Abstracts

Introduction

In adolescence, the period between 10 and 19 years of age ¹1. World Health Organization. Adolescent health. http://www.who.int/child_adolescent_health/topics/prevention_care/adolescent/en/index.html (accessed on 30/Dec/2021).
http://www.who.int/child_adolescent_heal... , important changes take place in individuals’ sleep/wake cycle patterns, including a delay in the sleep phase, characterized by later sleeping and waking times. Sleep acts as an important component of physical growth and biological and mental development, considered a source of revitalization of organic functions associated with health indicators ²2. Del Ciampo LA. Sleep in adolescence. Adolesc Saúde 2012; 9:60-6.. Moreover, proper sleep stimulates the immune system, helping it to fight infections and can thus reduce the risk of diseases ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,44. Rogers AE, Aldrich MS, Lin X. A comparison of three different sleep schedules for reducing daytime sleepiness in narcolepsy. Sleep 2001; 24:385-91.^,55. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78..

According to the National Sleep Foundation (NSF; United States) ⁶6. The National Sleep Foundation. Trusted sleep health information and product reviews. https://www.thensf.org/ (accessed on 30/Dec/2021).
https://www.thensf.org/... , sleep should last for nine hours per night for adolescents to have optimal good health and development. However, research indicates that many teenagers sleep for less hours than appropriate. A study conducted in Brazil with 177 adolescents aged 12 to 19 years showed an average duration of 7.7 hours during the week ⁷7. Caumo GH, Spritzer D, Carissimi A, Tonon AC. Exposure to electronic devices and sleep quality in adolescents: a matter of type, duration, and timing. Sleep Health 2020; 6:172-8.. Another, conducted with 524 Lebanese students, found an average sleep duration of 6.9 hours on weekdays ⁸8. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.. In South Korea, 1,796 adolescents reported sleeping only 6.4 hours on school days ⁹9. Chung JE, Choi SA, Kim KT, Yee J, Kim JH, Seong JW, et al. Smartphone addiction risk and daytime sleepiness in Korean adolescents. J Paediatr Child Health 2017; 54:800-6..

Among adolescents, digital screen viewing is common. These activities can take up more than 14 hours a day ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.. Increasing the time spent viewing television sets, computers, mobile phones, and various types of portable digital screens can damage adolescents’ health, causing, for example, poor quality of sleep ¹⁰10. Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PLoS One 2015; 10:e0119607.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,1212. Cabré-Riera A, Torrent M, Donaire-Gonzalez D, Vrijheid M, Cardis E, Guxens M. Telecommunication devices use, screen time and sleep in adolescents. Environ Res 2019; 10:341-7.^,1313. Scott H, Biello SM, Woods HC. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open 2019; 9:e031161.^,1414. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17..

In recent decades, the use of digital screens has changed how young people interact and acquire knowledge. As with cell phones, 75% of adolescents use them to access social media, online games, streaming services, and applications ¹⁵15. Guedes DP, Desiderá RA, Gonçalves HR. Prevalence of excessive screen time and correlates factors in Brazilian schoolchildren. Rev Bras Ativ Fís Saúde 2018; 23:407-14.^,1616. Hutter HP, Moshammer H, Wallner P, Cartellieri M, Denk-Linnert DM, Katzinger M, Ehrenberger K, et al. Tinnitus and mobile phone use. Occup Environ Med 2010; 67:804-8.^,1717. Lajunen HR, Keski-Rahkonen A, Pulkkinen L, Rose RJ, Rissanen A, Kaprio J. Are computer and cell phone use associated with body mass index and overweight? A population study among twin adolescents. BMC Public Health 2007; 7:24.. Therefore, it is important to highlight that screen time is their most common sedentary behavior, consisting of the time spent playing video games, using cell phones, tablets, computers, and/or watching television ¹⁵15. Guedes DP, Desiderá RA, Gonçalves HR. Prevalence of excessive screen time and correlates factors in Brazilian schoolchildren. Rev Bras Ativ Fís Saúde 2018; 23:407-14..

