimated at 1.9 per 1000 and at 6.8 per 1000 in December 2023, with postpandemic onset rates exceeding the expected by 131% (RR: 2.31, 95% CI: 2.08; 2.54). Prescription trends increased for all medications from -0.1% (95% CI: -0.2; 0.1%) per month prepandemic to +1.4% (95% CI: 1.2; 1.6%) after the pandemic onset for hydroxyzine; +0.1% (95% CI: 0.0; 0.2%) to +0.9% (95% CI: 0.7; 1.0%) for alimemazine; +2.2% (95% CI: 2.0; 2.3%) to +4.4% (95% CI: 3.9; 4.9%) for melatonin; and -3.2% (95% CI: -3.6;-2.8%) to +1.8% (95% CI: 1.4; 2.2%) for Z-drugs. Monthly prescription rates exceeded the expected by 38% (RR: 1.38, 95% CI: 1.31; 1.46) for hydroxyzine; 19% (RR: 1.19, 95% CI: 1.15; 1.22) for alimemazine; 344% (RR: 4.44, 95% CI: 4.07; 4.80) for melatonin; and 419% (RR: 5.19, 95% CI: 4.24; 6.14) for Z-drugs.

CONCLUSIONS

Recent substantial increases in hypnotic medication prescribing for children are possibly related to their persistently deteriorating mental health, changes in prescribing strategies, and/or unmet pre-existing needs.

Efficacy of a Personalized Mobile Health Intervention (BedTime) to Increase Sleep Duration Among Short-Sleeping Patients With Type 2 Diabetes: Protocol for a Pilot Randomized Controlled Trial

BACKGROUND

A strong association exists between sleep duration and glycemic control in patients with type 2 diabetes (T2D), yet convincing evidence of a causal link remains lacking. Improving sleep is increasingly emphasized in clinical T2D treatment guidance, highlighting the need for effective, scalable sleep interventions that can affordably serve large populations through mobile health (mHealth).

OBJECTIVE

This study aims to pilot an intervention that extends sleep duration by modifying bedtime behavior, assessing its efficacy among short-sleeping (≤6 hours per night) patients with T2D, and establishing robust evidence that extending sleep improves glycemic control.

METHODS

This randomized, single-blinded, multicenter study targets 70 patients with T2D from 9 institutions in Japan over a 12-week intervention period. The sleep extension intervention, BedTime, is developed using the Theory of Planned Behavior (TPB) and focuses on TPB's constructs of perceived and actual behavioral control (ABC). The pilot intervention combines wearable actigraphy devices with SMS text messaging managed by human operators. Both the intervention and control groups will use an actigraphy device to record bedtime, sleep duration, and step count, while time in bed (TIB) will be assessed via sleep diaries. In addition, the intervention group will receive weekly bedtime goals, daily feedback on their bedtime performance relative to those goals, identify personal barriers to an earlier bedtime, and select strategies to overcome these barriers. The 12-week intervention period will be followed by a 12-week observational period to assess the sustainability of the intervention's effects. The primary outcome is the between-group difference in the change in hemoglobin A1c (HbA1c) at 12 weeks. Secondary outcomes include other health measures, sleep metrics (bedtime, TIB, sleep duration, total sleep time, and sleep quality), behavioral changes, and assessments of the intervention's usability. The trial commenced on February 8, 2024, and is expected to conclude in February 2025.

RESULTS

Patient recruitment ended on August 29, 2024, with 70 participants enrolled. The intervention period concluded on December 6, 2024, and the observation period ended on February 26, 2025, with 70 participants completing the observation period. The data analysis is currently underway, and results are expected to be published in July 2025.

CONCLUSIONS

This trial will provide important evidence on the causal link between increased sleep duration and improved glycemic control in short-sleeping patients with T2D. It will also evaluate the efficacy of our bedtime behavior change intervention in extending sleep duration, initially piloted with human operators, with the goal of future implementation via an mHealth smartphone app. If proven effective, this intervention could be a key step toward integrating sleep-focused mHealth into the standard treatment for patients with T2D in Japan.

TRIAL REGISTRATION

Japan Registry of Clinical Trials jRCT1030230650; https://jrct.niph.go.jp/latest-detail/jRCT1030230650.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64023.

Adolescents' screen time displaces multiple sleep pathways and elevates depressive symptoms over twelve months

Recently the Swedish Public Health Agency published recommendations of a maximum of two-to-three hours of daily leisure screen time for adolescents aged 13-18, partly to promote better sleep (2024-Sep-02). Biologically and socially, adolescence is characterized by belated sleep times, and depressive effects of screen time can arise through sleep displacements. Theorized links between screen time, sleep, and depression, merited examination of four sleep mediators to determine their relative importance and determine which of them mediate future depression. Hypotheses were preregistered. Three-wave psychometric health data were collected from healthy Swedish students (N = 4810; 51% Boys; ages 12-16; N = 55 schools; n = 20 of 26 Stockholm municipalities). Multiple imputation bias-corrected missing data. Gender-wise Structural Equation Modelling tested four sleep facets as competing mediators (quality, duration, chronotype, social jetlag). The primary model result included the three first mediators to achieve acceptable fit indices (RMSEA = 0.02; SRMR = 0.03; CFI = 0.95; TLI = 0.94). Screen time deteriorated sleep within three months and effect sizes varied between mediators (Beta weights ranged: 0.14-0.30) but less between genders. Among boys, screen time at baseline had a direct adverse effect on depression after twelve months (Beta = 0.02; p <0.038). Among girls, the depressive effect was mediated through sleep quality, duration, and chronotype (57, 38, 45% mediation). Social jetlag remained non-significant. This study supports a modernized 'screen-sleep-displacement theory'. It empirically demonstrates that screen-sleep displacements impact several aspects of sleep simultaneously. Displacements led to elevated depressive symptoms among girls but not boys. Boys may be more prone to externalizing symptoms due to sleep loss. Results could mirror potentially beneficial public health effects of national screen time recommendations.

The relationship between childhood trauma and internet addiction in adolescents with depression: the mediating role of insomnia and alexithymia

BACKGROUND

The correlation between depressive symptoms and internet addiction in adolescents is strengthened, and childhood trauma is an important predictor of internet addiction. However, the mechanism of childhood trauma on internet addiction in adolescents with depression remains unclear. This study investigates the current status and factors influencing internet addiction in adolescents with depression and further examines whether insomnia and alexithymia mediate childhood trauma and internet addiction in adolescents with depression.

METHODS

This study investigated 300 adolescent patients in 7 hospitals in Anhui province. General demographic characteristics such as age and gender were collected. The clinical characteristics of the patients were measured using the Childhood Trauma Questionnaire Short Form (CTQ-SF), Internet Addiction Test (IAT), Insomnia Severity Index (ISI) and 20-item Toronto Alexithymia Scale (TAS-20). PROCESS (Model 4) was used to examine the mediating effects of insomnia and alexithymia.

RESULTS

The prevalence of internet addiction among adolescents with depression was 50.2%. There were statistically significant differences between the internet addiction group and the non-internet addiction group in terms of relationships with classmates, relationships with teachers, family relations, and economic status. The total score of CTQ and its five subscale scores were significantly and positively correlated with the total score of IAT. Insomnia and externally oriented thinking (EOT) played a significant mediating role in the effect of physical neglect (PN) on internet addiction.

CONCLUSION

Insomnia and alexithymia play a significant mediating role between childhood trauma and internet addiction in adolescents with depression, which expand the existing understanding of internet addiction in adolescents with depression, and provide some theoretical references to address the problem of internet addiction in adolescents with depression and prevent the development of adolescent depression.

Does the Usage Habits of Smart Wireless Devices Affect Educational Status and Sleep Quality? The Results of an Anonymous Questionnaire of Iranian High School Students

Objectives

The increasing popularity of wireless smart devices among adolescents has raised concerns about their possible negative effects on academic performance, phone addiction, and sleep disorders. In particular, this issue is of special importance in Iran because some studies have shown that more than 50% of Iranian adolescents are addicted to mobile phones according to the criteria of the Smartphone Addiction Scale-Short Version (SAS-SV). This study aimed to investigate the relationship between daily use time and/or exposure to wireless smart devices and some educational and psychological factors in high school students.

Materials & Methods

This study was conducted on anonymous Iranian high school students using an online questionnaire. Only students aged 14 to 18 who owned personal smart devices were included in this study.

Results

Twenty-nine participants met the inclusion criteria. The results showed that female students used these devices more frequently than male students, and having multiple devices had negative effects on educational performance, phone addiction, and sleep disorders. Sleeping next to wireless devices also negatively impacts sleep quality.

Conclusion

This study highlights the need to promote healthy device usage habits among adolescents.

