PICO Search Assignment Worksheet Name Rachel Freundlich
Brief description of patient problem/setting:
A mother presents with her 12 year old daughter for her daughter’s yearly well visit. The visit is uncomplicated and the physical exam is unremarkable. The mother remarks that her daughter has been asking for a phone recently and she and her husband have been discussing the pros and cons associated with having a phone. She states that she has heard that screen time before bed can negatively impact sleep, but her daughter is adamant this isn’t true. She is asking whether there is data that supports this concept. While I myself have heard similar statements, I wasn’t sure where that data emerged from. I decided to research this further.
Search Question:
Within the pediatric population, is extended screen time before sleep associated with negative impacts on sleep such as prolonged period of time before falling asleep, interrupted sleep and reduced rest associated with sleep?
Question Type: What kind of question is this?
☐Prevalence ☐Screening ☐Diagnosis
☐Prognosis ☐Treatment ☒Harms
Assuming that the highest level of evidence to answer your question will be meta-analysis or systematic review, what other types of study might you include if these are not available (or if there is a much more current study of another type)? Please explain your choices.
- If meta-analysis and systematic review are not available, I would use randomized controlled trials because they are high quality experiments which allow for control groups to be compared to the group receiving the treatment or medication of interest. It also reduces bias which makes it a good study to use. One group of subjects would be exposed to screen time before sleep while the other group would not be exposed to screens for a predetermined amount of time before sleep.
- A cohort study can also be used as it looks at the outcomes of two groups that received different treatment / interventions – in this case screen time before sleep compared to no screen time before sleep.
PICO search terms:
| P | I | C | O |
| Pediatric population | Screen time before bed | No screen time before bed | Interrupted sleep |
| Children | Screen time before sleeping | No screen time before sleeping | Disrupted sleep |
| Pediatrics | Screen time at night | No screen time at night | Sleepless night |
| Child | Screen time | No screen time | Prolonged period following sleep |
| Technology at night | No technology at night | Reduced rest associated with sleep | |
| Electronics at night | No electronics at night | No sleep | |
| Electronics before sleeping | No electronics before sleeping | Not sleeping | |
| Technology before sleeping | No technology before sleeping | ||
Search tools and strategy used:
Results found:
PubMed:
- Screen time associated with reduced sleep in children (Best Match) – 126
- Screen time associated with reduced sleep in children (Best Match, 5 years publication) – 83
- Screen time associated with reduced sleep in children (Best Match, 5 years publication, Systematic Review) – 9
Google Scholar:
- Age 5-15 population and screen time impacts sleep (Any time, sort by relevance) – 23,500
- Age 5-15 population and screen time impacts sleep (since 2024, sort by relevance) – 4,010
- Age 5-15 population and screen time impacts sleep (since 2024, Review articles) – 584
ScienceDirect:
- Screen time impacts sleep in pediatric population (any time, best match) – 9,097
- Screen time impacts sleep in pediatric population (since 2024, best match) – 630
- Screen time impacts sleep in pediatric population (since 2024, Research articles) – 251
– When I was looking for articles I was most interested in articles that asked the same question that I wanted to answer with my mini CAT. I used search terms that I thought would generate appropriate results and I then added search filters to narrow down the articles that populated. I generated the most results using Google Scholar, and therefore focused on reading the article titles to find articles which would fit my mini CAT. I found it interesting that so many articles appeared that were published within the year and therefore I chose to read through the titles. For the other databases, I read through the article titles, years the articles were published, and the location of the study. I would scan the abstract to ensure that the article had similar study goals as my mini CAT. Lastly, I would read the article in its entirety to confirm that I wanted to include the article in my mini CAT. I prioritized articles that have a high level of evidence such as Meta Analyses and Systematic Reviews.