Excessive use of digital screens can both impair sleep and reduce physical well-being among adolescents due to headaches, tinnitus, stomach pain, musculoskeletal pain, or high body mass index, among others ¹⁶16. Hutter HP, Moshammer H, Wallner P, Cartellieri M, Denk-Linnert DM, Katzinger M, Ehrenberger K, et al. Tinnitus and mobile phone use. Occup Environ Med 2010; 67:804-8.^,1717. Lajunen HR, Keski-Rahkonen A, Pulkkinen L, Rose RJ, Rissanen A, Kaprio J. Are computer and cell phone use associated with body mass index and overweight? A population study among twin adolescents. BMC Public Health 2007; 7:24.. Similarly, increased use of these digital screens is associated with a higher likelihood of social isolation, suicidal thoughts, self-mutilation, peer victimization, and mental health problems among adolescents ¹⁸18. Pagani LS, Lévesque-Seck F, Fitzpatrick C. Prospective associations between televiewing at toddlerhood and later self-reported social impairment at middle school in a Canadian longitudinal cohort born in 1997/1998. Psychol Med 2016; 46:3329-37..

Therefore, this systematic review aimed to verify the relation between the use of digital screens and adolescents’ sleep quality.

Methodology

This systematic review was registered on PROSPERO (protocol n. CRD42020203403) and was conducted according to PRISMA guidelines. Our clinical issue consisted of the question: “Does the time spent on digital screens influence the quality of adolescent sleep?” (P = adolescents; I = excessive use of digital displays; C = low use of digital displays; O = poor quality of sleep).

Eligibility criteria

Studies which evaluated screen usage time and sleep duration and quality among adolescents were included in this review. No restriction to date of publication, language, and study design were set but adolescents from 10 to 19 years of age were included, according to the World Health Organization (WHO) classification ¹1. World Health Organization. Adolescent health. http://www.who.int/child_adolescent_health/topics/prevention_care/adolescent/en/index.html (accessed on 30/Dec/2021).
http://www.who.int/child_adolescent_heal... . Case reports or series, letters to editors, literature reviews, theses, and dissertations were excluded.

Search strategy

The available articles from the following databases were included: MEDLINE/PubMed, LILACS, SciELO, Scopus, EMBASE, Web of Science, IBECS, Cochrane Library, ClinicalTrials.gov, and Open Gray.

The following descriptors were used in our advanced search: “Sleep Quality”, “Screen Time”, and “Adolescent” and their synonyms recognized by the Medical Subject Headings (MeSH) and Health Sciences Descriptors (DeCS) glossaries. Our search strategy used was: “Sleep Quality [MeSH Terms]) OR Sleep OR Sleep Disorders OR Quality) AND Screen Time [MeSH Terms]) OR Screen Times OR Digital) AND Adolescent [MeSH Terms]) OR Adolescents) OR Adolescence) OR Teens) OR Teenagers) OR Teenagers) OR Teenager) AND Youths) OR Youth”. This strategy was adapted to each database, based on their specificities.

A manual search was also performed in the references of the selected articles and in some journals on the topic, such as Sleep & Breathing, Journal of Clinical Sleep Medicine, Journal of Sleep Research, Nature and Science of Sleep, Sleep Medicine, and Sleep Health.

Articles were independently chosen by two trained and calibrated researchers (S.S.S. and M.A.C.S.). Disagreements were solved by a third reviewer (M.V.H.) via discussions and consensus. The corresponding author was contacted if studies lacked data or additional information was needed.

Methodological evaluation of the chosen studies

Article quality was assessed by the Newcastle-Ottawa Scale (NOS) ¹⁹19. Honório HM, Santiago Junior JF, Peralta-Mamani M. Qualitative analysis of the systematic review. In: Honório HM , Santiago Junior JF, editors. Fundamentals of systematic reviews in dentistry. São Paulo: Quintessence; 2018. p. 205-31.. NOS was used for cohort studies and the modified NOS for cross-sectional ones. These scales assess bias via three aspects: participant selection (generalization and applicability); group comparability; and outcome evaluation.

The NOS for cohort and transverse studies is composed of eight and six items, respectively. Each item can receive a point (one star), except for the second aspect “Comparability”, whose score ranges from zero to two stars. Study bias risk may receive a maximum score of nine stars for cohort studies and seven, for cross-sectional ones. Cohort studies with nine stars are considered good; six to eight stars, moderate; and those with five stars or less, poor. Cross-sectional studies with a seven-star rating are considered good; between four and six, moderate; and those with three stars or less, poor ²⁰20. Javidi H, Vettore M, Benson PE. Does orthodontic treatment before the age of 18 years improve oral health-related quality of life? A systematic review and meta-analysis. Orthod Orthop 2017; 151:644-55..

The methodological quality of the studies was assessed by two independent reviewers (S.S.S. and M.A.C.S.) who were previously trained and calibrated with a 0.91 inter-rater kappa. Disagreements were solved by a third reviewer (M.V.H.) via discussions and consensus.

