Relationship between Problematic Smartphone Use, Sleep Quality and Bedtime Procrastination: A Mediation Analysis

The purpose of this investigation was to study the relationship between sleep quality, problematic smartphone use (PSU) and bedtime procrastination, as well as to assess gender and age differences. A total of 313 participants, aged 18-60 (M = 30 ± 10.1; 53.2% males), completed an online survey between February and May 2023 in Spain. The Pittsburgh Sleep Quality Index, Smartphone Addiction Scale-Short Version and Bedtime Procrastination Scale were used to measure sleep quality, PSU and bedtime procrastination, respectively. Additionally, smartphone use habits were evaluated through self-report questions. Pearson correlations, independent samples t-tests, one-way ANOVA, Bonferroni's post hoc tests and mediation analysis were conducted. Correlation analysis showed positive associations between the three main variables. Independent sample t-tests indicated females were more prone to PSU along with higher overall smartphone use. Post hoc analysis of one-way ANOVA exposed age differences between young adults (18-25 years old), adults (26-44 years old) and middle-aged adults (45-60 years old) in PSU and bedtime procrastination. Finally, mediation analysis revealed that PSU had indirect effects on sleep quality through bedtime procrastination, but no direct effects on sleep quality. Therefore, PSU, and especially bedtime procrastination, should be considered as targets in future campaigns or intervention programs to improve sleep quality among the young Spanish population.

Sleep bruxism in children, from evidence to the clinic. A systematic review

Objectives

The present paper aims to systematically review the literature published from 2015 to 2023 on bruxism in children with the aim to compilate the best available evidence.

Materials and Methods

A systematic search in the National Library of Medicine's PubMed, Medline (EBSCO), SCOPUS, and Google Scholar databases was performed to identify all studies on humans assessing genetic, biopsychosocial, and sleep factors assessed with any different approach for sleep bruxism (SB) in children and its interventions. The selected articles were assessed independently by the two authors according to a structured reading of the article's format (PICO). The quality of the articles was evaluated using Quality Assessments Tool for Experimental Bruxism Studies (Qu-ATEBS) and the JBI critical appraisal tools.

Results

A total of 16 articles were included for discussion in the review and grouped into questionnaire/parental-report (n = 7), SB assessment through parental report of SB and clinical examination (n = 4), and instrumental assessment (n = 5) studies. The total quality scores evaluated with STROBE and Qu-ATEBS were high for all included papers. However, in general, there was no control of bias strategies and there was no control group in the intervention studies.

Conclusions

Investigations based on self-report, clinical, and instrumental bruxism assessment showed a positive association with genetics, quality of life aspects (school and emotional functions and overuse of screen-time), mother anxiety and family conformation, diet, alteration in sleep behaviors and architecture, and sleep breathing disorders. Additionally, the literature presents options to increase airway patency and, thus, reduce the occurrence of SB. Tooth wear was not found to be a major sign of SB in children. However, methods of SB assessment are heterogeneous and hamper a reliable comparison of the results.

Cardiorespiratory Fitness, Blood Pressure and Ethnicity Are Related to Salivary Cortisol Responses after an Exercise Test in Children: The ExAMIN Youth SA Study

BACKGROUND

Childhood elevated circulatory stress mediators such as cortisol seem to play an important role in the development of hypertension and metabolic disorders later in life. Little is known about the association of body composition, cardiorespiratory fitness (CRF), blood pressure (BP) and ethnicity with cortisol reactivity in young children.

METHODS

In this cross-sectional study, 324 black and 227 white school children (aged 7.4 ± 1.0 years) were screened for salivary cortisol reactivity, body mass index, BP and CRF (shuttle run) by standardised assessments for children.

RESULTS

Children in the lower cortisol reactivity percentile (<25th) had a higher heart rate (87.0 ± 12.9 bpm) and a lower CRF (3.1 ± 1.3 stages) compared to children in the upper (>25th) percentile (86.2 ± 11.5 bpm and 3.5 ± 1.7 stages, respectively). At baseline, children of black ethnicity had a higher cortisol level (p < 0.001). Immediately before the exercise test, no associations of obesity, BP, CRF and ethnicity with cortisol levels were found. In analysis of covariance (ANCOVA) we found that low CRF, high BP and black ethnicity were independently associated with lower cortisol reactivity by performing the shuttle run test (p < 0.01).

CONCLUSION

Low CRF and high BP were associated with lower cortisol reactivity after a cardiorespiratory exercise test. Black children showed a lower cortisol reactivity which may contribute to the earlier onset of hypertension reported in black compared to white populations. Primary prevention programs need to focus on improving physical fitness to reduce the growing prevalence of cardiometabolic disorders during childhood.

