The association of sleep and late-night cell phone use among adolescents☆

Amra, Babak; Shahsavari, Ali; Shayan-Moghadam, Ramin; Mirheli, Omid; Moradi-Khaniabadi, Bita; Bazukar, Mehdi; Yadollahi-Farsani, Ashkan; Kelishadi, Roya

doi:10.1016/j.jped.2016.12.004

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Original articles • J. Pediatr. (Rio J.) 93 (6) • Nov-Dec 2017 • https://doi.org/10.1016/j.jped.2016.12.004 linkcopy

The association of sleep and late-night cell phone use among adolescents^☆

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: This study aims to assess the relationship of late-night cell phone use with sleep duration and quality in a sample of Iranian adolescents.

Methods: The study population consisted of 2400 adolescents, aged 12-18 years, living in Isfahan, Iran. Age, body mass index, sleep duration, cell phone use after 9 p.m., and physical activity were documented. For sleep assessment, the Pittsburgh Sleep Quality Index questionnaire was used.

Results: The participation rate was 90.4% (n = 2257 adolescents). The mean (SD) age of participants was 15.44 (1.55) years; 1270 participants reported to use cell phone after 9 p.m. Overall, 56.1% of girls and 38.9% of boys reported poor quality sleep, respectively. Wake-up time was 8:17 a.m. (2.33), among late-night cell phone users and 8:03 a.m. (2.11) among non-users. Most (52%) late-night cell phone users had poor sleep quality. Sedentary participants had higher sleep latency than their peers. Adjusted binary and multinomial logistic regression models showed that late-night cell users were 1.39 times more likely to have a poor sleep quality than non-users (p-value < 0.001).

Conclusion: Late-night cell phone use by adolescents was associated with poorer sleep quality. Participants who were physically active had better sleep quality and quantity. As part of healthy lifestyle recommendations, avoidance of late-night cell phone use should be encouraged in adolescents.

KEYWORDS Sleep; Cell phone; Adolescents

		Bed time mean ± SD hour (p.m.)	Sleep latency mean ± SD minute	Wake-up time mean ± SD hour (a.m.)	Total sleep^d d Total sleep = (preferred wake-up time + 24) - (preferred bed time). mean ± SD hour
Cell phone use after 9 p.m.	Yes (n = 1270)	8.29 ± 10.21	23.90 ± 20.72	8.17 ± 2.33	7.86 ± 2.09
	No (n = 892)	12.03 ± 10.83	20.23 ± 17.67	7.63 ± 2.11	7.92 ± 2.06
p-Value^a a p-Value by Mann-Whitney's U test.		<0.001^c c Significant at the level of <0.05.	<0.001^c c Significant at the level of <0.05.	<0.001^c c Significant at the level of <0.05.	0.263

Health status	Healthy (n = 1513)	10.10 ± 10.66	21.65 ± 19.07	7.95 ± 2.22	7.94 ± 2.05
	Unhealthy (n = 744)	9.49 ± 10.60	23.78 ± 20.55	7.94 ± 2.32	7.83 ± 2.14
p-Value^a a p-Value by Mann-Whitney's U test.		0.317	0.008^c c Significant at the level of <0.05.	0.607	0.218

Physical activity	Yes (n = 1314)	10.28 ± 10.70	21.38 ± 19.44	8.12 ± 2.33	8.07 ± 2.09
	No (n = 851)	9.27 ± 10.54	23.92 ± 19.69	7.65 ± 2.11	7.60 ± 2.04
p-Value^a a p-Value by Mann-Whitney's U test.		0.003^c c Significant at the level of <0.05.	<0.001^c c Significant at the level of <0.05.	<0.001^c c Significant at the level of <0.05.	<0.001^c c Significant at the level of <0.05.

BMI (kg/m²)	Underweight (n = 658)	10.76 ± 10.73	21.58 ± 18.84	8.00 ± 2.29	8.04 ± 2.13
	Normal (n = 1346)	9.73 ± 10.62	22.87 ± 20.27	7.95 ± 2.23	7.90 ± 2.07
	Overweight (n = 241)	8.50 ± 10.38	21.60 ± 17.59	7.80 ± 2.26	7.57 ± 2.00
p-Value^b b p-Value by Kruskal Wallis test.		0.039^c c Significant at the level of <0.05.	0.432	0.679	0.023^c c Significant at the level of <0.05.