Results

Initially, we found 2,268 articles, of which we excluded 209 as duplicates, totaling 2,059 articles for title and abstract reading. After this phase, we chose 47 articles for a complete textual analysis. We excluded 24 studies since they failed to meet our inclusion criteria, leaving the 23 studies we included in this systematic review (Figure 1).

As for temporal distribution, 21.73% of studies took place between 2010-2015; 33.43%, in 2017; 8.69%, in 2018; 26.08%, in 2019; and 13.04%, in 2020. We found no studies for 2016. As for their geographical distribution, 39,13% of the studies was conducted in Europe; 34.78%, in Asia; 13.04%, in South America; 8.69%, in North America; and 4.34%, in Oceania. Regarding their study design, 20 were transversal, and three, cohort. We found no randomized clinical or case-control trials.

Table 1 summarizes the chosen studies on the use of digital screens and sleep quality, highlighting their authors, year, country of origin, type of study, sample, screen use duration, sleep quality, association between screen time and sleep quality, and the consequences of excessive screen use.

Tables 2 and 3 show our bias risk assessment according to the cohort-specific NOS score and its version adapted for cross-sectional studies, respectively. Of the 23 studies included, we considered seven as poor (three cohort and four cross-sectional studies) and 16, as moderate (all cross-sectional studies).

Discussion

This systematic review aimed to verify the relation between digital screen use and adolescents’ sleep quality. Our results indicates that digital screen use at bedtime was associated with poor sleep quality, shorter sleep duration, and greater daytime sleepiness ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,77. Caumo GH, Spritzer D, Carissimi A, Tonon AC. Exposure to electronic devices and sleep quality in adolescents: a matter of type, duration, and timing. Sleep Health 2020; 6:172-8.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,2121. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20.^,2222. Aguilar MM, Vergara FA, Velásquez EJ, García-Hermoso A. Physical activity, screen time and sleep patterns in Chilean girls. An Pediatr 2015; 83:304-10.. Our findings support recommendations suggesting that interventions be developed and evaluated to reduce access to digital screens at bedtime ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,77. Caumo GH, Spritzer D, Carissimi A, Tonon AC. Exposure to electronic devices and sleep quality in adolescents: a matter of type, duration, and timing. Sleep Health 2020; 6:172-8.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,1414. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17.^,2121. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20.^,2222. Aguilar MM, Vergara FA, Velásquez EJ, García-Hermoso A. Physical activity, screen time and sleep patterns in Chilean girls. An Pediatr 2015; 83:304-10.^,2323. Silva AO, Oliveira LMFT, Tassitano RM. Screen time, perception of sleep quality and episodes of parasomnia in adolescents. Rev Bras Med Esporte 2017; 23:375-9..

We considered the three cohort studies evaluated by the NOS (Table 2) as poor ²⁴24. McManus B, Underhill A, Mrug S, Anthony T, Stavrinos D. Gender moderates the relationship between media use and sleep quality. J Sleep Res 2021; 30:e13243.^,2525. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med 2019; 66:92-102.^,2626. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32. due to their incomplete sample data description and absent cohort monitoring, showing more than 20% of loss or incomplete description thereof. Moreover, it we found selection and information biases, confounding factors, and undescribed result importance and its applicability in clinical practice.