Results found:
| Title: Screen time and sleep among school-aged children and adolescents: a systematic literature review |
| Citation:Hale L, Guan S. Screen time and sleep among school-aged children and adolescents: a systematic literature review. Sleep Med Rev. 2015;21:50-58. doi:10.1016/j.smrv.2014.07.007 |
| Type of article: Systematic Review |
| Abstract:We systematically examined and updated the scientific literature on the association between screen time (e.g., television, computers, video games, and mobile devices) and sleep outcomes among school-aged children and adolescents. We reviewed 67 studies published from 1999 to early 2014. We found that screen time is adversely associated with sleep outcomes (primarily shortened duration and delayed timing) in 90% of studies. Some of the results varied by type of screen exposure, age of participant, gender, and day of the week. While the evidence regarding the association between screen time and sleep is consistent, we discuss limitations of the current studies: 1) causal association not confirmed; 2) measurement error (of both screen time exposure and sleep measures); 3) limited data on simultaneous use of multiple screens, characteristics and content of screens used. Youth should be advised to limit or reduce screen time exposure, especially before or during bedtime hours to minimize any harmful effects of screen time on sleep and well-being. Future research should better account for the methodological limitations of the extant studies, and seek to better understand the magnitude and mechanisms of the association. These steps will help the development and implementation of policies or interventions related to screen time among youth. |
| Why I chose it:I chose this article because it is a Systematic Review which is a high level of evidence. I appreciate that the article was published within the last 10 years. This article looked at the associations between various screen time usage and their impact on sleep. I thought it was interesting to include a study which evaluated the impact of various forms of screens rather than one single form such as smartphones. I thought that this strengthened its findings that screen time is associated with delayed bedtime, reduced total sleep time and quality of sleep. |
| Title: Screen media use and sleep disturbance symptom severity in children |
| Citation:Hisler GC, Hasler BP, Franzen PL, Clark DB, Twenge JM. Screen media use and sleep disturbance symptom severity in children. Sleep Health. 2020;6(6):731-742. doi:10.1016/j.sleh.2020.07.002 |
| Type of article: Cross sectional study |
| Abstract:Objectives: Few studies have sought to evaluate how screen media use relates to symptoms of sleep-wake disturbances. To extend these prior studies in a large sample of children, this study examined associations of different types of screen media with symptom severity of different classes of sleep-wake disturbances. This study was preregistered here.Design: This study utilized the baseline cross-sectional survey administered within the Adolescent Brain Cognitive Development Study (ABCD; Release 2.0).Participants: ABCD recruited over 11,000 U.S. children age 9-10 across 21 study sites using an epidemiologically-informed school-based recruitment strategy.Measurements: Children reported typical weekend and weekday use of TV, video, video game, social media, texting, and video chat, and parents completed reports of the child’s symptom severity of sleep-wake disturbances via the Sleep Disturbance Scale for Children.Results: Greater screen media use, TV, video, and video game use, was associated with decreased sleep duration, increased sleep onset latency as well as greater excessive sleepiness, insomnia, and overall sleep disturbance symptom severity. Use of these screen medias were also associated with clinically relevant sleep problems. Ethnoracial differences emerged in screen use and sleep, but did not moderate the association between screen use and sleep.Conclusions: Greater use of screen medias was not just associated with longer sleep onset latency and shorter sleep duration, but also increased severity of multiple types of sleep-wake disturbances. Future research should use longitudinal designs to determine the direction of these associations in adolescent populations. |
| Why I chose it:I chose this article because I thought it was interesting that it focused on a specific age group within the pediatric population. Although this article does not represent the highest level of evidence, I thought it provided important information regarding the effects of screen time use within the pediatric population and its effect on sleep-wake disturbances. This article was published in 2020 which was within the last 5 years. This makes the data presented in the article more relevant. |
| Title: The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement |
| Citation:Hartstein LE, Mathew GM, Reichenberger DA, et al. The impact of screen use on sleep health across the lifespan: A National Sleep Foundation consensus statement. Sleep Health. Published online May 25, 2024. doi:10.1016/j.sleh.2024.05.001 |
| Type of article: Systematic Review |
| Abstract:Objective: To achieve consensus on whether screen-based digital media (1) in general, (2) via prebedtime content, and (3) via prebedtime light impairs sleep health in (a) childhood, (b) adolescence, and (c) adulthood. Furthermore, to address whether employing behavioral strategies and interventions may reduce the potential negative effects of screens on sleep health.Methods: The National Sleep Foundation convened a 16-person multidisciplinary expert panel (“Panel”). Panelists met virtually 5 times throughout 2023, during which they followed a modified Delphi RAND/UCLA Appropriateness Method to reach consensus.Results: The Panel conducted a literature review starting with 2209 articles, narrowed down to 522 relevant empirical articles and 52 relevant review articles. The search was refined to include 35 experimental/intervention studies that examined whether there was a causal link between screen-based digital media and sleep. In addition, panelists reviewed 5 recent relevant systematic review articles. After reviewing the summarized current literature, panelists voted on 10 candidate statements about whether screen use impairs sleep health. The Panel met virtually to discuss the results of the first round of votes, which was then followed by a second round of voting, ultimately achieving consensus on 5 out of the 10 statements.Conclusions: The Panel achieved consensus that (1) in general, screen use impairs sleep health among children and adolescents, (2) the content of screen use before sleep impairs sleep health of children and adolescents, and (3) behavioral strategies and interventions may attenuate the negative effects of screen use on sleep health. |
| Why I chose it:I chose this article because it is a Systematic Review which represents a high level of evidence. This article was published within the last two months which makes the information contained in the article highly relevant. I appreciated that this Systematic Review focused on multiple age groups rather than only Pediatrics. While the effects of screen time on sleep within pediatrics is my primary concern, I am also curious how screen time affects older populations and this information is valuable as well. |
| Title: Sleep Duration, Restfulness, and Screens in the Sleep Environment |
| Citation:Falbe J, Davison KK, Franckle RL, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics. 2015;135(2):e367-e375. doi:10.1542/peds.2014-2306 |
| Type of article: Cross-Sectional study |
| Abstract:BACKGROUND AND OBJECTIVE:Associations of inadequate sleep with numerous health outcomes among youth necessitate identifying its modifiable determinants. Television (TV) has been associated with sleep curtailment, but little is known about small screens (eg, smartphones), which can be used in bed and emit notifications. Therefore, we examined associations of different screens in sleep environments with sleep duration and perceived insufficient rest or sleep.METHODS:Participants included 2048 fourth- and seventh-graders participating in the Massachusetts Childhood Obesity Research Demonstration Study in 2012 to 2013. Using linear and log binomial regression, we examined cross-sectional associations of small screens and TVs in sleep environments and screen time with weekday sleep duration and perceived insufficient rest or sleep in the past week.RESULTS:Children who slept near a small screen (compared with never) reported 20.6 fewer minutes of sleep (95% confidence interval [CI], −29.7 to −11.4) and had a higher prevalence of perceived insufficient rest or sleep (prevalence ratio, 1.39; 95% CI, 1.21 to 1.60). Children who slept in a room with a TV (compared with no TV) reported 18.0 fewer minutes of sleep (95% CI, −27.9 to −8.1). TV or DVD viewing and video or computer game playing were associated with both sleep outcomes (P < .01). Some associations were stronger among Hispanic, non-Hispanic black, and older children (P < .05 for heterogeneity).CONCLUSIONS:Sleeping near a small screen, sleeping with a TV in the room, and more screen time were associated with shorter sleep durations. Presence of a small screen, but not a TV, in the sleep environment and screen time were associated with perceived insufficient rest or sleep. These findings caution against unrestricted screen access in children’s bedrooms. |