		Good sleep quality^a a Good sleep quality: PSQI score <5.0. (n = 1169)	Poor sleep quality^c c Poor sleep quality: PSQI score ≥5.0. (n = 1086)	p-Value
Gender	Female (n = 1191)	523 (43.9)^b b n (%).	668 (56.1)	<0.001^d d p-Value by Cramer's V test. ,^e e Significant at level of <0.05.
	Male (n = 1041)	636 (61.1)	405 (38.9)

Cell phone use after 9 p.m.	Yes (n = 1270)	610 (48.0)	660 (52.0)	<0.001^d d p-Value by Cramer's V test. ,^e e Significant at level of <0.05.
	No (n = 892)	513 (57.5)	379 (42.5)


Health status	Healthy (n = 1513)	852 (56.3)	661 (43.7)	<0.001^d d p-Value by Cramer's V test. ,^e e Significant at level of <0.05.
	Unhealthy (n = 744)	318 (42.7)	426 (57.3)

Physical activity	Yes (n = 1314)	733 (55.8)	581 (44.2)	<0.001^d d p-Value by Cramer's V test. ,^e e Significant at level of <0.05.
	No (n = 851)	390 (45.8)	461 (54.2)

Age (year)	12 (n = 74)	45 (60.8)	29 (39.2)	<0.001^e e Significant at level of <0.05. ,^f f p-Value by Gamma test.
	13 (n = 185)	115 (62.2)	70 (37.8)
	14 (n = 384)	220 (57.3)	164 (42.7)
	15 (n = 370)	199 (53.8)	171 (46.2)
	16 (n = 506)	253 (50.0)	253 (50.0)
	17 (n = 472)	218 (46.2)	254 (53.8)
	18 (n = 155)	59 (38.1)	96 (61.9)

BMI (kg/m²)	Underweight (n = 658)	346 (52.6)	312 (47.4)	0.380^f f p-Value by Gamma test.
	Normal weight (n = 1346)	703 (52.2)	643 (47.8)
	Overweight (n = 241)	116 (48.1)	125 (51.9)

Duration of cell phone use (h ± SD)	4.58 ± 5.37	5.58 ± 6.07	<0.001^e e Significant at level of <0.05. ,^g g p-Value by Mann-Whitney's U test on sleep quality categories (good vs. poor).
Sleep latency (min ± SD)	16.71 ± 13.72	28.42 ± 22.88	<0.001^e e Significant at level of <0.05. ,^g g p-Value by Mann-Whitney's U test on sleep quality categories (good vs. poor).
Length of actual sleeping (h ± SD)	8.15 ± 1.80	7.64 ± 7.64	<0.001^e e Significant at level of <0.05. ,^g g p-Value by Mann-Whitney's U test on sleep quality categories (good vs. poor).
Bed time (p.m. ± SD hours)	10.75 ± 10.77	8.99 ± 10.43	0.003^e e Significant at level of <0.05. ,^g g p-Value by Mann-Whitney's U test on sleep quality categories (good vs. poor).
Wake-up time (a.m. ± SD hours)	8.08 ± 2.17	7.80 ± 2.32	<0.001^e e Significant at level of <0.05. ,^g g p-Value by Mann-Whitney's U test on sleep quality categories (good vs. poor).

Dependent variable		Model 1			Model 2^e e Model 2 was adjusted for potential confounders (gender, age, GPA, health status and physical activity).
		n	OR (95% CI)	p-Value	n	OR (95% CI)	p-Value
Global PSQI^a a Global Pittsburgh Sleep Quality Index (good sleep quality: PSQI score <5.0 and poor sleep quality: PSQI score ≥5.0). ,^b b Using binary logistic regression analysis.	Classification	2031	1.44 (1.21, 1.73)	<0.001^d d Significant at level of 5%.	2031	1.39 (1.15, 1.67)	0.001^d d Significant at level of 5%.
PSQI subscale