Sleep bruxism in children: relationship with screen-time and sugar consumption

Objective/background

Consumption of added sugar and excessive screen-time is increasing worldwide and is associated with sleeping and behavior disorders, which are related with possible Sleep Bruxism (SB) in children. Therefore, the objective of this investigation was to examine the relationship between screen-time and sugar-consumption and possible SB in children.

Patients/methods

A cross-sectional study, including parents of 460 4- to 8-year-old children, was performed. Frequency of possible SB was assessed with the Children's Sleep Habits Questionnaire; sugar consumption with the Health Behaviour in School-Aged Children Food-Frequency Questionnaire. Comprehensive measures of screen-time (including cell phones, computers, electronic devices, electronic games, and TV) were taken. The time was recorded in hour/day. All data were analyzed with STATA© data analysis and statistical software version 13.0 (Copyright 1996–2016; Stata-Corp LP, College Station, TX, USA). Spearman correlation test and ordinal-multiple-variable regression analyses were used.

Results

Data of 440 subjects Mean age 6.2 years (S.D. 1.8) were analyzed. Prevalence of possible SB was 35% and screen-time was available for 92.9% of the children. Mean screen-time was 2.1 h/day. Parents reported 73% of the children (n = 319) to consume added sugar once a day every day and 20% more than once every day. Correlations of possible SB were statistically significant with screen-time (Rho = 0.8; p = 0.002) and sugar-consumption (Rho = 0.7; p = 0.03). Associations were found between possible SB and increase-to-increase screen-time and sugar-consumption (OR > 2).

Conclusion

The results of this study demonstrated that as screen-time and sugar consumption increased, the frequency of bruxism in children increased.

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Sleep bruxism is regulated centrally and deals with the reward system, particularly the neurotransmission of dopamine.

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Sugar and the excessive use of screens alter neurotransmission of dopamine.

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Excessive sugar consumption and increased screen time are common behaviors in children.

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Parenting habits affects the consumption of sugar, the use of screens and the occurrence of sleep bruxism.

The Relationship between Sleep, Obesity, and Metabolic Health in Adolescents - a Review

In this literature review, we discuss the importance of adequate sleep and the various effects of suboptimal sleep on weight maintenance and metabolic health specifically for adolescents. Two major contributors to adolescents experiencing decreased sleep duration and quality, and thus increasing the risk for developing metabolic syndrome in adolescence as well as later in adulthood, are increased electronic screen time particularly at night and early school start times. The less time adolescents spend sleeping, the less quality sleep they obtain, and the greater the disruption of endocrine hormone function. As another consequence, adolescents are more prone to making poor food choices, from choosing relatively nutrient-poor foods to consuming excess calories without necessarily increasing their energy expenditure. These choices put adolescents at greater risk for becoming obese throughout their lifespan.

Screen Time and Children with Autism Spectrum Disorder

BACKGROUND

Research is increasingly raising concerns regarding the negative consequences of children's use of screens.

SUMMARY

This article reviews the literature on the benefits and risks of screen time with attention to explaining possible reasons that children with autism are more at risk for the negative effects of screen time. Based on the science of learning literature, a framework for choosing appropriate digital media for children with autism is described. The 3-component framework considers the characteristics of the child, the context in which digital media are used, and the content of the media. Key Message: Using the framework, the speech-language pathologist will be better able to select appropriate digital media content for children with autism that is engaging (while not being distracting), encourages the child to be actively involved with the media, is meaningful in the child's life, and incorporates social interactions with others.

Contextualizing pubertal development: The combination of sexual partners' age and girls' pubertal development confers risk for externalizing but not internalizing symptoms among girls in therapeutic day schools

OBJECTIVE

Early pubertal development is associated with negative health and mental health outcomes. Research on the influence of puberty on mental health underscores a need to examine the interplay between puberty and exposure to environmental risk. This study investigates a more rarely studied aspect of girls' environments - romantic relationships with boyfriends. Specifically, this study examined sexual partner age and the timing of girls' pubertal development in relation to externalizing and internalizing symptoms among female students attending therapeutic day schools in the United States, a population at elevated risk for negative mental health outcomes.

METHODS

A total of 121 13 to 19-year-old adolescent girls (Mean age = 15.4; SD = 1.5) reported on the relative age of their past 3 sexual partners, their age of pubertal onset, and mental health challenges via clinical assessments of externalizing and internalizing symptoms.