| Why I chose it:I chose this article because I thought it was interesting that it specifically looked at the impact of small screens in a room. I initially was interested in this question for my mini CAT because of a conversation that I had with a mother regarding a cell phone for her child. A cell phone is a typical example of a small screen which may be found in a bedroom and I thought it was interesting to read the data from this article. I also appreciated that this article was published within the last 10 years. |
| Title: U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines |
| Citation:Friel CP, Duran AT, Shechter A, Diaz KM. U.S. Children Meeting Physical Activity, Screen Time, and Sleep Guidelines. Am J Prev Med. 2020;59(4):513-521. doi:10.1016/j.amepre.2020.05.007 |
| Type of article: Cross-Sectional study |
| Abstract:Introduction: Physical inactivity, high screen time, and short sleep are targets of public health initiatives for children. However, few data exist on how many U.S. children meet guidelines for these behaviors-data vital to inform which needs greater targeting. This study describes national prevalence estimates of U.S. children who meet physical activity, screen time, and sleep guidelines alone or in combination across each childhood year.Methods: This analysis (completed in 2019) used cross-sectional data from the 2016-2017 National Survey of Children’s Health, a nationally representative sample of U.S. children. Child physical activity (days per week with ≥60 minutes), recreational screen time (hours per day of TV viewing and electronic device use), and sleep duration (hours per day) were assessed through parental report. Guidelines recommend ≥60 minutes per day of physical activity, ≤2 hours per day of screen time, and 9-12 hours per day of sleep for individuals aged 6-12 years (8-10 hours for those aged 13-17 years).Results: Only 8.8% (95% CI=8.2%, 9.5%) of U.S. children meet all the 3 guidelines combined. Majority of children/adolescents attain the sleep guideline (86.0%, 95% CI=85.2%, 86.7%), but a lower proportion meet physical activity (23.0%, 95% CI=22.1%, 23.9%) or screen time (32.9%, 95% CI=31.9%, 33.8%) guidelines. A substantial age effect was identified, with prevalence of meeting each distinct guideline and all the 3 declining with age (p<0.001).Conclusions: Few U.S. children meet all the 3 movement guidelines, with prevalence rates of children meeting guidelines declining with age. Although many meet sleep guidelines, few meet physical activity or screen time guidelines. Initiatives targeting physical activity and screen time, especially for adolescents, should be pursued. |
| Why I chose it:I chose this article because I thought it was interesting that it specifically looked at the impact of small screens in a room. I initially was interested in this question for my mini CAT because of a conversation that I had with a mother regarding a cell phone for her child. A cell phone is a typical example of a small screen which may be found in a bedroom and I thought it was interesting to read the data from this article. I also appreciated that this article was published within the last 10 years. |
Summary of the Evidence:
| Author (Date) | Level of Evidence | Sample/Setting(# of subjects/ studies, cohort definition etc. ) | Outcome(s) studied | Key Findings | Limitations and Biases |
| Hale L, Guan S, 2015 | Systematic review | A literature search was conducted using Web of Science, PubMed and Google Scholar. Inclusion Criteria:Articles published from January 2013-January 2020Studies that looked at patients between the ages of 5 – 17 Studies that looked at the association between sleep and screen time 577 articles resulted following duplicate removal106 full-text articles were evaluated for inclusion67 articles were included in this Systematic Review | The outcomes studied included the following: Sleep outcomes such as delayed sleep duration and delayed timing, sleep quality, sleep onset latency (SOL), daytime sleepiness | 32 out of 42 studies which looked at the association between watching TV and sleep found that there was a negative association between the two. – Two studies found that TV only affected sleep when multiple screens were being used- 29 out of 31 studies which looked at the associated between computer use and sleep found an adverse assocation between the two. – 24 studies showed shortened total amount of sleep time when associated with computer use. – 5 out of 6 studies which looked at sleep problems founds that computer use was a positive predictor of other sleep problems as well- 13 out of 16 articles which looked at the impacts of video gaming on sleep found that total sleep time was reduced. Studies estimated that video gaming was associated with 28 minutes of decreased sleep- 10 out of 12 articles which looked at the associated between smartphone use and sleep found decreased total sleep time and delayed bedtime. Among 9 studies that looked at aggregate screen time and sleep, 8 found a negatives association between the two. | While the articles included in this Systematic Review and Meta analysis were all published in English, they may not have originally been conducted in America. This limits the application of the results to the American population due to differing standards of care, baseline sleep habits and sleep requirements.Publication bias may have a role in this Systematic Review as authors may have intended to prove a negative association between sleep and screen time.The data collected is observational, and therefore it is difficult to prove causality. |