We considered the quality of the studies included in the modified NOS as moderate ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,55. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,77. Caumo GH, Spritzer D, Carissimi A, Tonon AC. Exposure to electronic devices and sleep quality in adolescents: a matter of type, duration, and timing. Sleep Health 2020; 6:172-8.^,99. Chung JE, Choi SA, Kim KT, Yee J, Kim JH, Seong JW, et al. Smartphone addiction risk and daytime sleepiness in Korean adolescents. J Paediatr Child Health 2017; 54:800-6.^,1010. Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PLoS One 2015; 10:e0119607.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,1212. Cabré-Riera A, Torrent M, Donaire-Gonzalez D, Vrijheid M, Cardis E, Guxens M. Telecommunication devices use, screen time and sleep in adolescents. Environ Res 2019; 10:341-7.^,1313. Scott H, Biello SM, Woods HC. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open 2019; 9:e031161.^,1414. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17.^,2121. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20.^,2222. Aguilar MM, Vergara FA, Velásquez EJ, García-Hermoso A. Physical activity, screen time and sleep patterns in Chilean girls. An Pediatr 2015; 83:304-10.^,2323. Silva AO, Oliveira LMFT, Tassitano RM. Screen time, perception of sleep quality and episodes of parasomnia in adolescents. Rev Bras Med Esporte 2017; 23:375-9.^,2727. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res 2017; 6:55-60.^,2828. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,2929. Foerster M, Henneke A, Chetty-Mhlanga S, Röösli M. Impact of adolescents screen time and nocturnal mobile phone-related awakenings on sleep and general health symptoms: a prospective cohort study. Int J Environ Res Public Health 2019; 16:518. (Table 3). Their limitations include non-validated measurement instruments ²⁸28. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,2929. Foerster M, Henneke A, Chetty-Mhlanga S, Röösli M. Impact of adolescents screen time and nocturnal mobile phone-related awakenings on sleep and general health symptoms: a prospective cohort study. Int J Environ Res Public Health 2019; 16:518.^,3030. Royant-Parola S, Londe V, Tréhout S, Hartley S. Nouveaux médias sociaux, nouveaux comportements de sommeil chez les adolescents. Encephale 2018; 44:321-8.^,3131. Akçay D, Akçay BD. The influence of media on the sleep quality in adolescents. Turk J Pediatr 2018; 60:255-63., the fact that only three studies performed inferential analyses ¹²12. Cabré-Riera A, Torrent M, Donaire-Gonzalez D, Vrijheid M, Cardis E, Guxens M. Telecommunication devices use, screen time and sleep in adolescents. Environ Res 2019; 10:341-7.^,2424. McManus B, Underhill A, Mrug S, Anthony T, Stavrinos D. Gender moderates the relationship between media use and sleep quality. J Sleep Res 2021; 30:e13243.^,2626. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32., and lack of adjustment analysis for confounding factors ⁸8. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,2222. Aguilar MM, Vergara FA, Velásquez EJ, García-Hermoso A. Physical activity, screen time and sleep patterns in Chilean girls. An Pediatr 2015; 83:304-10.^,2727. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res 2017; 6:55-60.^,3232. Falbe J, Davison KK, Franckle RL, Ganter C, Gortmaker SL, Smith L, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015; 135:e367-75..

We observed differences in the results of the analyzed studies. We believed that the low and moderate quality of their scientific evidence is due to disparities in their methodological and sampling criteria. Moreover, studies proved to be heterogeneous due to factors related to socioeconomic status ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,2727. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res 2017; 6:55-60.; local cultural issues ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,1212. Cabré-Riera A, Torrent M, Donaire-Gonzalez D, Vrijheid M, Cardis E, Guxens M. Telecommunication devices use, screen time and sleep in adolescents. Environ Res 2019; 10:341-7.^,2323. Silva AO, Oliveira LMFT, Tassitano RM. Screen time, perception of sleep quality and episodes of parasomnia in adolescents. Rev Bras Med Esporte 2017; 23:375-9.; questionnaire type, associated to different digital screen types ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,88. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.^,99. Chung JE, Choi SA, Kim KT, Yee J, Kim JH, Seong JW, et al. Smartphone addiction risk and daytime sleepiness in Korean adolescents. J Paediatr Child Health 2017; 54:800-6.^,3232. Falbe J, Davison KK, Franckle RL, Ganter C, Gortmaker SL, Smith L, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015; 135:e367-75.; and time analysis of answers ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,1414. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17.^,2121. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20..

Only four studies (out of 23) found sufficient sleep duration in their samples ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,2222. Aguilar MM, Vergara FA, Velásquez EJ, García-Hermoso A. Physical activity, screen time and sleep patterns in Chilean girls. An Pediatr 2015; 83:304-10.^,3232. Falbe J, Davison KK, Franckle RL, Ganter C, Gortmaker SL, Smith L, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015; 135:e367-75.^,3333. Adelantado-Renau M, Diez-Fernandez A, Beltran-Valls MR, Soriano-Maldonado A, Moliner-Urdiales D. The effect of sleep quality on academic performance is mediated by Internet use time: DADOS study. J Pediatr (Rio J.) 2019; 95:410-8.. The literature reports that inadequate sleep duration leads to lower performance in social and school activities and greater daytime sleepiness in adolescents ⁸8. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.^,2828. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,3333. Adelantado-Renau M, Diez-Fernandez A, Beltran-Valls MR, Soriano-Maldonado A, Moliner-Urdiales D. The effect of sleep quality on academic performance is mediated by Internet use time: DADOS study. J Pediatr (Rio J.) 2019; 95:410-8.. These findings indicate that access to and use of digital screens at bedtime damages individuals’ health, causing low immunity, heart diseases, and reduced longevity, among others ²²22. Aguilar MM, Vergara FA, Velásquez EJ, García-Hermoso A. Physical activity, screen time and sleep patterns in Chilean girls. An Pediatr 2015; 83:304-10.. Moreover, we also found, in the study by McManus et al. ²⁴24. McManus B, Underhill A, Mrug S, Anthony T, Stavrinos D. Gender moderates the relationship between media use and sleep quality. J Sleep Res 2021; 30:e13243., an association of poor sleep quality with symptoms of depression.