Findings and Methodological Shortcomings of Investigations Concerning the Relationship Between Sleep Duration and Blood Pressure: A Comprehensive Narrative Review

Cardiology and sleep societies recommend 7-9 h sleep/night for adults (7-8 h for seniors) and more for youngsters; nonetheless, short sleep duration (SSD) of <7 h/night is epidemic. We searched PubMed for representative investigations, including those cited by meta-analyses, that reported association between SSD and long sleep duration (LSD) of >9 h/night and blood pressure (BP) levels to assess shortcomings of their methods. Studies indicate both SSD and LSD negatively impact BP despite major deficiencies, such as (i) reliance mainly on cross-sectional rather than longitudinal protocols, (ii) inclusion of participants diagnosed with hypertension (HTN) and/or taking antihypertension medications, (iii) assessment of BP and diagnosis of HTN performed by single wake-time office measurement rather than multiple measurements performed by 24 h ambulatory BP monitoring (ABPM), and (iv) determination of SD by subjective recall, single-night polysomnography, or diary recordings rather than objective wrist actigraphy of sufficient duration. The limited number of ABPM-based studies, despite evidencing major shortcomings, particularly (i) assessment for 24 h rather than preferred ≥48 h and (ii) inclusion of subjects diagnosed with HTN and/or taking antihypertension medications, also report association between abnormal SD and elevated 24 h 'daytime'/wake-time diastolic and systolic (SBP) means plus 'nighttime'/sleep-time SBP mean and dipping-the latter two indices, in combination, the strongest predictors of major adverse cardiovascular events.

Insomnia severity and obesity mediated by health behaviors in adolescents

OBJECTIVE

Sleep difficulties in youth have been associated with numerous negative outcomes, such as higher risk of obesity. Though the relationship between sleep and obesity is not well clarified, past research has shown that modifiable health behaviors, such as diet, physical activity, and screen time, may explain this relationship. The purpose of this study was to simultaneously examine these health behaviors as mediators of the relationship between insomnia severity and obesity among a sample of adolescents aged 12-18 years.

METHOD

English-speaking parents/legal guardians of adolescents were invited to participate in an online survey focused on pediatric sleep patterns, health behaviors, and weight. Parents/guardians (N = 599) reported on their adolescent's diet (i.e., consumption of fruits/vegetables, fast food, and breakfast), physical activity, screen time, and BMI. A multiple mediation analysis was run to test these health behaviors as mediators of the relationship between insomnia severity and BMI, after controlling for sex, age, race, and poverty.

RESULTS

While insomnia was related to most health behaviors, screen time was the only significant mediator of the relationship between insomnia and BMI, after controlling for the effects of the other mediators and all covariates, ab = .04, 95% CrI [.01, .09].

CONCLUSIONS

Screen time has implications for both adolescents' sleep health and weight. Pediatric clinicians should systematically assess for, and provide, recommendations on ways to improve sleep and screen time use, in addition to providing traditional dietary and physical activity recommendations.

Prospective relationship between family screen time rules, obesogenic behaviours, and childhood obesity

Family screen use rules (FSRs) could plausibly protect against the development of childhood obesity, although the mechanisms underlying these protective effects remain largely unexplored. This research aimed to investigate prospectively the associations between exposure to FSRs at age 24 months, obesogenic behaviours (excessive screen time and short sleep duration) at age 45 months, and obesity at age 54 months. Additionally, a model proposing the mediating role of obesogenic behaviours in the association between FSRs and childhood obesity was tested. Data were obtained from 5733 children and their mothers participating in the 'Growing Up in New Zealand' study. Logistic regressions examined the association between three FSRs (rules on quality, quantity and timing of screen time, and different numbers of FSRs), obesogenic behaviours, and childhood obesity. Structural equation modelling (SEM) was applied to assess the potential mediating roles of obesogenic behaviours in the association between FSRs and zBMI. Neither exposure to individual nor all three FSRs was significantly associated with lower odds of obesity. However, protective effects of FSRs were observed concerning obesogenic behaviours. Exposure to individual or all three FSRs correlated with reduced odds of not meeting screen time and sleep duration recommendations. SEM analysis indicated no direct association between FSRs and zBMI; nevertheless, a significant indirect association was identified through the mediation of obesogenic behaviours. These findings suggest the potential benefits of promoting the adoption of FSRs as a promising population-based strategy to enhance child health behaviours and mitigate the risk of childhood obesity.

Social network site addiction, sleep quality, depression and adolescent difficulty describing feelings: a moderated mediation model

BACKGROUND AND OBJECTIVES

Social network site addiction is strongly correlated with sleep quality among adolescents. However, the underlying mechanisms driving these relationships require further exploration. This study aims to supplement the understanding of the psychological mechanisms linking social network site addiction and sleep quality by investigating depression as a mediating factor and difficulty describing feelings as a moderating factor.

METHODS

A self-report survey was conducted with 1,670 adolescents in China, assessing social network site addiction, sleep quality, depression, and difficulty describing feelings. Descriptive and correlational analyses were performed on these variables, followed by the construction of a moderated mediation model.

RESULTS

Social network site addiction was significantly positively correlated with sleep quality, depression, and difficulty describing feelings among adolescents. Difficulty describing feelings was also significantly positively correlated with depression. Depression partially mediated the relationship between social network site addiction and sleep quality, while difficulty describing feelings intensified the relationship between social network site addiction and depression.

CONCLUSION

This study further elucidates the psychological mechanisms linking social network site addiction and sleep quality in adolescents. Depression acts as a mediating factor, while difficulty describing feelings strengthens the relationship between social network site addiction and depression. These findings highlight the role of difficulty describing feelings in the interplay between social network site addiction and sleep quality, offering valuable insights for a more comprehensive understanding and targeted interventions aimed at improving sleep quality in adolescents.

Digital Detox Strategies and Mental Health: A Comprehensive Scoping Review of Why, Where, and How

Excessive use of social media (SM) platforms and digital technology (DT), often driven by habitual scrolling due to adaptive feed experiences, has been linked to anxiety, sleep disturbances, and obsessive-compulsive behaviors while also exacerbating mental health concerns. Yet, the role of "digital detox", defined as a voluntary reduction or temporary cessation of device use, remains only partially understood as both a clinical and lifestyle intervention. This comprehensive scoping review was conducted to consolidate existing research on digital detox interventions and evaluate contextual factors that may influence their effectiveness for mental health and well-being. A targeted keyword search for "digital detox" was conducted in the PubMed database on December 12, 2024, yielding 34 initial results. This review followed the approach recommended by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) to identify, screen, and extract evidence from relevant studies as per pre-specified inclusion criteria. A total of 14 studies were found eligible, and data from these studies and their relevant references (totaling 640 citations) were extracted and synthesized. Our findings suggest that digital detox interventions may alleviate depression and problematic internet use, and individuals with higher baseline symptom severity appear to derive higher benefits. However, the impact on broader outcomes such as life satisfaction and overall well-being remains variable. Divergent intervention approaches, ranging from short-term SM abstinence to sustained, moderate device restrictions and individual differences in baseline severity of symptoms, coping styles, environmental pressures, and support systems, may contribute to different outcomes across various studies and systematic reviews. Overall, age, gender, baseline mental health, and range and duration of DT usage prior to detox are the key variables that may determine the effectiveness of digital detox interventions. Tailored DT usage in moderation, aligned with each individual's age, developmental stage, and academic needs, has greater benefits among younger populations, particularly adolescents and young adults, while mindful and regulated SM use is especially advantageous for female populations. However, other populations could also benefit, provided interventions address self-regulation challenges specific to adult lifestyles. Given the growing global prevalence of problematic smartphone use (PSU) and its documented comorbidity with psychiatric disorders, digital detox strategies have the potential to be integrated into clinical recommendations and policy initiatives. However, a framework for assessing intervention quality and long-term outcomes is essential.

Association of digital media use with sleep habits in school children: A cross-sectional study

Background

The use of digital media (DM) is increasing among school-children, which can affect their sleep habits. The primary objective of this study was to evaluate the association of DM use with sleep habits in school-children.

Methods

It was a cross-sectional study of healthy school children. Sleep habits and DM use were assessed using the Children's Sleep Habits Questionnaire (CSHQ) and SCREENS-Q, respectively. The Pearson correlation coefficient was used to establish the correlation between the two variables. Logistic regression analysis was performed to quantify the extent of association between variables. A p-value <0.05 was considered statistically significant.

Results

A total of 205 children were enrolled with a mean (SD) age of 7.1 (2.1) years. The mean (SD) sleep duration was 7.58 (0.80) hours. The mean (SD) CSHQ score was 50.6 (5.1). Use of DM was observed in 204 (99.5 %) children. On multivariate logistic regression analysis, DM use ≥2 h/day was significantly associated with higher CSHQ score (OR 1.28, 95%CI 1.18-1.40; p = 0.001). Sleep domains significantly affected by DM use ≥2 h/day were bedtime resistance (OR 1.55, 95 % CI 1.24-1.94; p < 0.001), sleep duration (OR 0.40, 95 % CI 0.28-0.58:p < 0.001), sleep anxiety (OR 1.69, 95%CI 1.40-2.04:p < 0.001), night awakening (OR 4.81 95 % CI 2.98-7.78:p < 0.001), parasomnias (OR 1.86, 95 % CI 1.45-2.38:p < 0.001), and daytime sleepiness (OR1.89,95 % CI 1.52-2.36: p < 0.001). DM use 30 min before bedtime was significantly associated with a higher CSHQ score (OR 1.32, 95 % CI 1.20-1.45; p < 0.001). In bivariate regression analysis, DM use ≥2 h/day was associated with poor academic performance (OR 2.36 95 % CI 1.28-4.35; p 0.006).

