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Association Between Portable Screen-Based Media Device Access or Use and Sleep Outcomes: A Systematic Review and Meta-analysis
Open accessAbstract
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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“Incoming alerts, ringers, and notifications can occur at any stage of sleep, with the potential to disrupt natural sleep progression and REM cycles.208”
From Digital Ecosystems, Children, and Adolescents: Technical Report (2026) · cites this paper as [208]
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“Moreover, the evidence on which these guidelines are based largely comes from cross-sectional studies with many inherent limitations.2,10,11,12”
From Screen Use at Bedtime and Sleep Duration and Quality Among Youths (2024) · cites this paper as [10]
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“Thus, short-wavelength light on the preceding evening reduced next-morning alertness because its alerting effects in the evening may have interfered with the subsequent sleep.”
From Preliminary Results: The Impact of Smartphone Use and Short-Wavelength Light during the Evening on Circadian Rhythm, Sleep and Alertness (2021) · cites this paper as [40]
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“Indeed, even teens who kept their devices in their bedrooms but did not access them experienced inadequate or poor sleep quality and excessive daytime sleepiness.208”
From Digital Ecosystems, Children, and Adolescents: Technical Report (2026) · cites this paper as [208]
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“Heterogeneity exceeding 85% was explored using subgroup analyses [23].”
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“Although several studies have reported that many adolescents use MTSDs frequently [2, 3, 5, 6], and commonly at night or before sleeping [19, 20], little is known about adolescents’ daily routines of using these devices, which can be affected by different types of day (e.g. weekdays versus weekend, school days versus holidays) or settings (e.g. home versus school).”
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“Night time or before bedtime use in their bedrooms were also a standard routine of use for many adolescents, which is consistent with other studies showing prevalent technology use at night or before sleeping [2, 3, 20].”
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“given the evidence for associations between prebedtime screen use and a number of poor sleep markers (eg, inadequate sleep quantity, poor sleep quality, and excessive daytime sleepiness) [62].”
From Using Wearable Cameras to Categorize the Type and Context of Screen-Based Behaviors Among Adolescents: Observational Study (2022) · cites this paper as [62]
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Metadata
- Authors
- Carter, B., Rees, P., Hale, L., Bhattacharjee, D., & Paradkar, M. S.
- Affiliations
- University of Nottingham (GB)
- University College London (GB)
- Stony Brook School (US)
- University Hospital of Wales (GB)
- Johns Hopkins University (US)
- Corresponding author
- Carter, Ben
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2016-12-01
- Volume
- 170
- Issue
- 12
- Pages
- 1202
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5380441
- OpenAlex
- W2548384288
- Cited by
- 718
- References
- 42
- Citations by year
- 2026: 128 · 2025: 89 · 2024: 80 · 2023: 71 · 2022: 93 · 2021: 81 · 2020: 61 · 2019: 53 · 2018: 38 · 2017: 24
- FWCI
- 5.03
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Funders
- Johns Hopkins University
- University College London
- University of Nottingham
- Stony Brook University
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD073352)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Social Sciences › Education › Child Development and Digital Technology
- Social Sciences › Sociology and Political Science › Impact of Technology on Adolescents
- Keywords
- children's sleep, sleep duration, sleep quality, excessive daytime sleepiness, mobile devices, tablets, sleep environment, screen time, elementary school students, sleep deprivation
- MeSH terms
- Adolescent, Child, Cross-Sectional Studies, Female, Humans, Male, Sleep, Sleep Wake Disorders, Computers, Handheld, Cell Phone, Young Adult
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