Source: Stine F, Collier DN, Fang X, et al. Impact of body mass index, socioeconomic status, and bedtime technology use on sleep duration in adolescents [published online ahead of print September 25, 2021). Clin Pediatr (Phila). doi:10.1177/00099228211047791Investigators from East Carolina University, Greenville, NC, conducted a cross-sectional study to evaluate the association of use of technology prior to going to bed and insufficient sleep. Study participants were children enrolled in the seventh grade in the fall of 2017 at 1 of 47 schools in 10 counties in North Carolina who were participating a school-based wellness program. Data were analyzed on those children in the program who had height and weight measured for BMI determination and who completed a questionnaire on sleep and technology use. Participant sex and race data also were collected. Socioeconomic status was approximated for each participant by school-level participation in the National School Lunch Program (NSLP), with higher percentages of participation indicative of lower SES. The primary study outcome was insufficient sleep, defined as a self-report of sleeping <8 hours/night. The main exposure of interest was high technology use (TU), which was based on a student reporting use of a form of technology within 1 hour of trying to go to sleep either “a few nights each week,” or “every night or almost every night.” The bivariate association between insufficient sleep and self-report of having a TV in the bedroom, being overweight (BMI ≥85th and <95th percentile for age) or obese (BMI >95th percentile for age), sex, race, and SES also were evaluated using chi-square tests. Logistic regression was used to determine the independent association of these variables and insufficient sleep.Data were analyzed on 3,956 seventh graders, of whom 38.7% reported getting insufficient sleep (<8 hours/night), 83.1% reported high TU, and 72.9% reported having a TV in their bedroom. There were no significant differences in reporting insufficient sleep by sex (P = 0.116), or race (P = 0.160), and these characteristics were not included in the multivariate model. In the multivariate logistic model, high TU was an independent predictor of insufficient sleep (OR, 0.53; 95% CI, 0.46, 0.61), indicating that the risk of sleep <8 hours/night was almost twice as high in those with high TU. Having a TV in the bedroom (OR, 0.82; 95% CI, 0.70, 0.95) and being obese (OR, 0.82; 95% CI, 0.70, 0.95) also were significantly associated with sleeping <8 hours/night. There was no significant association between being overweight and insufficient sleep (OR, 0.85; 95% CI, 0.71, 1.01), but children in schools with higher participation in the NSLP were at significantly increased risk for reporting <8 hour/night of sleep.The authors conclude that seventh graders reporting high bedtime TU were at increased risk for insufficient sleep.Dr Candee has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.Adolescent sleep deprivation is a growing health problem with profound consequences, including depressed mood, cognitive impairment, behavioral dysregulation, and poor school performance.1 This problem is in large part related to the availability and use of electronic devices at bedtime.2The investigators of the current study found that more than a third of nearly 4,000 seventh graders in rural North Carolina were not getting sufficient sleep. Those with high TU within 1 hour of trying to go to sleep were nearly twice as likely (as those with lower TU) to be getting <8 hours of sleep per night. Having a TV in the bedroom, obesity, and lower SES also were associated with a higher likelihood of sleep insufficiency. The study results fortify those of previous studies showing that portable devices have more deleterious effects on sleep than those that are not (eg, a TV).3The investigators’ findings are strengthened by the large sample size. Potential weaknesses include the use of the national school lunch program as a surrogate for the SES level of the entire school (rather than tracking by individual participants), the use of self-reported health data, and the use of a single question to capture sleep duration despite adolescent propensity for weekend catch-up sleep. The results of another recently published study showed that greater electronic device use at bedtime was not only associated with delayed sleep onset and decreased sleep duration but also with overall sleep disturbance symptom severity.4If seventh graders in rural North Carolina aren’t getting enough sleep, it stands to argue that older adolescents attending high school in more urban settings with increased access to phones/technology are likely not getting enough sleep either. More counseling on the importance of sleep hygiene and the impact of electronic device use upon sleep is needed in order to help adolescents and their families prioritize and protect sleep duration.High bedtime technology use in adolescents is a significant risk factor for insufficient sleep and is a modifiable behavior.
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