Subjective sleep quality^c c Using multinomial logistic regression analysis.	Very good	1454	1.23 (0.77, 1.98)	0.386	1365	1.22 (0.74, 2.00)	0.445
	Fairy good	439	1.04 (0.63, 1.71)	0.885	410	1.09 (0.64, 1.84)	0.758
	Fairly bad	134	1.18 (0.66, 2.09)	0.579	126	1.04 (0.56, 1.93)	0.981
	Very bad	78	Reference	-	77	Reference	-

Sleep latency^c c Using multinomial logistic regression analysis.	No problem at all	588	2.35 (1.62, 3.41)	<0.001^d d Significant at level of 5%.	546	2.11 (1.42, 3.15)	<0.001^d d Significant at level of 5%.
	Only a very slight problem	861	1.69 (1.18, 2.43)	0.004^d d Significant at level of 5%.	816	1.59 (1.08, 2.34)	0.018^d d Significant at level of 5%.
	Somewhat of a problem	546	1.54 (1.06, 2.24)	0.025^d d Significant at level of 5%.	513	1.42 (0.95, 2.13)	0.086
	A very big problem	167	Reference	-	156	Reference	-

Sleep duration^c c Using multinomial logistic regression analysis.	No problem at all	1371	1.27 (0.91, 1.77)	0.159	1287	1.25 (0.87, 1.79)	0.236
	Only a very slight problem	384	1.08 (0.74, 1.57)	0.700	368	1.15 (0.77, 1.72)	0.654
	Somewhat of a problem	242	0.90 (0.60, 1.36)	0.613	222	0.93 (0.60, 1.46)	0.758
	A very big problem	165	Reference	-	154	Reference	-

Habitual sleep efficiency^c c Using multinomial logistic regression analysis.	No problem at all	1523	1.39 (1.01, 1.91)	0.044^d d Significant at level of 5%.	1430	1.44 (1.02, 2.05)	0.039^d d Significant at level of 5%.
	Only a very slight problem	273	1.32 (0.90, 1.95)	0.155	255	1.47 (0.97, 2.24)	0.071
	Somewhat of a problem	126	1.12 (0.70, 1.79)	0.650	120	1.15 (0.69, 1.91)	0.585
	A very big problem	184	Reference	-	172	Reference	-

Sleep disturbances^c c Using multinomial logistic regression analysis.	No problem at all	145	1.69 (0.42, 6.82)	0.458	138	1.51 (0.36, 6.35)	0.575
	Only a very slight problem	1643	1.69 (0.44, 6.65)	0.449	1540	1.48 (0.37, 6.00)	0.580
	Somewhat of a problem	334	1.34 (0.34, 5.29)	0.673	315	1.13 (0.27, 4.61)	0.870
	A very big problem	10	Reference	-	10	Reference	-

Use of sleeping medication^c c Using multinomial logistic regression analysis.	No problem at all	1903	1.06 (0.57, 1.97)	0.848	1787	1.23 (0.61, 2.48)	0.566
	Only a very slight problem	108	1.05 (0.51, 2.16)	0.892	103	1.26 (0.56, 2.81)	0.576
	Somewhat of a problem	51	0.91 (0.39, 2.09)	0.821	49	0.92 (0.36, 2.34)	0.850
	A very big problem	43	Reference	-	39	Reference	-

Daytime dysfunction^c c Using multinomial logistic regression analysis.	No problem at all	635	2.15 (1.46, 3.19)	<0.001^d d Significant at level of 5%.	597	2.19 (1.42, 3.39)	<0.001^d d Significant at level of 5%.
	Only a very slight problem	929	1.37 (0.94, 2.01)	0.104	876	1.56 (1.02, 2.37)	0.039^d d Significant at level of 5%.
	Somewhat of a problem	416	1.16 (0.77, 1.74)	0.491	390	1.22 (0.78, 1.91)	0.384
	A very big problem	139	Reference	-	129	Reference	-

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[TFN17] BMI, body mass index.

[TFN1] ^a
p-Value by Mann-Whitney's U test.

[TFN2] ^b
p-Value by Kruskal Wallis test.

[TFN3] ^c
Significant at the level of <0.05.

[TFN4] ^d
Total sleep = (preferred wake-up time + 24) - (preferred bed time).