RESULTS

Forty-three percent of participants qualified for at least one mental health diagnosis. Earlier pubertal onset predicted greater internalizing symptoms, and this effect did not depend on the age of girls' sexual partners. However, early-developing girls who also reported having a sexual partner more than 2 years older than them were at increased risk for externalizing symptoms.

CONCLUSIONS

Findings underscore that sexual relationships are an important risk factor for early-developing girls already at risk for mental health problems. Early developing girls with older partners may experience stronger social pressure to stay in relationships that expose them to partner violence and delinquency-related pressure, which combine with interpersonal stress to predict externalizing symptoms.

Adverse physiological and psychological effects of screen time on children and adolescents: Literature review and case study

A growing body of literature is associating excessive and addictive use of digital media with physical, psychological, social and neurological adverse consequences. Research is focusing more on mobile devices use, and studies suggest that duration, content, after-dark-use, media type and the number of devices are key components determining screen time effects. Physical health effects: excessive screen time is associated with poor sleep and risk factors for cardiovascular diseases such as high blood pressure, obesity, low HDL cholesterol, poor stress regulation (high sympathetic arousal and cortisol dysregulation), and Insulin Resistance. Other physical health consequences include impaired vision and reduced bone density. Psychological effects: internalizing and externalizing behavior is related to poor sleep. Depressive symptoms and suicidal are associated to screen time induced poor sleep, digital device night use, and mobile phone dependency. ADHD-related behavior was linked to sleep problems, overall screen time, and violent and fast-paced content which activates dopamine and the reward pathways. Early and prolonged exposure to violent content is also linked to risk for antisocial behavior and decreased prosocial behavior. Psychoneurological effects: addictive screen time use decreases social coping and involves craving behavior which resembles substance dependence behavior. Brain structural changes related to cognitive control and emotional regulation are associated with digital media addictive behavior. A case study of a treatment of an ADHD diagnosed 9-year-old boy suggests screen time induced ADHD-related behavior could be inaccurately diagnosed as ADHD. Screen time reduction is effective in decreasing ADHD-related behavior.

CONCLUSIONS

Components crucial for psychophysiological resilience are none-wandering mind (typical of ADHD-related behavior), good social coping and attachment, and good physical health. Excessive digital media use by children and adolescents appears as a major factor which may hamper the formation of sound psychophysiological resilience.

Association between Information and Communication Technology Usage and the Quality of Sleep among School-Aged Children during a School Week

Objective. To determine the association between intensity of information and communication technology (ICT) usage and quality of sleep in school-aged children during a school week. Methods. In all 61 subjects, 10–14 years of age, a quasiexperimental laboratory study where criterions for inclusion were absence of prior medical condition and duration of ICT use. A portable device (Holter monitor) was used to measure heart rate variability (HRV) over a 24-hour period, while activity diary was used to record in 15-minute intervals ICT use and sleep and wake up time. Low and high ICT user groups were formed according to their intensity of ICT use. Statistical analysis was done with two independent samples tests and factorial ANCOVA. Results. The higher ICT users showed a lower sleep time standard deviation of normal to normal interval (SDNN) measures in comparison to the low ICT users. Conclusion. The intensive ICT use was associated with poorer quality of sleep indicated by physiological measures among children and adolescents. Knowing the crucial role of healthy sleep in this age, the results are reason for concern.

The role of daily activities in youths' stress physiology

PURPOSE

This study examined links between diurnal patterns of the stress hormone cortisol and time spent by adolescents in nine common daily activities.

METHODS

During eight consecutive nightly telephone interviews, 28 youths (n = 12 girls), 10-18 years of age, reported their daily activities. On 4 days, four saliva samples were also collected and assayed for cortisol. Multilevel models assessed within- and between-person associations between time in each activity and cortisol area under the curve (AUC), cortisol awakening response (CAR), morning peak (30 minutes after wake up), and daily decline (morning peak to bedtime).

RESULTS

Links with AUC were found for most activities; significant associations with cortisol rhythms suggested that most effects were due to anticipation of the day's activities. Specifically, on days when youths spent more time than usual on video games and television, they had lower AUCs, with lower morning peaks. Youths who spent more time reading (within-person) and in computer-related activities (between-person) had higher AUCs, with stronger CARs (within-person). Youths who slept more had lower AUCs, with lower morning peaks on both the between- and within-person levels. Amounts of time spent in clubs, and for older adolescents in sports, were also linked to lower AUCs. Finally, youths who spent more time in school/schoolwork had lower average AUCs, but on days when youths spent more time than usual in school, they had higher AUCs, stronger CARs, and steeper daily declines.

CONCLUSION

Beyond their known implications for psychological adjustment, youths' everyday activities are linked to stress physiology.