Objective: to determine whether there is an association between the use of media devices (MDs) and a decrease in sleep quantity and quality and an increase in daytime sleepiness.
Design: systematic review (SR) with meta-analysis (MA) following the PRISMA guidelines.
Data sources: the authors searched for experimental and observational studies using 24 MeSH terms across 12 databases (British Education Index, Cumulative Index to Nursing and Allied Health Database, Cochrane Library, Educational Resources Information Center, International Biography of Social Sciences, Ovid MEDLINE [EMBASE, MEDLINE and PsycINFO], PubMed, Science Direct, Scopus and Web of Science). The reviewers searched for grey literature in the OpenGrey Online Database. Bibliographies of included studies were hand searched and authors of included studies were contacted to identify additional works. There were no language restrictions. Articles that studied other electronic devices, such as desktop or laptop computers, were excluded.
Study selection: the search identified 463 studies. After two reviewers independently assessed the methodological quality of the studies following a structured procedure (with disagreements resolved by a third reviewer), 11 cross-sectional studies were selected for the MA (random-effects model).
Data extraction: two reviewers extracted the data independently, and a third one resolved any disagreements. Exposure to MDs was measured using three categories: no access to a MD at bedtime (understood as access to MD < 3 nights a week), access to a MD at bedtime (access to MD > 3 nights/week) and use of MD at bedtime (use of MD around bedtime). Inadequate sleep duration was defined as less than 10 hours in children and less than 9 hours in adolescents. Sleep quality was also assessed (with poor quality defined as difficulty with sleep initiation or maintenance), as was excessive daytime sleepiness (defined as poor daytime functioning as a result of reduced sleep quantity or quality).
Main outcomes: 1) sleep quantity (seven studies): the use of MDs was associated with inadequate sleep quantity (adjusted odds ratio [aOR], 2.52; 95% confidence interval [95 CI], 1.79 to 3.55; I2 = 72%); 2) sleep quality (five studies): access to MDs was associated with poor sleep quality (aOR, 1,46; 95 IC, 1.14 to 1.88; I2 = 76%); daytime sleepiness (two studies): the use or access to MDs at bedtime was associated with increased daytime sleepiness (aOR, 2.27; 95 CI, 1.54 to 3.35; I2 = 24%).
Conclusion: the use or access to MDs at bedtime is associated with a reduced sleep quality and quantity at night and with daytime sleepiness.
Conflict of interest: none disclosed.
Funding sources: grant R01HDO73352 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The funding source did not participate in the study.