Conclusion

This study has shown that the average sleep duration in children was shorter than the recommended duration. DM use was common in school children and it has a significant association with sleep habits especially with use of ≥2 h/day and 30 mints before bedtime. It was also associated with poor academic performance. Public awareness on effect of DM use in school children is the need of the hour.

Association between excessive screen time and falls, with additional risk from insufficient sleep duration in children and adolescents, a large cross-sectional study in China

Objective

Falls is a major global public health issue that occur in all age groups. However, the association between screen time, sleep duration and falls in children and adolescents remains unclear.

Methods

This study included children and adolescents who participated in the 2017 Nutrition and Health Surveillance of Children and Lactating Mothers in China. Screen time, sleep duration and falls in the past 12 months were assessed using baseline questionnaires completed by the participants. We utilized a multivariate logistic regression model to estimate the association between screen time, sleep duration, and falls in children and adolescents. Stratified analyses and sensitivity analyses were performed using the same modelling strategies.

Results

A total of 564 participants (5.7%) self-reported falls in the past 12 months. Multivariate logistic regression analysis revealed that high screen time (> 2 h per day) was associated with a higher incidence of falls (cOR:1.46, 95% CI: 1.22-1.74, p < 0.001). The combination of high screen time and low sleep duration was associated with an increased risk of falls compared to the recommended low screen time and high sleep duration group (cOR: 1.62, 95% CI: 1.25-2.09, p < 0.001). After adjusting for relevant covariates, the associations remained significant (aOR: 1.30, 95% CI: 1.08-1.56, p = 0.006; aOR: 1.43, 95% CI: 1.10-1.87, p = 0.008).

Conclusion

Our study demonstrates that both high screen time and the combination of high screen time and low sleep duration were associated with an increased risk of falls. Interventions to promote healthy physical development should commence in early childhood to decrease the incidence of fall injuries in children and adolescents.

Perceptions around sleep hygiene practices and beliefs among urban Black adolescents and their caregivers during the COVID-19 pandemic

OBJECTIVE

This study gathered adolescent and caregiver perspectives on sleep hygiene practices and beliefs for Black families living in low-resourced urban communities.

METHODS

Semistructured interviews were conducted with adolescents (n = 9) and caregivers (n = 9) from January-March 2021, during the COVID-19 pandemic. Interview questions included adolescent's current sleep habits, barriers, and home and neighborhood influences. Trained researchers coded data using inductive analysis and a constant comparative method to derive themes.

RESULTS

Two themes focused on sleep hygiene practices, including items used to facilitate sleep (e.g., melatonin, electronics) and COVID-19 consequences on sleep schedules. Two themes focused on sleep hygiene beliefs, including a common value on the importance of sleep and influences on caregiver's bedtime rules.

CONCLUSIONS

Findings provide important insights on sleep hygiene practices and beliefs in a historically marginalized population of Black adolescents and caregivers in urban communities to inform targeted sleep interventions, policies, and programs for optimal sleep and well-being.

Accelerometer-measured sleep behaviour and parent-child sleep guideline adherence and sleep quality in Czech families with children aged 3-8 years: the FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study

Assessing parent-child relationship in sleep behaviours is important for facilitating changes in the sleep guideline compliance in preschool age children. The aim of this study was to examine accelerometer-measured sleep quantity and quality in families with children aged 3-8 years and investigate the parents' influence on the child's sleep. The data were obtained from the Czech cross-sectional FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study, with a final sample of 374 families. Families were recruited through the enrolment of their children in kindergartens/primary schools between March 2022 and May 2023. The sleep time window and total sleep time were assessed using a wrist-worn ActiGraph accelerometer. Participants wore this device continuously for 24 h/day over a period of 7 consecutive days. Demographic data and potential correlates were obtained via questionnaires completed by parents. Statistical analyses were completed using logistic regression and independent-samples Mann-Whitney U test. In all, 65.5% of children (60% boys, 70.9% girls) and 58.3% of parents (52.4% fathers, 64.3% mothers) achieved the recommended sleep duration. Greater sleep quantity and duration in good-quality sleep were significantly higher in girls/mothers, compared to boys/fathers. Preschoolers were more likely to comply with sleep guidelines if their mother (but not father) met the sleep recommendation and their mothers did not have a higher education level. Adhering to sleep guidelines in children was also associated with children's female gender, absence of screen device in the bedroom, and being more active. Given the high concurrence in mother-child sleep quantity, it is important to promote healthy sleep behaviours in the whole family.

Social determinants of health at multiple socio-ecological levels and sleep health in adolescents: A scoping review

Heightened sleep disturbances occur in adolescence, yet existing research has predominantly focused on individual factors linked to poor sleep and a limited set of sleep outcomes, such as sleep duration and timing. This scoping review aimed to identify the multilevel social determinants of adolescent sleep health across domains, including regularity, satisfaction/quality, alertness/sleepiness, timing, efficiency/continuity, duration, and behavior. Social determinants of health (SDoH) were categorized through a socio-ecological lens, while sleep health domains were aligned with the RU-SATED and Peds B-SATED sleep health frameworks. A systematic database search resulted in 57 studies of non-clinical adolescent and young adult populations (age 10-24 y) in North America, published between 2014 and 2022. Research gaps include 1) absence of other sleep health domains other than duration which is predicated on the included studies using a limited set of sleep outcome measures rather than a more comprehensive measurement strategy that align with the multifaceted domains of sleep health, and 2) inconsistent terminology and/or absent conceptual and operational definitions of subjective sleep reports. The findings highlight the multilevel SDoH that influence adolescent sleep health, underscoring the need for more comprehensive research. Such efforts will facilitate the development of interventions focused on fostering optimal adolescent sleep health this populations.

The relationship between chronotype video game addiction and sleep quality in school-age children: A structural equation modeling approach

This study aimed to investigate the relationship between chronotype, video game addiction, and sleep quality in school-age children using structural equation modeling. It was performed using structural equation modeling, with 545 secondary school students in northern Turkey meeting the inclusion criteria. Data were collected through face-to-face interviews utilizing the Personal Information Form, the Morningness Eveningness Scale for Children (MESC), the Video Game Addiction Scale for Children (VASC), and the Sleep Quality Scale. The findings revealed that the average video game addiction score of children was 55.22, which was associated with poor sleep quality and efficiency. Additionally, chronotype was found to mediate the relationship between video game addiction and both sleep quality (β = 0.024; p < 0.001) and sleep efficiency (β = -0.068; p < 0.001). The model was found to be close to acceptable levels for the variables according to the fit indices.

Screen Use at Bedtime and Sleep Duration and Quality Among Youths

Importance

Although questionnaire-based cross-sectional research suggests that screen time before bed correlates with poor sleep, self-reported data seem unlikely to capture the complexity of modern screen use, requiring objective night-by-night measures to advance this field.

Objective

To examine whether evening screen time is associated with sleep duration and quality that night in youths.

Design, Setting, and Participants

This repeated-measures cohort study was performed from March to December 2021 in participant homes in Dunedin, New Zealand. Participants included healthy youths aged 11 to 14.9 years. Data were analyzed from October to November 2023.

Exposure

Objectively measured screen time, captured using wearable or stationary video cameras from 2 hours before bedtime until the first time the youth attempted sleep (shut-eye time) over 4 nonconsecutive nights. Video data were coded using a reliable protocol (κ = 0.92) to quantify device (8 options [eg, smartphone]) and activity (10 options [eg, social media]) type.

Main Outcomes and Measures

Sleep duration and quality were measured objectively via wrist-worn accelerometers. The association of screen use with sleep measures was analyzed on a night-by-night basis using mixed-effects regression models including participant as a random effect and adjusted for weekends.

Results

Of the 79 participants (47 [59.5%] male; mean [SD] age, 12.9 [1.1] years), all but 1 had screen time before bed. Screen use in the 2 hours before bed had no association with most measures of sleep health that night (eg, mean difference in total sleep time, 0 minutes [95% CI, -3 to 20 minutes] for every 10 minutes more total screen time). All types of screen time were associated with delayed sleep onset but particularly interactive screen use (mean difference, 10 minutes; 95% CI, 4 to 16 minutes for every additional 10 minutes of interactive screen time). Every 10 minutes of additional screen time in bed was associated with shorter total sleep time (mean difference, -3 minutes; 95% CI, -6 to -1 minute). The mean difference in total sleep time was -9 minutes (95% CI, -16 to -2 minutes) for every 10 minutes of interactive screen use and -4 minutes (95% CI, -7 to 0 minutes) for passive screen use. In particular, gaming (mean difference, -17 minutes; 95% CI, -28 to -7 minutes for every 10 minutes of gaming) and multitasking (mean difference, -35 minutes; 95% CI, -67 to -4 minutes on nights with vs without multitasking) were associated with less total sleep time.