| Hisler GC, Hasler BP, Franzen PL, Clark DB, Twenge JM 2020 | Cross Sectional study | This study is a multi-site longitudinal study. It included 9-10 year old children from 21 sites across the United States. Data from 11,878 participants was extracted.Inclusion Criteria: – 9-10 year old children | The primary outcomes studied include the following:Sleep wake disturbance severitySleep onset latencySleep duration | Children with two or more hours of screen time use had shorter durations of sleep. The prevalence of insufficient sleep increased with the number of hours the child engaged with a screen.Video game use and non-TV screen use were associated with increased sleep latencyTwo or more hours of screen time such as video games was associated with increased symptoms of insomnia and excessive daytime sleepinessTexting and social media use was not associated with increased sleep-wake disturbancesScreen use over the weekend was more closely associated with sleep-wake disturbances compared to screen use during the weekdays. | The cross-sectional nature of this study may interfere with causalityIt is unclear whether increased screen time is associated with increased sleep-wake disturbances or whether the relationship is inverse and increased sleep-wake disturbances result in increased use of screens at nightThe children included in this study encompass a limited age group |
| Hartstein LE, Mathew GM, Reichenberger DA, et al 2024 | Systematic Review | A literature search was conducted using MEDLINE/PubMed, EMBASE and Clarivate’s Web of Science Inclusion Criteria:Objective measure of sleepValidated sleep scaleTexts Included2,209 records resulted42 articles were screened for full text reviews35 articles were included in the Systematic Review | The primary outcomes studied included children and the impact of screen usage on sleep. Additional outcomes included adolescents and adults and the impact of screen time on sleep within these populations. | Excessive screen usage was associated with impaired sleep among all three populations analyzed. This is partially due to blue light associated with screens which suppressed melatonin.Screen time amongst the pediatric population most negatively affects sleep and causes decreased duration of sleep and later bedtimes.The material that is consumed during the screen time prior to sleeping may have an effect on how detrimental screen time is to sleep and how greatly it reduces the quality of sleep | This study does not differentiate between various forms of screen use which is seen in other articles. This generalizes the effects of screen usage.Many of the articles included in this systematic review are cross-sectional studies which limits the ability to establish causality.This study did not differentiate between the content absorbed during screen time. |
| Falbe J, Davison KK, Franckle RL, et al. 2015 | Cross sectional study | Data was collected from fourth – seventh graders in a Massachusetts public school. 2,061 students completed the survey. 2,048 students were included in this study. Inclusion Criteria:Data was collected from fourth – seventh graders in a Public school in Massachusetts from October 2012 – December 2012Texts Included:92 articles resultedOne RCT and one Systematic Meta analysis was included | Primary outcomes:Typical weekday sleep durationSelf perceived insufficient sleep Secondary outcomes included typical bedtime and waketimes. | 54% of students reported sleeping near a small screen while sleeping while 75% reported having a TV in their roomA negative association between duration of sleep and sleeping near a small screen was found20.6 fewer minutes of sleep were associated with sleeping with a small screen in the roomPlaying video games was associated with a later bedtime with each hour of playing (9.8 minute)Small screens in the room were associated with perceived feelings of sleeping less while TVs in the room did not generate this same feeling. | This study was a cross-sectional observational study. This limits the value of its evidence as the data is gathered from the studentsFurthermore, the data was collected from elementary school children who are not as reliable as adultsThe study did not use statistical data to measure sleep quality and duration and relied on the data from the surveys |
