A large prospective cohort study has found significant associations between bedtime screen use behaviors and adverse sleep outcomes 1 year later in early adolescents residing in the United States.
In the study, published in the Journal of Adolescent Health, investigators analyzed the data of 9,398 participants aged 11 to 12 years (48.4% female, 45% racial/ethnic minority) in the Adolescent Brain Cognitive Development (ABCD) study.
The study analyzed data from years 2 to 3 (2018 to 2021) of the ABCD study. The participants were predominantly aged 11 to 12 years of age at year 2. Bedtime screen use behaviors were assessed via self-report questionnaires at year 2. Sleep outcomes at year 3 included self-reported sleep duration and caregiver-reported sleep disturbance. Regression analyses examined associations between year 2 bedtime screen use and year 3 sleep variables, adjusting for sociodemographic covariates and baseline sleep variables. Propensity weights based on the American Community Survey were applied.
The investigators discovered that having a TV or internet-connected device in the bedroom was associated with shorter sleep duration (B = –0.21, 95% confidence interval [CI] = –0.28 to –0.13) 1 year later. Leaving phone ringers on overnight compared with turning phones off was linked to a greater risk of sleep disturbance (odds ratio [OR] = 1.25, 95% CI = 1.00–1.56) and shorter sleep duration (B = –0.27, 95% CI = –0.40 to –0.13). Talking and texting on phones, listening to music, and using social media prior to sleep were all associated with shorter sleep durations, greater overall sleep disturbances, and higher scores for disorders of initiating and maintaining sleep.
All bedtime screen activities were linked to a shorter sleep duration, including:
- Watching videos and TV (B = –0.10, 95% CI = –0.14 to –0.06)
- Playing video games (B = –0.14, 95% CI = –0.19 to –0.08)
- Listening to music (B = –0.10, 95% CI = –0.14 to –0.07)
- Talking and texting (B = –0.17, 95% CI = –0.22 to –0.12)
- Using social media = (B = –0.21, 95% CI = –0.26 to –0.16).
Associations with sleep disturbances included:
- Talking and texting (OR = 1.13, 95% CI = 1.05–1.23)
- Listening to music (OR = 1.10, 95% CI = 1.04–1.17)
- Using social media (OR = 1.10, 95% CI = 1.01–1.20).
Total recreational screen time was also linked to sleep disturbances (OR = 1.02, 95% CI = 1.01–1.04) and shorter sleep durations (B = –0.03, 95% CI = –0.04 to –0.02), though the effects were lower than bedtime-specific activities.
The investigators also reported on screen usage prevalence:
- 62.5% of participants had a TV or electronic device in their bedroom
- 54.9% turned their phones off at bedtime
- 18.4% put ringers on silent or vibrate
- 11.2% left ringers on
- 15.5% put phones outside the bedroom.
In the past week:
- 16.2% were woken by phone calls or messages at least once
- 19.3% used devices when waking during the night.
Specific bedtime activities (5 to 7 nights/week) included:
- Watching videos and TV: 13.4%
- Playing video games: 5.8%
- Listening to music: 14.1%
- Talking and texting: 6.3%
- Using social media: 6.2%.
At year 3, the investigators found that the mean sleep duration was 8.94 hours/night (standard deviation [SD] = 1.62) and the sleep disturbance prevalence was 25.5%. The mean disorders of initiating and maintaining sleep scores was 12.30 (SD = 4.01).
The investigators recognized potential recall and social desirability biases in self-reported measures. The binary sleep disturbance outcome may have led to misclassification. The study also did not assess context or content of screen use or dynamic changes in use patterns over the year.
The authors have no conflicts of interest to declare.