Conclusions and Relevance

In this repeated-measures cohort study, use of an objective method showed that screen time once in bed was associated with impairment of sleep, especially when screen time was interactive or involved multitasking. These findings suggest that current sleep hygiene recommendations to restrict all screen time before bed seem neither achievable nor appropriate.

An Overview of Health-Promoting Programs and Healthy Lifestyles for Adolescents and Young People: A Scoping Review

The health of children, adolescents, and young adults is a primary global concern. In 2021, there were 2.1 million deaths among children and adolescents. Injuries, violence, communicable diseases, nutritional deficiencies, substance use, non-communicable diseases, and mental health disorders are among the leading causes of death in this age group. Background/objectives: This scoping review aims to identify and describe health promotion and healthy lifestyle programs developed worldwide targeting adolescents and young adults. Methods: A total of 106 programs were included, of which 8 were selected through scientific databases and 98 through other research methods (e.g., government websites and other online sources). Results: The results show that Europe, North America, New Zealand, and the United States of America are the continents and countries with the highest number of programs. Most programs originated before 2020 and are aimed at children, adolescents, and young adults. Mental health, substance and non-substance dependencies, and sexual and reproductive health were the most frequent areas among the available youth programs. Most programs do not mention evaluating or monitoring the services provided. Conclusions: This work allows for a deeper understanding of the programs available for adolescents and young adults, providing an overview of their characteristics. Moreover, it emphasizes the importance of increasing the number of available programs, especially in countries with higher morbidity and mortality rates among the young population. The programs must be based on population studies to better meet their needs. Lastly, programs should become sustainable and integrated into national public policies, accompanied by ongoing training, supervision, and intervision of professionals working in these contexts.

Bedtime Screen Use Behaviors and Sleep Outcomes in Early Adolescents: A Prospective Cohort Study

PURPOSE

To determine prospective associations between bedtime screen use behaviors and sleep outcomes one year later in a national study of early adolescents in the United States.

METHODS

We analyzed prospective cohort data from 9,398 early adolescents aged 11-12 years (48.4% female, 45% racial/ethnic minority) in the Adolescent Brain Cognitive Development Study (Years 2-3, 2018-2021). Regression analyses examined the associations between self-reported bedtime screen use (Year 2) and sleep variables (Year 3; self-reported sleep duration; caregiver-reported sleep disturbance), adjusting for sociodemographic covariates and sleep variables (Year 2).

RESULTS

Having a television or Internet-connected electronic device in the bedroom was prospectively associated with shorter sleep duration one year later. Adolescents who left their phone ringer activated overnight had greater odds of experiencing sleep disturbance and experienced shorter sleep duration one year later, compared to those who turned off their phones at bedtime. Talking/texting on the phone, listening to music, and using social media were all prospectively associated with shorter sleep duration, greater overall sleep disturbance, and a higher factor score for disorders of initiating and maintaining sleep one year later.

DISCUSSION

In early adolescents, several bedtime screen use behaviors are associated with adverse sleep outcomes one year later, including sleep disturbance and shorter weekly sleep duration. Screening for and providing anticipatory guidance on specific bedtime screen behaviors in early adolescents may be warranted.

A multi-school study in England, to assess problematic smartphone usage and anxiety and depression

AIM

To assess the association between problematic smartphone usage and anxiety and depression in adolescents.

METHODS

A cross-sectional study in five schools in the UK were included. The primary outcome was moderate anxiety (GAD-7 ≥10) symptoms and secondary outcomes were moderate depression symptoms (PHQ-9 ≥10) and insomnia. Problematic smartphone usage was assessed using screentime and the Smartphone Addiction Scale. A multi-level logistic regression was fitted and adjusted Odds Ratio (aOR) with 95% confidence intervals (95% CI) reported. A mediation analysis was conducted.

RESULTS

Of the five included schools, 657 adolescents aged 16-18 years were enrolled. The median age was 17.5 years (17-18 [IQR]) and 508 (77.3%) were female. Of these 188 (28.6%) exhibited moderate anxiety and 226 (34.4%) moderate depression symptoms. Almost two thirds (421, 64.1%) have tried to cut down their smartphone use and 81 (12.5%) wanted help to reduce use. Problematic smartphone use was associated with increased anxiety (aOR = 2.03, 95% CI 1.28-3.23); depression (aOR = 2.96, 95% CI 1.80-4.86); and insomnia (aOR = 1.64, 95% CI 1.08-2.50). Screentime was not associated with anxiety (β = 0.99, 95% CI 0.91-1.08); or depression (β = 0.98, 95% CI 0.89-1.07). Problematic smartphone use had a significant direct, indirect and total effect on both anxiety and depression.

CONCLUSION

Problematic smartphone usage was associated with anxiety and depression, independent of screentime. Interventions are needed to reduce problematic use.

The enigma of sleep: Implications of sleep neuroscience for the dental clinician and patient

BACKGROUND

Sleep disturbances have been shown to result in considerable morbidity and mortality. It is important for dental clinicians to understand the neuroscience behind sleep disorders.

TYPES OF STUDIES REVIEWED

The authors conducted a search of the literature published from January 1990 through March 2024 of sleep medicine-related articles, with a focus on neuroscience. The authors prioritized articles about the science of sleep as related to dental medicine.

RESULTS

The authors found a proliferation of articles related to sleep neuroscience along with its implications in dental medicine. The authors also found that the intricate neuroscientific principles of sleep medicine are being investigated robustly. The salient features of, and the differences between, central and obstructive sleep apneas have been elucidated. Sleep genes, such as CRY, PER1, PER2, and CLOCK, and their relationship to cancer and neurodegeneration are also additions to this rapidly developing science.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The dental clinician has the potential to be the first to screen patients for possible sleep disorders and make prompt referrals to the appropriate medical professionals. This can be lifesaving as well as minimize potential future morbidity for the patient.

Effects of COVID-19 lockdown on children´s sleep quality, physical activity, screen time, and diet

Introduction

Background: this study aimed to assess how the COVID-19 lockdown (March to June 2020) affected children's sleep quality, physical activity, screen time, and nutrition. Material and methods: the survey consisted of 479 children from the SENDO project, a pediatric cohort in Spain, aged 4-5 years. The BEAR questionnaire was used to evaluate sleep quality. Hierarchical models with two-level clustering were used to account for intra-cluster correlation between siblings, and the difference regression method was used to study the association between changes in screen consumption and physical activity and changes in sleep quality. Results: the results showed an increase in the consumption of homemade pastries and snacks. Sleep quality worsened significantly during confinement, with a mean score on the BEAR scale of 0.52 before, 1.43 during, and 1.07 after confinement. Although sleep quality improved significantly after the end of confinement, it remained worse than before. The average daily screen time increased from 1.13 hours before confinement to 2.65 hours during confinement. Physical activity decreased during confinement, with the mean number of hours per day decreasing from 1.27 to 0.79. Children who spent more time on screens during confinement had worse sleep quality, as indicated by their higher scores on the BEAR scale. We used the difference regression method to identify a statistically significant association between the increased screen time for leisure hours and the worsening of children's sleep quality during confinement. Conclusion: we observed a significant relationship between confinement and reduced sleep quality. Although the end of the lockdown led to a slight improvement, the average BEAR scale score remained higher post-confinement, suggesting that the consequences of the lockdown may persist over time.

Effect of sleep on oral health: A scoping review

Sleep is a vital biological process that facilitates numerous vital functions integral to mental and physical restoration of the body. Sleep deprivation or poor sleep quality not only affects physical health but may also affect oral health. This scoping review aims to collate existing evidence related to the impact of sleep duration and/or quality on oral health. A systematic search strategy using PubMed, Embase, Scopus and CINAHL databases was performed to identify studies that assessed the association between sleep quality or duration and oral health or hygiene. Two researchers independently screened and extracted the data. Eligible studies were critically appraised using the NIH quality assessment tool for observational cohort and cross-sectional studies checklist. The search identified 18,398 studies, from which 14 fulfilled the inclusion criteria. Of the 14 papers, four papers were associated with effect of sleep on caries, 8 papers described the effect of sleep on gingival and periodontal health, and two papers described the effect of sleep on general oral health and oral disease symptoms. This review found a direct link between sleep and dental decay in children, and short sleep duration was associated with an increased risk of periodontitis adults.

Impact of sleep on educational outcome of Indigenous Australian children: A systematic review

INTRODUCTION

The association between quality sleep and improved cognition is well reported in literature. However, very few studies have been undertaken to evaluate the impact of poor sleep on educational outcomes in Indigenous Australian children.

OBJECTIVES

The objective of this review was to explore the association between sleep and educational outcomes of Indigenous children.