| Friel CP, Duran AT, Shechter A, Diaz KM 2020 | Cross sectional study | Data from the National Survey of Children’s Health from 2016 – 2017 was collected and analyzed. The survey includes children from 0 – 17. Inclusion Criteria:Data collected from participants aged 6-17 were included in this study.Data from 49,606 participants was included in this study | Primary outcomes:Sleep quality was assessedPhysical fitness and physical health were analyzedMental health including emotional health ere analyzed | This study looked at three guidelines which include physical activity, screen time and sleepThe article discussed that while 91.2% of children meet at least one guideline, only about 8.8% of children meet all three guidelinesScreen time use below 2 hours/ day significantly decreases amongst children as they get olderAdolescents ages 15-16 experience decreases in adequate amounts of sleep with 86.0% meeting sleep guidelines | This study was completed based upon responses from surveys and may not accurately reflect the populationThe responses were completed by parents who may not have accurate knowledge and understanding of their children’s habitsScreen time was a general definition used and did not refer to one specific form of screen time |
Conclusions:
Article #1: This Systematic Review looks at the outcomes of screen time in regards to sleep. In particular, the article looks at outcomes such as sleep quality, total sleep time and time that the participants go to sleep. The study found that screen time before bed was negatively associated with poor sleep outcomes. While 32 out or 42 studies found that watching TV and falling asleep were negatively associated, 29 out of 31 studies similarly found that computer use and sleep were negatively associated. 10 out of 12 studies which looked at the impact of smartphone use on sleep found that smartphones reduced the quantity of sleep, length of sleep and delayed bedtime.
Article #2: The findings of this Cross-sectional study provide important information for this mini CAT. This article focuses on screen time and the resulting sleep-wake disturbances which it causes. The article found that increased screen time was associated with reduced sleep duration, increased sleep onset latency and increased reported sleepiness. This article delivered important information regarding the effects felt by the participants in the study, rather than the data regarding reduced sleep. This article explored the sleep-wake disturbances associated with screen time and the form of screen time which affected sleep the most. Active screen engagement including video games and texting were found to have a more negative impact on sleep compared to passive screen time such as watching TV.
Article #3: This Systematic Review looked at the impacts of screen time when used prebedtime most significantly impacts sleep due to the content or the blue light emitted. Panelists involved in the study analyzed the data and concluded that screen time affects sleep in a multitude of ways. A majority of the panelists concluded that screen use in general affects the quality of sleep, while the actual content on the screen as well also negatively impacts sleep.
Article #4: This study compared the relationship between small screens and TV and the quality of sleep that children receive with these devices in their room while they are sleeping. The study looked at fourth – seventh graders in an American public school. The study found that having a small screen in the room while the student was sleeping interfered with the quality of the sleep and led to reduced quantity of sleep. Playing video games also led to later bedtimes by 9.8 minutes per each hour of video games played. Interestingly, perceived lack of sleep was observed when students slept in the same room as a TV while this finding was not as significantly observed in regards to TVs.
Article #5: This study looked at the child and adolescent population in the US between the years 2016 – 2017. The study defined three main guidelines which included screen time, physical activity and sleep. While the majority of the population (86.0%) maintains adequate sleep habits, physical activity and screen time habits are not meeting the guidelines. The article states that children and adolescents are engaging in increased amounts of screen time and reduced amounts of physical activity. This combination is leading to unhealthy lifestyles and may lead to poor outcomes.
Overarching Conclusions: Research suggests that screen time is associated with negative impacts on sleep for children. Factors such as duration of sleep, quality of sleep, sleep onset latency and bedtime are all negatively affected by screen time. Various forms of screen time such as smartphone, TV, video games and computers all have various degrees of impact on sleep. However, the research concludes that the impact of each of these forms is significant.