The studies by Hisler et al. ²⁵25. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med 2019; 66:92-102. and Jun et al. ²⁷27. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res 2017; 6:55-60. showed a 4h30 and 4h40 daily use of digital screens (TV, mobile phones, video games, and computers), respectively. Scott et al. ¹³13. Scott H, Biello SM, Woods HC. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open 2019; 9:e031161. verified a daily use of digital screens greater than 5h per day. Mak et al. ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19. highlighted that adolescents spent 5h54min/day on digital screens. Among the limitations of the mentioned studies is their lack of description of the time of day at which individuals used screens.

Many factors lead to poor sleep quality in adolescents, ranging from biological factors (such as maturation changes) to environmental factors (such as family life, caffeine consumption, and use of electronic devices) ¹³13. Scott H, Biello SM, Woods HC. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open 2019; 9:e031161.. Among young people, poor quality of sleep may be associated with its insufficient duration ¹⁰10. Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PLoS One 2015; 10:e0119607.^,1414. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17.^,2525. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med 2019; 66:92-102.^,2626. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32.^,2828. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,3131. Akçay D, Akçay BD. The influence of media on the sleep quality in adolescents. Turk J Pediatr 2018; 60:255-63. which, in turn, may be related to biological and maturational factors, behavioral and social changes, increased school obligations, social activities, and excessive use of electronic equipment ¹⁴14. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17.^,2525. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med 2019; 66:92-102.^,2626. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32.^,2828. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,3131. Akçay D, Akçay BD. The influence of media on the sleep quality in adolescents. Turk J Pediatr 2018; 60:255-63.. Note that bedtime changes appear to be greater in adolescents than in other age groups ²⁵25. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med 2019; 66:92-102.. The literature has suggested that stressful (and sometimes annoying) media content may be an underlying factor of how mobile phone use can affect sleep ¹⁴14. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17..

A large proportion of adolescents ignore the adverse effects of the use of digital screens, such as mobile phones, in bed ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.. They mistakenly believe that these media can help them sleep since they associate digital screens with their personal routine. However, using digital screens at bedtime can delay the onset of sleep. Some adolescents report finding it hard to turn off social media to sleep ¹³13. Scott H, Biello SM, Woods HC. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open 2019; 9:e031161..

Among all the digital screens the studies evaluated, cell phones are the most associated with poor sleep quality ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,55. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,77. Caumo GH, Spritzer D, Carissimi A, Tonon AC. Exposure to electronic devices and sleep quality in adolescents: a matter of type, duration, and timing. Sleep Health 2020; 6:172-8.^,99. Chung JE, Choi SA, Kim KT, Yee J, Kim JH, Seong JW, et al. Smartphone addiction risk and daytime sleepiness in Korean adolescents. J Paediatr Child Health 2017; 54:800-6.^,1111. Amra B, Shahsavari A, Shayan-Moghadam R, Mirheli O, Moradi-Khaniabadi B, Bazukar M, et al. The association of sleep and late-night cell phone use among adolescents. J Pediatr (Rio J.) 2017; 93:560-7.^,1212. Cabré-Riera A, Torrent M, Donaire-Gonzalez D, Vrijheid M, Cardis E, Guxens M. Telecommunication devices use, screen time and sleep in adolescents. Environ Res 2019; 10:341-7.^,2121. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20.^,2727. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res 2017; 6:55-60.^,3030. Royant-Parola S, Londe V, Tréhout S, Hartley S. Nouveaux médias sociaux, nouveaux comportements de sommeil chez les adolescents. Encephale 2018; 44:321-8.^,3131. Akçay D, Akçay BD. The influence of media on the sleep quality in adolescents. Turk J Pediatr 2018; 60:255-63. due to their ease of access and practicality. The study by Munezawa et al. ²¹21. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20. pointed out that using a mobile phone after switching off the lights (> 2h a night) to make calls or send text messages is associated with poor quality of sleep among adolescents. It is important to highlight how school schedules influence adolescents’ sleep duration and the conflict with the use of screens at night ³⁴34. Crowley SJ, Wolfson AR, Tarokh L, Carskadon MA. An update on adolescent sleep: new evidence informing the perfect storm model. J Adolesc 2018; 67:55-65. since the excessive use of screens compromises school routine and sleep duration ²⁶26. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32.^,3131. Akçay D, Akçay BD. The influence of media on the sleep quality in adolescents. Turk J Pediatr 2018; 60:255-63..

