Associations between adolescent sleep difficulties and active versus passive screen time across 38 countries

• Published in: Journal of affective disorders 2023-01, Vol.320, p.298-304
• Main Authors: Khan, Asaduzzaman, Reyad, Md Amjad Hossain, Edwards, Elizabeth, Horwood, Sharon
• Format: Article
• Language: English
• Subjects: Adolescent; Child; Children; Cross-Sectional Studies; Female; HBSC; Humans; Male; Multi-country; Prospective Studies; Screen Time; Screen use; Sleep; Sleep Initiation and Maintenance Disorders; Sleep problems; Video Games
• ISSN: 0165-0327; 1573-2517
• DOI: 10.1016/j.jad.2022.09.137

High screen use has been adversely linked with mental wellbeing; however, little is known about how active versus passive screen time are associated with sleep-onset difficulties among adolescents. We analysed data from 38 European and North American countries that participated in the 2014 Health Behaviour in School-aged Children (HBSC) survey. Difficulties in falling sleep were assessed using a self-reported item with a 5-point Likert scale, and then dichotomised. Participants reported h/day of discretional time spent watching television, electronic gaming, and computer use. Of the 195,668 participants (Mage 13.59 [1.62] years; 51 % girls), about 25 % of girls reported sleep-onset difficulties, while the rate was 18 % in boys. Adolescents who played electronic games >4 h/day (≤1 h/day as reference) had 30 % higher odds in boys (OR 1.30; 95 % CI: 1.23–1.38) and 38 % higher odds in girls (OR 1.38; 95 % CI: 1.31–1.45) of reporting sleep difficulties. High computer use (>4 h/day) increased the odds of sleep difficulties by 41 % in boys (OR 1.41, 95 % CI: 1.33–1.49) and 61 % in girls (OR 1.61, 95 % CI: 1.53–1.69). Similarly, high television time (>4 h/day) had increased the odds of sleep difficulties by 15 % in boys (OR 1.15, 95 % CI: 1.08–1.22) and 19 % in girls (OR 1.19, 95 % CI: 1.12–1.25). Cross-sectional analyses cannot establish causality of the associations. Higher levels of recreational screen use of any type were associated with sleep-onset difficulties among adolescents with adverse effects being more prevalent in active than passive screen time. Prospective research with objective measures is warranted to understand causality of these relationships. •Sleep difficulties appeared after 2 h/day of active but >4 h/day of passive screen time.•Gaming >4 h/day was associated with 30 % more sleep difficulties in boys; 38 % in girls.•Screen time/sleep difficulties relationship did not vary across physical activity level.•Girls and younger adolescents reported slightly greater negative relationships.•Association estimates were marginally stronger for screen use in weekdays than weekends.