Weight of Evidence:
Article #1: I ranked this article as #1. This article is a Systematic Review which is of the highest level of evidence. Although this article was published in 2015, because this is a Systematic Review I felt that the data it included was of the most important. This article specifically looked at the associations between screen time and sleep. I appreciated that this article differentiated between various forms of screen use. The primary outcomes of this study were consistent with my question and addresses the goal of this mini CAT directly.
Article #2: I ranked this article as #3. This article is a Cross-sectional study which looks at the impact of screen time on sleep quality, length and perceived sleepiness. I ranked this article third because it was published within the last 5 years. This makes the article more relevant. I appreciated that this article emphasized perceived sleepiness. I think that this is an important aspect of impaired sleep and is a meaningful method to categorize poor sleep habits. I also thought it was valuable that this article posited that active screen time was more detrimental to sleep than passive screen time such as watching TV.
Article #3: I ranked this article as #4. This article is a Systematic analysis which is of the highest level of evidence. I appreciate that this article was published within the last year which makes it relevant. I thought that it was interesting that this article looked at the specific causes of the impact of screen time on sleep. However, it did not include as much data as I would have hoped in regard to the specific outcomes on sleep. This article did add an interesting element to my research and I am glad that I included it.
Article #4: I ranked this article as #2. This article specifically looks at the association between small screens and sleep. I thought that this was appropriate as my original question asks about smartphone usage and sleep. Small screens represent phones that children may have in their room and analyzed how and why it affects their sleep. I thought that this was also important and contributed to my mini CAT because it includes data which was gathered from fourth – seventh graders. This included the age of my patient that inspired this mini CAT.
Article #5: I ranked this article as #5. This article looked at three guidelines that children should be meeting. Two out of the three of these guidelines were relevant to my original question. I thought that it would be interesting to include this article because it suggested that adequate sleep may be possible despite increased amounts of screen time. I thought this article added an interesting point of view.
Magnitude of Effects:
All of the articles included conclude with a similar recommendation. The research analyzed in this mini-CAT reports that screen time negatively impacts sleep amongst children. Therefore, these articles have a high magnitude of effect as they can be translated into clinical practice.
Clinical Bottom Line:
The articles included show that when analyzing the impact of screen time of sleep quality, screen time has been repeatedly shown to reduce duration of sleep, quality of sleep and bedtime amongst the pediatric population. The first article concludes screen time such as watching TV, playing video games, viewing a computer and spending time on one’s phone are all negatively associated with sleep. While each of these methods of screen time effect sleep in various ways and to various degrees, they are all found to be associated with poor sleep. The second article focused on sleep-wake disturbances caused by screen time amongst 9-10 year olds. The article showed that for every hour in which a participant engaged in screen time, their duration of sleep was reduced. This article also found that screen time during the weekends was more negatively associated with poor sleep compared to screen time during the weekdays. The third article analyzed children, adolescents and adults. It concluded that screen time impacts sleep both due to the content on the screen as well as the blue light. Blue light suppresses melatonin which inhibits sleep. Screen time was found to have the greatest negative impact on sleep amongst the pediatric population compared to the adolescent and adult groups. The fourth article aimed to answer the research question in regards to the impact of small screens in the same room when an individual is sleeping. 20.6 fewer minutes of sleep were noted for those that slept in the same room as a small screen. Playing video games was also associated with delayed bedtime by 9.8 minutes. The fifth and final article looked at three guidelines which are set forth for children. These guidelines consist of screen time, physical activity and sleep. While 86% of the population maintains adequate amounts of sleep according to the guidelines, screen time is increasing amongst children while physical activity is decreasing. This article posits that increased screen time does not necessarily have to be correlated with reduced sleep, although many of the articles have concluded this.
Referring back to the original clinical scenario presented, the research presented concludes that the mother in the vignette is correct that increased screen time is associated with negative impacts on sleep. Although continued research is indicated to further dissect the various aspects the impacts of screen time on sleep, I would feel confident telling this mother that giving her child a cell phone will negatively impact her child’s sleep.
