Associations of screen time, sedentary time and physical activity with sleep in under 5s: a systematic review and meta-analysis

Janssen, X., Martin, A. , Hughes, A. R., Hill, C. M., Kotronoulas, G. and Hesketh, K. R. (2020) Associations of screen time, sedentary time and physical activity with sleep in under 5s: a systematic review and meta-analysis. Sleep Medicine Reviews, 49, 101226. (doi: 10.1016/j.smrv.2019.101226) (PMID:31778942) (PMCID:PMC7034412)

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Sleep is crucial to children's health and development. Reduced physical activity and increased screen time adversely impact older children’s sleep, but little is known about these associations in children under 5 years. This systematic review examined the association between screen time/movement behaviors (sedentary behavior, physical activity) and sleep outcomes in infants (0-1 year); toddlers (1-2 years); and preschoolers (3-4 years). Evidence was selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and synthesized using vote counting based on the direction of association. Quality assessment and a Grading of Recommendations, Assessment, Development and Evaluation was performed, stratified according to child age, exposure and outcome measure. Thirty-one papers were included. Results indicate that screen time is associated with poorer sleep outcomes in infants, toddlers and preschoolers. Meta-analysis confirmed these unfavorable associations in infants and toddlers but not preschoolers. For movement behaviors results were mixed, though physical activity and outdoor play in particular were favorably associated with most sleep outcomes in toddlers and preschoolers. Overall, quality of evidence was very low, with strongest evidence for daily/evening screen time use in toddlers and preschoolers. Although high-quality experimental evidence is required, our findings should prompt parents, clinicians and educators to encourage sleep-promoting behaviors (e.g. less evening screen time) in the under 5s.

Item Type:Articles
Additional Information:AM was supported by the UK Medical Research Council (grant number MC_UU_12017/14) and the Scottish Government Chief Scientist Office (grant number SPHSU14). KRH is supported by the Wellcome Trust (107337/Z/15/Z).
Glasgow Author(s) Enlighten ID:Martin, Dr Anne and Kotronoulas, Dr Greg
Authors: Janssen, X., Martin, A., Hughes, A. R., Hill, C. M., Kotronoulas, G., and Hesketh, K. R.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
Journal Name:Sleep Medicine Reviews
ISSN (Online):1532-2955
Published Online:01 November 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Sleep Medicine Reviews 49:101226
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
727661SPHSU Core Renewal: Complexity in Health Improvement Research ProgrammeLaurence MooreMedical Research Council (MRC)MC_UU_12017/14IHW - MRC/CSO SPHU
Chief Scientist Office (CSO)SPHSU14