METHODS

For this systematic review, a literature search covering research articles in academic databases and grey literature sources was conducted to retrieve studies published until March 2022. Eight online e-databases (PubMed, Ovid MEDLINE, CINAHL, SCOPUS, HealthinfoNet, PsycINFO, Cochrane and Google Scholar) were searched for data extraction and two appraisal tools (NIH and CREATE) were used for quality assessment. Studies that explored any aspect of sleep health in relation to educational/academic outcomes in school going Indigenous Australian children aged 5-18 were included in this study. All review articles and studies that focused on physical/ mental disabilities or parent perceptions of sleep and educational outcomes were excluded. A convergent integrated approach was used to collate and synthesize information.

RESULTS

Only three studies (two cross-sectional and one longitudinal) met the eligibility criteria out of 574 articles. The sample size ranged from 21-50 of 6 to 13 year old children. A strong relationship was indicated between sleep quantity and educational outcomes, in two of the three studies. One study related the sleep fragmentation/shorter sleep schedules of short sleep class and early risers with poorer reading (B = -30.81 to -37.28, p = 0.006 to 0.023), grammar (B = -39.79 to -47.89, p = 0.012-0.013) and numeracy (B = -37.93 to -50.15, p = 0.003 to 0.022) skills compared with long sleep and normative sleep class whereas another reported no significant relation between sleep and educational outcomes.

CONCLUSION

The review highlights the need for more research to provide evidence of potentially modifiable factors such as sleep and the impact these may have on academic performance.

Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions

BACKGROUND

Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population.

METHODS

Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices.

RESULTS

Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents.

CONCLUSIONS

Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

'There's more to life than staring at a small screen': a mixed methods cohort study of problematic smartphone use and the relationship to anxiety, depression and sleep in students aged 13-16 years old in the UK

BACKGROUND

Depression and anxiety are common in adolescents and have increased over the last decade. During that period, smartphone usage has become ubiquitous.

OBJECTIVES

The study aim was to assess the association between problematic smartphone usage (PSU) and anxiety.

METHODS

Using a prospective mixed methods cohort study design, students aged 13-16 year old from two schools were enrolled regarding their smartphone use, mood and sleep via a semistructured questionnaire at baseline and week 4. The primary outcome was symptoms of anxiety (Generalised Anxiety Disorder Questionnaire, GAD-7) and exposure was PSU (Smartphone Addiction Scale Short Version). A linear regression was fitted to assess the change in anxiety. Thematic analysis of free-text responses was conducted.

FINDINGS

The sample included 69 participants that were enrolled and followed up between 28 March and 3 June 2022. Of those with PSU, 44.4% exhibited symptoms of moderate to severe anxiety compared with 26.4% of those without PSU. There was a linear association between change in symptoms of anxiety and PSU β=0.18 (95% CI 0.04 to 0.32, p=0.013). Several themes were found: both positive and negative effects of smartphones on relationships; negative effects on school performance and productivity; mixed effects on mood; a desire to reduce the amount of time spent on smartphones.

CONCLUSIONS

Increased anxiety, depression and inability to sleep were seen in participants as their PSU score increased over time. Participants reported both positive and negative effects of smartphones and almost all used strategies to reduce use.

CLINICAL IMPLICATIONS

Interventions need to be developed and evaluated for those seeking support.

Social Media Use and Sleep Quality Among Secondary School Students in Aseer Region: A Cross-Sectional Study

Background

Use of different social media platforms has increased radically over the past decade, emerging as an important part of adolescents and young people's everyday life. This might exert potential adverse effects on sleep quality and daytime performance of young adults.

Aim of Study

To assess the relation between use of social media platforms and sleep quality among public secondary school students.

Methods

A cross-sectional study was conducted on 961 students in Aseer region, Saudi Arabia. Students were asked to fill in a structured interview questionnaire covering personal data, pattern of social media use, sleep quality using The Pittsburgh Sleep Quality Index (PSQI) and their mental health status using the depression, anxiety and stress scale (DASS-21).

Results

Students' ages ranged from 15 to 20 years with a mean age of 16.7 ± 2.1 years old. A total of 570 (59.3%) students were females. Tiktok (80%), Snapchat (77.9%), Instagram (63.8%) and YouTube (58.8%) were the most reported platforms used. Regarding their sleep quality, 34.7% of students were poor sleepers. TikTok use (OR 1.33, 95% CI 1.01-1.77), hours spent on social media (OR 1.26, 95% CI 1.16-1.37) and having moderate to severe depressive symptoms (OR 1.69, 95% CI 1.19-2.40) were significant independent predictors of poor sleep among the studied sample.

Conclusion

The present study emphasized the association between prolonged use of social media and poor sleep quality among Saudi adolescents. Awareness and behavioral change strategies and activities concerning the drawbacks of poor sleep and proper use of social media are urgently called for to control mental and physical health consequences of poor sleep and social media addiction.

The mediating effect of after-midnight use of digital media devices on the association of internet-related addictive behavior and insomnia in adolescents

Background

There is evidence that overexposure to digital media devices (DMD) can not only lead to addictive patterns of internet use, but also cause insomnia symptoms. The aim of this cross-sectional study among adolescents is to provide an estimate of the prevalence of sleep impairments and to explore the mediating role of after-midnight use of DMD between internet-related addictive behavior (IRAB) and insomnia.

Methods

2,712 school students from Styrian schools participated in a population-representative online survey in a supervised school setting in spring 2022. School students were screened using established and validated scales. Data analysis was carried out using multiple imputation, linear multilevel regression and mediation analysis.

Results

Prevalence estimation indicates high proportions of clinically relevant moderate [12.6% (11.3%; 14.1%)] and severe [3.6% (2.9%; 4.4%)] insomnia, with an additional 30.6% (29.0%; 32.2%) at subthreshold level. DMD are typically used after midnight an average of 1.66 (1.58; 1.75) evenings with subsequent school day per school week. Linear multilevel regression analysis shows significant associations for sleep disparities as outcome variable e.g., with generalized anxiety [b = 0.329 (0.287; 0.371)], after-midnight use of DMD [b = 0.470 (0.369; 0.572)] and IRAB [b = 0.131 (0.097; 0.165)]. Mediation analysis shows a mediated proportion of 18.2% (13.0%; 25.0%) of the association of IRAB and insomnia by after-midnight use of DMD [Indirect effect: b = 0.032 (0.023; 0.040), direct effect: b = 0.127 (0.083; 0.170)].

Conclusions

Although the cross-sectional nature of this study limits causal inference, the results indicate a need for policies, which are already in preparation in Styria as part of a respective action plan.

Developmental changes in school burnout: The importance of sleep and problematic Internet use

INTRODUCTION

School burnout remains a prevalent problem among adolescents; it is associated with low academic achievement and school dropout risk, in turn linked to a whole host of deleterious developmental outcomes. The current longitudinal study sought to better understand the developmental course of school burnout by testing whether poor sleep and problematic internet use each uniquely and additively explained the variance in school burnout over time.

METHOD

Data were collected four times over 18 months, 6 months apart from N = 405 adolescents, grades 9 to 11.

RESULTS

Sleep quality, but not quantity, was significantly associated with the school burnout intercept (β = -0.29); no effects were found for the slope. Problematic internet use was also significantly associated with the intercept (β = .44), but not the slope. In a combined model, both sleep quality and problematic internet use significantly predicted the school burnout intercept. The slope was only predicted by age (β = -0.21).

CONCLUSIONS

The study found partial support for the hypotheses that both poor sleep quality and problematic internet use predicted school burnout, intercept only, not the rate of change. The evidence suggests that school burnout increased across high school; however, the rate of increase slowed with age. In contrast to some previous work, study findings highlight the importance of separately considering both poor sleep and problematic internet use in understanding the development of school burnout during adolescence. N = 229.

Screen time, sleep, brain structural neurobiology, and sequential associations with child and adolescent psychopathology: Insights from the ABCD study

Background and Aims

The precise roles of screen media activity (SMA) and sleep problems in relation to child/adolescent psychopathology remain ambiguous. We investigated temporal relationships among sleep problems, SMA, and psychopathology and potential involvement of thalamus-prefrontal-cortex (PFC)-brainstem structural covariation.

Methods

This study utilized data from the Adolescent Brain Cognitive Development study (n = 4,641 ages 9-12) at baseline, Year1, and Year2 follow-up. Cross-Lagged Panel Models (CLPMs) investigated reciprocal predictive relationships between sleep duration/problems, SMA, and psychopathology symptoms. A potential mediating role of baseline Thalamus-PFC-brainstem covariation on SMA-externalizing relationships was examined.

Results

Participants were divided into discovery (n = 2,359, 1,054 girls) and replication (n = 2,282, 997 girls) sets. CLPMs showed 1) bidirectional associations between sleep duration and SMA in late childhood, with higher frequency SMA predicting shorter sleep duration (β = -0.10 [95%CI: -0.16, -0.03], p = 0.004) and vice versa (β = -0.11 [95%CI: -0.18, -0.05], p < 0.001); 2) externalizing symptoms at age 10-11 predicting sleep problems (β = 0.11 [95%CI: 0.04, 0.19], p = 0.002), SMA (β = 0.07 [95%CI: 0.01, 0.13], p = 0.014), and internalizing symptoms (β = 0.09 [95%CI: 0.05, 0.13], p < 0.001) at age 11-12; and 3) externalizing behavior at age 10-11 partially mediating the relationship between baseline thalamus-PFC-brainstem covariation and SMA at age 11-12 (indirect effect = 0.032 [95%CI: 0.003, 0.067], p-value = 0.030). Findings were replicable.