Melatonin is a hormone produced by our body which regulates the circadian rhythm. The study by Cabré-Riera et al. ¹²⁰ describes that refraining from using digital screens at least one hour before going to sleep is ideal for good sleep, as the light from the screen reduces the production of melatonin and gives the brain a false sensation that it is still day. Moreover, time spent on digital screens can replace time which might be devoted to study, which, together with worse sleep, can result in lower academic performance ⁸8. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.^,2828. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,3333. Adelantado-Renau M, Diez-Fernandez A, Beltran-Valls MR, Soriano-Maldonado A, Moliner-Urdiales D. The effect of sleep quality on academic performance is mediated by Internet use time: DADOS study. J Pediatr (Rio J.) 2019; 95:410-8.. For a good sleep regimen, individuals need to stipulate an hour to sleep and wake and promote a silent environment with low light and away from electronic devices ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,2020. Javidi H, Vettore M, Benson PE. Does orthodontic treatment before the age of 18 years improve oral health-related quality of life? A systematic review and meta-analysis. Orthod Orthop 2017; 151:644-55..

Smith et al. ²⁶26. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32. identified interventions to limit the use of screens to improve sleep in adolescents. Silent mode, turning theme off, time restrictions, no screens in bedrooms, screenless nights, and parent-set bedtime effectively restricted screen usage and improved sleep quality in adolescents, especially younger ones.

Mobile phone use and online browsing increase physical and emotional arousal, which could interfere with sleep quality ²³23. Silva AO, Oliveira LMFT, Tassitano RM. Screen time, perception of sleep quality and episodes of parasomnia in adolescents. Rev Bras Med Esporte 2017; 23:375-9.. Note that, besides cell phones, television is one of the digital screens adolescents most use ⁵5. Mireku MO, Barker MM, Mutz M, Dumontheil I, Thomas MSC, Roosli M, et al. Night-time screen-based media device use and adolescents' sleep and health-related quality of life. Environ Int 2019; 12:66-78.^,2323. Silva AO, Oliveira LMFT, Tassitano RM. Screen time, perception of sleep quality and episodes of parasomnia in adolescents. Rev Bras Med Esporte 2017; 23:375-9.^,2626. Smith C, de Wilde T, Taylor RW, Galland BC. Prebedtime screen use in adolescents: a survey of habits, barriers, and perceived acceptability of potential interventions. J Adolesc Health 2020; 66:725-32.^,3131. Akçay D, Akçay BD. The influence of media on the sleep quality in adolescents. Turk J Pediatr 2018; 60:255-63.^,3232. Falbe J, Davison KK, Franckle RL, Ganter C, Gortmaker SL, Smith L, et al. Sleep duration, restfulness, and screens in the sleep environment. Pediatrics 2015; 135:e367-75., especially at night, followed by electronic games, which are more used by boys ⁸8. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.^,3333. Adelantado-Renau M, Diez-Fernandez A, Beltran-Valls MR, Soriano-Maldonado A, Moliner-Urdiales D. The effect of sleep quality on academic performance is mediated by Internet use time: DADOS study. J Pediatr (Rio J.) 2019; 95:410-8..

