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Original Investigation
December 2016

Association Between Portable Screen-Based Media Device Access or Use and Sleep OutcomesA Systematic Review and Meta-analysis

Author Affiliations
  • 1Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, England
  • 2Institute of Primary Care and Public Health, Cardiff University School of Medicine, Neuadd Meirionnydd, Cardiff, Wales
  • 3Cochrane Skin Group, Centre for Evidence Based Dermatology, The University of Nottingham School of Medicine, Nottingham, England
  • 4Institute of Child Health, University College London, London, England
  • 5Department of Family, Population and Preventive Medicine Program in Public Health, Stony Brook University School of Medicine, Stony Brook, New York
  • 6Department of General Paediatrics, Child Health Offices, University Hospital of Wales, Cardiff
  • 7Johns Hopkins Center for Clinical Global Health Education, Johns Hopkins University Baltimore-Washington-India Clinical Trials, B. J. Medical College, Pune, India
JAMA Pediatr. 2016;170(12):1202-1208. doi:10.1001/jamapediatrics.2016.2341
Key Points

Question  Is there an association between screen-based media device access or use in the sleep environment, and sleep quantity and quality?

Findings  A systematic review and meta-analysis showed strong and consistent evidence of an association between access to or the use of devices and reduced sleep quantity and quality, as well as increased daytime sleepiness.

Meaning  An integrated approach among teachers, health care professionals, and parents is needed to improve sleep hygiene.

Abstract

Importance  Sleep is vital to children’s biopsychosocial development. Inadequate sleep quantity and quality is a public health concern with an array of detrimental health outcomes. Portable mobile and media devices have become a ubiquitous part of children’s lives and may affect their sleep duration and quality.

Objective  To conduct a systematic review and meta-analysis to examine whether there is an association between portable screen-based media device (eg, cell phones and tablet devices) access or use in the sleep environment and sleep outcomes.

Data Sources  A search strategy consisting of gray literature and 24 Medical Subject Headings was developed in Ovid MEDLINE and adapted for other databases between January 1, 2011, and June 15, 2015. Searches of the published literature were conducted across 12 databases. No language restriction was applied.

Study Selection  The analysis included randomized clinical trials, cohort studies, and cross-sectional study designs. Inclusion criteria were studies of school-age children between 6 and 19 years. Exclusion criteria were studies of stationary exposures, such as televisions or desktop or personal computers, or studies investigating electromagnetic radiation.

Data Extraction and Synthesis  Of 467 studies identified, 20 cross-sectional studies were assessed for methodological quality. Two reviewers independently extracted data.

Main Outcomes and Measures  The primary outcomes were inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness, studied according to an a priori protocol.

Results  Twenty studies were included, and their quality was assessed. The studies involved 125 198 children (mean [SD] age, 14.5 [2.2] years; 50.1% male). There was a strong and consistent association between bedtime media device use and inadequate sleep quantity (odds ratio [OR], 2.17; 95% CI, 1.42-3.32) (P < .001, I2 = 90%), poor sleep quality (OR, 1.46; 95% CI, 1.14-1.88) (P = .003, I2 = 76%), and excessive daytime sleepiness (OR, 2.72; 95% CI, 1.32-5.61) (P = .007, I2 = 50%). In addition, children who had access to (but did not use) media devices at night were more likely to have inadequate sleep quantity (OR, 1.79; 95% CI, 1.39-2.31) (P < .001, I2 = 64%), poor sleep quality (OR, 1.53; 95% CI, 1.11-2.10) (P = .009, I2 = 74%), and excessive daytime sleepiness (OR, 2.27; 95% CI, 1.54-3.35) (P < .001, I2 = 24%).

Conclusions and Relevance  To date, this study is the first systematic review and meta-analysis of the association of access to and the use of media devices with sleep outcomes. Bedtime access to and use of a media device were significantly associated with the following: inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness. An integrated approach among teachers, health care professionals, and parents is required to minimize device access at bedtime, and future research is needed to evaluate the influence of the devices on sleep hygiene and outcomes.

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