Conclusion

We found bi-directional SMA-sleep-duration associations in late childhood. Externalizing symptoms preceded future SMA and sleep disturbances and partially mediated relationships between structural brain covariation and SMA. The findings emphasize the need for understanding individual differences and developing and implementing integrated strategies addressing both sleep concerns and screen time to mitigate potential impacts on psychopathology.

Exposure to maternal experiences of IPV in early childhood and sleep health in adolescence

BACKGROUND

Half of US women will experience intimate partner violence (IPV), and nearly all children in families experiencing such violence will be exposed. The negative effects of IPV exposure on children's mental and physical health are well-documented; however, less is known about effects on children's sleep health, a key marker of well-being.

OBJECTIVE

This study examines the associations of early childhood exposure to maternal experiences of IPV with sleep health in adolescence, focusing on multiple dimensions of sleep health and differences by child sex.

PARTICIPANTS AND SETTING

We rely on data from the Future of Families and Child Wellbeing Study, a population-based study following 5000 children in large US cities, from birth to age 15. Analyses are based on 2687 adolescents interviewed at the year-15 follow-up.

METHODS

Early childhood exposure to IPV is based on mothers' reports of her experiences of IPV from the child's birth to age 5. Adolescent sleep health is measured using 6 items approximating the BEARS sleep problem scale, at age 15. We estimate multivariate linear regression models to examine associations of early childhood IPV exposure with adolescent sleep health and stratify models by child sex.

RESULTS

Early childhood IPV exposure is associated with worse overall sleep health (β = 0.08; p < 0.001) and multiple dimensions of poor sleep health in adolescence. Associations are notably stronger among girls than boys.

CONCLUSIONS

The strong and lasting associations of early childhood exposure to IPV with adolescents' sleep health, particularly among girls, has important consequences for addressing adolescent health disparities.

Sex Differences in Temporal Sleep Patterns, Social Jetlag, and Attention in High School Adolescents

Insufficient sleep and irregular sleep hours are common in adolescents, who experience a delayed sleep phase due to biopsychosocial changes associated with puberty, resulting in later sleep times. However, early morning class hours shorten sleep duration on weekdays. This condition is harmful to cognitive performance, which may be accentuated in girls due to a greater sleep need and less resistance to sleep deprivation. In this study, we evaluated sex differences concerning temporal sleep patterns, social jetlag, and attention in high school adolescents attending morning classes. Students ( n  = 146 - F: 73-16.1 ± 0.8 years; M: 73-16.2 ± 0.9 years) completed a Health and Sleep questionnaire, kept a sleep diary for 10 days, which incorporated a Maldonado Sleepiness Scale, and performed a Continuous Performance Task. Girls went to bed earlier and woke up on weekends, and spent more time in bed at night and in 24 h on weekdays and weekends, while they also had a greater irregularity in wake-up times ( p  < 0.05). There were no differences between sexes in terms of social jetlag, sleep debt, and sleepiness upon awakening ( p  > 0.05). Regarding attention, the girls had a longer reaction time in phasic alertness ( p  < 0.01) and a tendency to have fewer errors in selective attention ( p  = 0.06). These results persisted when controlled for sleep parameters. Therefore, we suggest that girls have a greater sleep need and less resistance to sleep deprivation, while the differences in attention performance could be due to different strategies, the girls could be making a trade, increasing reaction time in favor of better accuracy, while the boys could be prioritizing a faster response time.

Screen time and sleep in children

QUESTION

I continue to hear concerns from parents in my practice about the frequent use of light-emitting devices by their children. I have also found that many children suffer from sleep disturbances. What are the effects of screen time on sleep, and what are some best practices for sleep hygiene and screen use among children?

ANSWER

Screen time is higher now than before the onset of the COVID-19 pandemic, and knowledge about the effects of screen time is evolving. Spending time in front of a screen may replace sleep time or sleep-promoting activities such as exercise, and the engaging content and social interactions on screens interfere with falling asleep. Evidence exists on the disruption of the circadian rhythm by light emitted by screens. Advice to families should include sleep hygiene activities as well as elimination of screen use at least 1 hour before sleep.

Effects of evening smartphone use on sleep and declarative memory consolidation in male adolescents and young adults

Exposure to short-wavelength light before bedtime is known to disrupt nocturnal melatonin secretion and can impair subsequent sleep. However, while it has been demonstrated that older adults are less affected by short-wavelength light, there is limited research exploring differences between adolescents and young adults. Furthermore, it remains unclear whether the effects of evening short-wavelength light on sleep architecture extend to sleep-related processes, such as declarative memory consolidation. Here, we recorded polysomnography from 33 male adolescents (15.42 ± 0.97 years) and 35 male young adults (21.51 ± 2.06 years) in a within-subject design during three different nights to investigate the impact of reading for 90 min either on a smartphone with or without a blue-light filter or from a printed book. We measured subjective sleepiness, melatonin secretion, sleep physiology and sleep-dependent memory consolidation. While subjective sleepiness remained unaffected, we observed a significant melatonin attenuation effect in both age groups immediately after reading on the smartphone without a blue-light filter. Interestingly, adolescents fully recovered from the melatonin attenuation in the following 50 min before bedtime, whereas adults still, at bedtime, exhibited significantly reduced melatonin levels. Sleep-dependent memory consolidation and the coupling between sleep spindles and slow oscillations were not affected by short-wavelength light in both age groups. Nevertheless, adults showed a reduction in N3 sleep during the first night quarter. In summary, avoiding smartphone use in the last hour before bedtime is advisable for adolescents and young adults to prevent sleep disturbances. Our research empirically supports general sleep hygiene advice and can inform future recommendations regarding the use of smartphones and other screen-based devices before bedtime.

Evolution of Sleep Duration and Screen Time Between 2018 and 2022 Among Canadian Adolescents: Evidence of Drifts Accompanying the COVID-19 Pandemic

PURPOSE

We quantified the joint evolution of sleep duration and screen time between 2018 and 2022 in a large sample of adolescents from Quebec, Canada, to ascertain changes that occurred during the COVID-19 pandemic.

METHODS

A natural experiment design was used to compare variations from year to year and in association with the pandemic outbreak. Using structural equation modeling on data collected between 2018 and 2022 among adolescents attending 63 high schools, we analyzed the joint evolution of sleep duration and screen time while adjusting for previous year values, concurrent flourishing score, sex, age, and family level of material deprivation.

RESULTS

A total of 28,307 adolescents, aged on average 14.9 years, were included in the analyses. Between 2019 and 2022, sleep duration increased by 9.6 (5.7, 13.5) minutes and screen time by 129.2 (120.5, 138.0) minutes on average. In 2022, the adolescents spent almost equal amounts of time sleeping and using screens. Lower flourishing scores were associated with shorter sleep duration and lengthier screen time. Girls' screen time became similar to boys' over time.

DISCUSSION

Adolescents now spend almost equal amounts of time sleeping and using screens, a situation that calls for urgent public health actions. These findings highlight the importance of tracking changes in adolescents' behaviours over time, to design and implement interventions adapted to the changing health needs of different groups.

Interactive Screen-Based Activities Predict Worse Actigraphic Sleep Health That Night Among Adolescents

PURPOSE

To determine the micro-longitudinal effects of duration and timing of screen-based activities on sleep within and between adolescents.

METHODS

Daily survey and actigraphy data from the age 15 wave of the Future of Families and Child Wellbeing Study were analyzed using multilevel modeling. Four hundred seventy five adolescents provided three or more days of valid daily survey and nighttime sleep data.

RESULTS

Within-person results showed that on days when adolescents played video games more than their daytime average ± SE (1.3 ± 1.2 hours), sleep onset (6 ± 2 minutes, p < .01) and midpoint (4 ± 2 minutes, p < .02) were delayed for each additional hour of gaming. Between-person results showed that for each hour adolescents used screens to communicate with friends across the day, sleep onset was later (11 ± 3 minutes, p < .01), sleep midpoint was later (8 ± 3 minutes, p < .01), and sleep duration was shorter (-5 ± 2 minutes, p < .03). Adolescents who used screens to communicate with friends or play video games in the hour before bed had later sleep onset (30 ± 14 minutes, p < .03) and midpoint (25 ± 13 minutes, p < .05).

DISCUSSION

Among adolescents, passive screen usage such as browsing the Internet or watching videos may not affect sleep timing or duration, but limiting interactive screen-based activities could protect adolescent sleep health and well-being.