It is important to point out that the excessive use of digital screens generates consequences which affect adolescents’ quality of life, such as: night awakening ¹³13. Scott H, Biello SM, Woods HC. Social media use and adolescent sleep patterns: cross-sectional findings from the UK millennium cohort study. BMJ Open 2019; 9:e031161.^,1414. Hrafnkelsdottir SM, Brychta RJ, Rognvaldsdottir V, Chen KY, Johannsson E, Gudmundsdottir SL, et al. Less screen time and more physical activity is associated with more stable sleep patterns among Icelandic adolescents. Sleep Health 2020; 2:8-17.^,3030. Royant-Parola S, Londe V, Tréhout S, Hartley S. Nouveaux médias sociaux, nouveaux comportements de sommeil chez les adolescents. Encephale 2018; 44:321-8.^,3434. Crowley SJ, Wolfson AR, Tarokh L, Carskadon MA. An update on adolescent sleep: new evidence informing the perfect storm model. J Adolesc 2018; 67:55-65.; daytime sleepiness ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,99. Chung JE, Choi SA, Kim KT, Yee J, Kim JH, Seong JW, et al. Smartphone addiction risk and daytime sleepiness in Korean adolescents. J Paediatr Child Health 2017; 54:800-6.^,2121. Munezawa T, Kaneita Y, Osaki Y, Kanda H, Minowa M, Suzuki K, et al. The association between use of mobile phones after lights out and sleep disturbances among Japanese adolescents: a nationwide cross-sectional survey. Sleep 2011; 34:1013-20.^,2727. Jun N, Lee A, Baik I. Associations of caffeinated beverage consumption and screen time with excessive daytime sleepiness in Korean high school students. Clin Nutr Res 2017; 6:55-60.; anxiety, depression, psychopathology, sadness, irritability, and mood swings ¹⁰10. Wu X, Tao S, Zhang Y, Zhang S, Tao F. Low physical activity and high screen time can increase the risks of mental health problems and poor sleep quality among Chinese college students. PLoS One 2015; 10:e0119607.^,3030. Royant-Parola S, Londe V, Tréhout S, Hartley S. Nouveaux médias sociaux, nouveaux comportements de sommeil chez les adolescents. Encephale 2018; 44:321-8.; and bruxism ²³23. Silva AO, Oliveira LMFT, Tassitano RM. Screen time, perception of sleep quality and episodes of parasomnia in adolescents. Rev Bras Med Esporte 2017; 23:375-9..

We also point out that the use of cell phones can cause musculoskeletal pain in adolescents’ thoracolumbar region and back, caused by incorrect posture, inadequate furniture or prolonged use of screens while sitting ³3. Mak YW, Wu CST, Hui DWS, Lam SP, Tse HY, Yu WY, et al. Association between screen viewing duration and sleep duration, sleep quality, and excessive daytime sleepiness among adolescents in Hong Kong. Int J Environ Res Public Health 2014; 11:11201-19.^,3535. Queiroz LB, Lourenço B, Silva LEV, Lourenço DMR, Silva CA. Musculoskeletal pain and musculoskeletal syndromes in adolescents related to electronic devices. J Pediatr (Rio J.) 2012; 94:673-9.. Adolescents may experience neck pain due to overload by head tilt during device use ³⁵35. Queiroz LB, Lourenço B, Silva LEV, Lourenço DMR, Silva CA. Musculoskeletal pain and musculoskeletal syndromes in adolescents related to electronic devices. J Pediatr (Rio J.) 2012; 94:673-9..

Poor sleep, associated with the excessive use of digital screens, has been closely related to adverse effects on the cognitive processes of the prefrontal cortex, which can negatively influence operational memory and the executive function of the brain ³³33. Adelantado-Renau M, Diez-Fernandez A, Beltran-Valls MR, Soriano-Maldonado A, Moliner-Urdiales D. The effect of sleep quality on academic performance is mediated by Internet use time: DADOS study. J Pediatr (Rio J.) 2019; 95:410-8.. Moreover, poor sleep reduces daytime alertness, the ability to learn new information in school, and hinder sports, driving, and working which, in turn, can affect attention and lead to adolescents’ lower performance on social activities ⁸8. Hawi NS, Samaha M, Griffiths MD. Internet gaming disorder in Lebanon: relationships with age, sleep habits, and academic achievement. J Behav Addict 2017; 7:70-8.^,2424. McManus B, Underhill A, Mrug S, Anthony T, Stavrinos D. Gender moderates the relationship between media use and sleep quality. J Sleep Res 2021; 30:e13243.^,2828. Husarova D, Blinka L, Geckova AM, Sirucek J, van Dijk JP, Reijneveld SA. Do sleeping habits mediate the association between time spent on digital devices and school problems in adolescence? Eur J Public Health 2018; 28:463-8.^,3333. Adelantado-Renau M, Diez-Fernandez A, Beltran-Valls MR, Soriano-Maldonado A, Moliner-Urdiales D. The effect of sleep quality on academic performance is mediated by Internet use time: DADOS study. J Pediatr (Rio J.) 2019; 95:410-8..

Due to the evolution of technology and the replacement of textbooks by media devices in schools, the access and use of digital screens increased, especially due to the COVID-19 pandemic. We are unable to ignore the impacts of the COVID-19 pandemic, which emerged in China in late 2019 and spread rapidly around the world ³⁶36. World Health Organization. Coronavirus disease 2019 (COVID-19). Situation report - 51. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200311-sitrep-51-covid-19.pdf?sfvrsn=1ba62e57_10 (accessed on 30/Dec/2021).
https://www.who.int/docs/default-source/... .