Nocturnal Smartphone Use Affects Sleep Quality and Cognitive and Physical Performance in Tunisian School-Age Children

Nocturnal smartphone use emits blue light, which can adversely affect sleep, leading to a variety of negative effects, particularly in children. Therefore, the present study aimed to determine the effect of acute (AC) (one night) and repeated (RC) (five nights) nocturnal smartphone exposure on sleep, cortisol, and next-day performance in Tunisian children. Thirteen participants (seven girls and six boys, age 9 ± 0.6, height 1.32 ± 0.06, weight 34.47 ± 4.41) attended six experimental nights. The experiment started with a baseline night (BL) with no smartphone exposure, followed by repeated sessions of nocturnal smartphone exposure lasting 90 minutes (08:00 pm-09:30 pm). Actigraphy; salivary cortisol; the Stroop test (selective attention); choice reaction time (CRT); N-back (working memory); counter-movement jump (CMJ), composed of flight time (time spent in the CMJ flight phase) and jump height; and a 30 m sprint were assessed the morning after each condition. Both AC and RC shortened total sleep time (TST) (p < 0.01), with a greater decrease with RC (-46.7 min, ∆% = -9.46) than AC (-28.8 min, ∆% = -5.8) compared to BL. AC and RC significantly increased waking after sleep onset (3.5 min, ∆% = 15.05, to 9.9 min, ∆% = 43.11%) and number of errors made on the Stroop test (1.8 error, ∆% = 74.23, to 3.07 error, ∆% = 97.56%). Children made 0.15 and 0.8 more errors (∆% = 6.2 to 57.61%) and spent 46.9 s and 71.6 s more time on CRT tasks (∆% = 7.22 to 11.11%) with AC and RC, respectively, compared to BL. The high-interference index of the Stroop task, CMJ performance, and 30 m sprint speed were only altered (p < 0.01) following RC (0.36, Δ% = 41.52%; -34 s, Δ% = -9.29%, for flight time and -1.23 m, -8.72%, for jump height; 0.49 s, Δ% = 6.48, respectively) when compared to BL. In conclusion, one- or five-night exposure to smartphones disturbed the children's sleep quality and their performance, with more pronounced effects following RC.

The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions

Sleep problems are common in youth with attention-deficit/hyperactivity disorder (ADHD). Externalizing and internalizing problems contribute to dysfunction in youth with ADHD and are amplified by disrupted sleep. This objective of this article is to synthesize empirical studies that examined the associations between sleep and internalizing or externalizing problems in individuals with ADHD. The main findings are that sleep problems precede, predict, and significantly contribute to the manifestation of internalizing and externalizing behavior problems among children and adolescents with ADHD. Clinicians should assess sleep and integrate sleep interventions into the management of youth with ADHD.

Contributions of the light environment and co-sleeping to sleep consolidation into nighttime in early infants: A pilot study

BACKGROUND

Sleep consolidation into nighttime is considered the primary goal of sleep development in early infants. However, factors contributing to sleep consolidation into nighttime remain unclear.

AIM

To clarify the influences of the light environment and nighttime co-sleeping on sleep consolidation into nighttime in early infants.

STUDY DESIGN

Cross-sectional study.

SUBJECTS AND METHODS

Sleep-wake time and light stimulation were measured in infants for 4 consecutive days using actigraphy. The infants' mothers were asked to complete a sleep events diary and a questionnaire about childcare, including "co-sleeping", defined as when the infant and mother slept on the same surface throughout the night.

OUTCOME MEASURES

The data were analyzed with a focus on daytime and nighttime sleep parameters.

RESULTS

Daytime light stimulation reduced daytime "active sleep", tended to reduce daytime sleep, and increased daytime waking. Nighttime light stimulation reduced nighttime "quiet sleep" and nighttime sleep and increased nighttime waking. Co-sleeping reduced nighttime waking, and, as a result, nighttime sleep time and sleep efficiency increased. Co-sleeping reduced daytime sleep and tended to increase daytime waking. Consequently, co-sleeping tended to increase the ratio of nighttime sleep to daytime sleep.

CONCLUSIONS

The present findings suggest that an appropriate light environment promotes daytime waking and nighttime sleep in early infants, but it does not contribute to sleep consolidation into nighttime by itself. On the other hand, co-sleeping may promote sleep consolidation into nighttime. Therefore, further methods for safe co-sleeping need to be established while avoiding risk factors for sudden unexpected death in infancy/sudden infant death syndrome.

Associations of social jetlag with physical activity and sedentary behaviour in children and adolescents: A systematic review and meta-analysis

Sleep and daytime movement behaviours occur co-dependently with each other within a finite 24 h day. Sleep parameters other than sleep duration, such as social jetlag and chronotype, have been linked to health problems and unhealthy behaviours among children and adolescents. Given the increasing number of studies examining sleep timing/chronotype and weight-related behaviours, including physical activity and sedentary behaviour, in the past decade, this systematic review and meta-analysis collated and evaluated the evidence on the relationships of social jetlag and chronotype with physical activity and sedentary behaviour among children and adolescents aged 3-17 years. Seven databases were searched on 16 March 2022, and 52 studies were identified as eligible for inclusion, 47 of which were suitable for the meta-analysis. A positive association was found between social jetlag and screen media use (r = 0.14, 95% CI: 0.04-0.24; I2  = 96%; p = 0.008). The morning chronotype was associated with a higher level of physical activity and a lower level of sedentary behaviour than the evening chronotype. No relationship was found between social jetlag and physical activity. The magnitude of heterogeneity among the included studies was high. Further experimental studies are urgently required to understand how circadian preference or misalignment affects activity behaviours. Interventions to promote an active lifestyle in young populations should consider their circadian preference, especially among individuals with the evening chronotype.

'I tried to take my phone off my daughter, and i got hit in the face': a qualitative study of parents' challenges with adolescents' screen use and a toolbox of their tips

BACKGROUND

Concerns about adolescent screen use are often expressed but poorly understood, particularly in terms of how parents are supposed to respond in ways that balance safety, care and developing independence and autonomy. This qualitative study investigated parental perceptions and concerns about screen use of adolescents aged 13 to 17. Current strategies to manage screen use and barriers to doing so were explored, and parents were asked to outline recommended interventions for better outcomes.

METHODS

Interviews and focus groups were held with 33 adults in Auckland, Aotearoa New Zealand (mean age 48 years) who were parenting adolescents (mean age 14 years). Interviews were transcribed verbatim, then inductive analysis and interpretation by the research team distilled the key ideas and illustrative quotes. A table of recommendations for a practical 'toolbox' was developed from these in-depth conversations.

RESULTS

Parents reported extensive use of screens by their adolescents, constantly throughout the day (and night, instead of sleeping). Four areas of specific concern included: (1) addict-like behavior, (2) exposure to harmful (and inane) content, (3) living in a virtual world, and (4) negative impacts on physical, mental, and cognitive wellbeing. To manage adolescent screen use, family rules and restrictions (on time and place) were common. Some used technical control via software or accessing the adolescent's devices and/or accounts to check for inappropriate content (such as pornography). Communication about device use and self-regulation were important. Barriers to managing screen use included trying to avoid conflict with their child; difficulties with consistency or follow-through on rules; lack of technical knowledge; parental screen use that set a bad example; and device use needed for school or other purposes. Recommendations from parents are presented in a toolbox of tips and techniques they shared, and their 'wish list' for better access to practical, local, scientific information, examples of techniques that have worked for other families, tools for problematic behavior and risk (including how to begin conversations with adolescents about their concerns), and having schools and young people involved in developing interventions to build digital citizenship.

CONCLUSIONS

Rich, nuanced accounts from parents about adolescent screen use in their families and communities underpinned their practical ideas for more skillful responses to young people grappling with an addictive digital existence.

A Study of the Correlation Between Screen Time and Hypertension Among Young Adults in North India: A Cross-Sectional Analysis

BACKGROUND

Hypertension is a major risk factor for coronary artery disease. Due to the increased accessibility of smartphones over the past decade, there has been an increase in the screen time of adolescents and young adults. However, the relationship between screen time and hypertension has not been adequately studied. Our study aims to find a correlation between screen time and blood pressure (BP) among young adults.

METHODS

A cross-sectional analysis was performed on a sample of medical students (n = 210) from New Delhi, India. Participants' screen time was monitored over three weeks and BP was recorded using a standardized sphygmomanometer by auscultatory method. Exclusion criteria included known cases of hypertension (with or without ongoing treatment), smokers > five pack year, heavy alcoholics, and participants having sleep time of less than seven hours or more than nine hours per day. Screen time was correlated with BP readings using standard statistical methods.

RESULTS

 Participants with screen time >390 minutes (six hours and 30 minutes), >420 minutes (seven hours), and >480 minutes (eight hours) had higher odds of elevated BP (OR: 1.86, 95% CI: 1.05-3.30; OR: 1.86, 95% CI: 1.04-3.30; OR: 1.87, 95% CI: 1.02-3.43, respectively) compared to students with screen time <390 minutes. The findings were consistent after excluding participants with high BMI based on the WHO and Asia-Pacific criteria, which also showed higher odds of elevated BP with screen time >390 minutes (OR: 3.21, 95% CI: 1.58-6.49 and OR: 3.92, 95% CI: 1.49-10.31, respectively). Regression analysis showed no significant linear correlation between screen time and BP (p > 0.05). However, a significant association was observed between BMI and elevated BP (p < 0.001).