Changes in the pattern of daily activity (as due to the COVID-19 pandemic), have further increased time spent with digital screens. This new condition caused several changes in lifestyle, physical and mental health, and relationships ³⁷37. Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig 2020; 17:175-6.. Measures of social isolation, school closing, linked to stress and anxiety made adolescents more vulnerable to excessive exposure to screens ³⁸38. Nagata JM, Abdel Magid HS, Gabriel KP. Screen time for children and adolescents during the COVID-19 pandemic. Obesity (Silver Spring) 2020; 28:1582-3.. A Polish study found that the percentage of children and adolescents who spend more than six hours a day watching TV and using the Internet increased from 1.3% to 5.1%, influencing the quality of how they spend their hours ³⁹39. Luszczki E, Bartosiewicz A, Pezdan-Sliz I, Kuchciak M, Jagielski P, Oleksy L, et al. Children's eating habits, physical activity, sleep, and media usage before and during COVID-19 pandemic in Poland. Nutrients 2021; 13:2447..

Another study conducted with immunosuppressed and healthy adolescents aged 10-18 years confirmed the increased use of meshes by both groups during the pandemic ⁴⁰40. Helito AC, Lindoso L, Sieczkowska SM, Astley C, Queiroz LB, Rose N, et al. Poor sleep quality and health-related quality of life impact in adolescents with and without chronic immunosuppressive conditions during COVID-19 quarantine. Clinics (São Paulo) 2021; 76:e3501., corroborating the findings of Zhou et al. ⁴¹41. Zhou SJ, Wang LL, Yang R, Yang XJ, Zhang LG, Guo ZC, et al. Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic. Sleep Med 2020; 74:39-47., who studied healthy adolescents and young adults aged 12-29 years old, who showed increased cell phone screen use and worse sleep quality, prolonged sleep latency, and shorter sleep duration.

We should emphasize that adolescents have a greater need for sleep than adults ²⁵25. Hisler G, Twenge JM, Krizan Z. Associations between screen time and short sleep duration among adolescents varies by media type: evidence from a cohort study. Sleep Med 2019; 66:92-102., in addition to the occurrence of a natural delay in the time of sleep onset. Before the pandemic, adolescents followed a usual routine, with face-to-face classes and set times, which reduced the use of screens during school activities. After the pandemic, adolescents were able to make the schedule of their classes more flexible and adapt it to their sleep preferences. Online classes starting later, social distancing, changes in the class system (use of screens), and the pressure of confinement motivated a shift in sleep habits and quality ⁴²42. Genta FD, Lorenzi Filho G, Genta PR, Rodrigues Neto GB, Sunfeld JPV, Porto JF, et al. COVID-19 pandemic impact on sleep habits, chronotype, and health-related quality of life among high school students: a longitudinal study. J Clin Sleep Med 2021; 17:1371-7..

We found that the excessive use of digital screens has negatively affected these adolescents’ lives. The increased use of these devices at bedtime negatively affects the relation between sleep and rest, stimulating physiological processes such as the suppression of melatonin release, a sleep-inducing hormone, and providing psychological changes, such as high levels of anxiety and depression ¹²12. Cabré-Riera A, Torrent M, Donaire-Gonzalez D, Vrijheid M, Cardis E, Guxens M. Telecommunication devices use, screen time and sleep in adolescents. Environ Res 2019; 10:341-7.. Shorted sleep affects school and family routines. Thus, establishing a sleep regimen in adolescents’ routines is essential to improve their quality of sleep and, consequently, their lives.

Limitations

The limitations of this study relate to most included studies showing cross-sectional designs, which precludes the assessment of cause-and-effect relations. Moreover, we observed some methodological limitations, such as undescribed sample losses and team calibration. Furthermore, the lack of standardization in the data collection methods of the chosen studies, such as sleep duration and screen use, hindered our comparisons.

Conclusion

This systematic review could verify that the use of digital screens influences sleep quality and can generate consequences which affect adolescents’ quality of life. The analyzed studies showed that adolescents’ show insufficient sleep duration (less than eight hours per day) and that the main digital screens used before sleeping are cell phones, televisions, computers, and video games. Excessive use of digital screens can bring some consequences, such as daytime sleepiness, night awakenings, difficulty waking, poor school performance, irritability, anxiety, depression, feelings of sadness, and sleep deprivation.

Acknowledgments

This article was conducted with the support of the Brazilian Graduate Studies Coordinating Board (CAPES).

References

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