CONCLUSION

 This study revealed an association exists between screen time and BP.

Recreational screen time behaviour among ambulatory children and adolescents diagnosed with cerebral palsy: A cross-sectional analysis

AIM

To describe the recreational screen time behaviour of 8-16-year-olds diagnosed with cerebral palsy (CP) and explore associations between health-related quality of life, sleep duration and physical activity behaviour versus screen time.

METHODS

This cross-sectional study used proxy-reported questionnaire data of 381 ambulatory (with or without assistance) 8-16-year-olds diagnosed with CP corresponding to Gross Motor Function Classification System (GMFCS) levels I-III. Descriptive statistics were used to report age, sex and the GMFCS level. The potential associations of health-related quality of life, physical activity behaviour and sleep duration (dependent variables) versus screen time (independent variable) were determined using multiple linear regression. Health-related quality of life was evaluated using the Pediatric Quality of Life Inventory, including seven dimensions: Daily Activities; School Activities; Movement and Balance; Pain and Hurt; Fatigue; Eating Activities; and Speech and Communication.

RESULTS

The participants spent a median screen time of 3.9 h daily. The boys spent a longer screen time during weekends than the girls (p = 0.003). Boys spent more time on games (p < 0.001), whereas girls spent more time on social media and video calls (p < 0.001). Increasing age (p < 0.001) was associated with increased screen time but did not differ between the GMFCS levels. Sleep duration, perceived fatigue and perceived movement and balance correlated negatively with screen time.

CONCLUSION

This study sheds light on the recreational screen time habits of ambulatory children and adolescents diagnosed with CP. Further investigation into the observed associations is warranted to investigate potential causation and relationships between sleep behaviour, quality of life and screen time behaviour.

Gamification as a health education strategy of adolescents at school: Protocol for a systematic review and meta-analysis

The objective of the study is to present a systematic review and meta-analysis protocol for evaluating the effects of health education gamification-based interventions, on health parameters (food consumption, sleep quality and physical activity) of adolescent students. This protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022373833). The search will be performed in the following databases: MEDLINE, Embase, Scopus, ERIC, ScienceDirect, Web of Science, Cochrane, LILACS, APA, and ADOLEC. Intervention studies (clinical trials - randomized or non-randomized) and quasi-experimental studies will be included. The risk of bias will be assessed using the Risk of Bias in Non-randomized Studies of Interventions tool for randomized controlled trials, non- randomized controlled trials and quasi-experimental trials. Two independent researchers will conduct all assessments, and any disagreements will be consulted with a third reviewer. Data analysis and synthesis will be analyzed using RevMan 5.4.1 software. We will conduct the study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline. The review will summarize the current evidence on gamification health education changes in parameters related to the health of adolescents. Gamification has been used to verify the increase in adherence to healthy habits or the development of health-related skills, but there are still few results for the adolescent population. We expect that the systematic review could indicate strategies with gamification interventions and also determine how these strategies can improve health parameters of adolescent students, and they will be available as a reference for these interventions.

Investigation of the correlation between internet addiction, obesity risk and sleep disorder in children

AIM

This study was performed with the aim of investigating the correlation and the effective factors between internet addiction, obesity risk and sleep disorders in children.

MATERIAL AND METHOD

The sample for this descriptive and relational search type study comprised the parents of 458 children aged 7-10 years attending a primary school in Turkey. Data were collected the Parent and Child Descriptive Information Form, Family Child Internet Addiction Scale (FCIAS), Family Nutrition and Physical Activity Tool (FNPAT) and Sleep Disturbance Scale for Children (SDSC).

RESULTS

There was a statistically significant, positive and weak correlation between the Body Mass Index (BMI) and FCIAS scores of children (p < 0.001). There was a statistically significant, negative and very weak correlation between FNPAT total score with FCIAS total score (p = 0.007). There was a statistically significant, positive and moderate correlation between SDSC total score and FCIAS total score (p < 0.001). According to regression analysis, FCIAS was a determinant at significant levels for FNPAT and SDSC (p < 0.05).

CONCLUSION

There was a relationship between internet addiction and obesity and sleep quality. As a result of the study, the increase in internet use was determined to negatively impact physical activity and health nutrition behavior, and to increase sleep disturbance.

IMPLICATIONS FOR PRACTICE

Pediatric nurses are recommended to give counseling to children and families about preventing obesity and the risk of sleep disorders by identifying children at risk in terms of internet addiction in the early period.

Healthy Social Network Use and Well-Being during Adolescence: A Biopsychosocial Approach

Screen time and the use of social networks is the most frequent form of leisure time occupation and socializing for adolescents. The present study is aimed at understanding and characterizing, from an ecological perspective, what distinguishes healthy and less healthy or even dependent use of social media in young people and the influence on adolescents' well-being. This paper is based on the Health Behaviour in School-aged Children (HBSC) from 2022, a survey carried out every 4 years, in collaboration with the World Health Organisation (WHO), following an international protocol. A total of 7643 students from the 6th, 8th, 10th, and 12th school grades responded, of which 53.9% were female, with an average age of 15.05 (SD = 2.36). The sample is representative of the school grades under study. The results allow us to study and identify similarities and differences between three groups related to the level of healthiness in the use of social networks and its relations to well-being from an ecological perspective. What distinguishes adolescents with less healthy use of social networks is that they are more often female, older, have more self-injurious behaviour, higher alcohol consumption, and a worse relationship with teachers. The adolescents with the highest level of dependence on social networks are those who have a higher perception of lack of safety at school and in their area of residence, as well as a higher use of screen time as a leisure activity. The well-being of adolescents using social media in a healthy way is explained by fewer psychological symptoms, better stress management strategies, better body awareness, more physical activity, less time online with friends, and better relationships with family and teachers. Technologies and social networks are important for the well-being of adolescents; it is essential to promote a healthy, critical and balanced use with other "screen-free" activities and to promote socio-emotional skills, a lack of which seems to be one of the biggest risk factors associated with the healthy use of technologies.

Bedtime screen use behaviors and sleep outcomes: Findings from the Adolescent Brain Cognitive Development (ABCD) Study

OBJECTIVES

To determine associations between bedtime screen time behaviors and sleep outcomes in a national study of early adolescents.

METHODS

We analyzed cross-sectional data from 10,280 early adolescents aged 10-14 (48.8% female) in the Adolescent Brain Cognitive Development Study (Year 2, 2018-2020). Regression analyses examined the association between self-reported bedtime screen use and self- and caregiver-reported sleep measures, including sleep disturbance symptoms, controlling for sex, race/ethnicity, household income, parent education, depression, data collection period (pre- vs. during COVID-19 pandemic), and study site.

RESULTS

Overall, 16% of adolescents had at least some trouble falling or staying asleep in the past 2 weeks and 28% had overall sleep disturbance, based on caregiver reports. Adolescents who had a television or an Internet-connected electronic device in the bedroom had a greater risk of having trouble falling or staying asleep (adjusted risk ratio 1.27, 95% CI 1.12-1.44) and overall sleep disturbance (adjusted risk ratio 1.15, 95% CI 1.06-1.25). Adolescents who left their phone ringer activated overnight had more trouble falling/staying asleep and greater overall sleep disturbance compared to those who turned off their cell phones at bedtime. Streaming movies, playing video games, listening to music, talking/texting on the phone, and using social media or chat rooms were all associated with trouble falling/staying asleep and sleep disturbance.

CONCLUSIONS

Several bedtime screen use behaviors are associated with sleep disturbances in early adolescents. The study's findings can inform guidance for specific bedtime screen behaviors among early adolescents.

Sleep Quality of Undergraduate Medical Students during and Post-Lockdown: A Cross-Sectional Research

Background

The COVID-19 and associated lockdowns have significantly impacted the lives of undergraduate medical students, including their sleep quality. This study attempts to investigate how sleep patterns, sleep quality, and associated factors altered during and post-lockdown.

Material and Methods

In this cross-sectional study, 171 medical students from colleges registered under the National Medical Council participated. The study used a validated PSQI questionnaire. The data collected through Google forms were analyzed using SPSS v2021.

Result

Among 171 study participants, 9.4% had bad sleep quality during lockdown which reduced to 4.7% post-lockdown significantly. Sleep latency and sleep duration were also significantly affected by the lockdown. There was a weak correlation between PSQI score during and post-lockdown, suggesting that individuals with poor sleep quality during lockdown also had poor sleep post-lockdown. According to the study, poor sleep quality decreased after lockdown as opposed to lockdown, with improvements in sleep latency and decreased use of sleep duration.

Conclusion

However, there was a weak correlation between PSQI score during and post-lockdown. Increased screen time during lockdown negatively affected sleep quality, emphasizing the importance of practicing sleep hygiene and promoting outdoor activities to reduce stress levels and improve mental health.