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

Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis
Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis
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.
1087-0792
Janssen, Xanne
5315eb26-8a9a-4e78-93d6-f5d31dc8a24c
Martin, Anne
3c4a9207-abe5-478e-8f94-856ee1a38d0f
Hughes, Adrienne
8ac73f0f-b446-46b4-820b-362092f594c4
Hill, Catherine
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Kotronoulas, Grigorios
f6ab3d85-f5f8-4ac5-a3da-2dfde996438c
Hesketh, Kathryn
bf5b0fb7-173e-4f9b-8518-5d36a2a8df59
Janssen, Xanne
5315eb26-8a9a-4e78-93d6-f5d31dc8a24c
Martin, Anne
3c4a9207-abe5-478e-8f94-856ee1a38d0f
Hughes, Adrienne
8ac73f0f-b446-46b4-820b-362092f594c4
Hill, Catherine
867cd0a0-dabc-4152-b4bf-8e9fbc0edf8d
Kotronoulas, Grigorios
f6ab3d85-f5f8-4ac5-a3da-2dfde996438c
Hesketh, Kathryn
bf5b0fb7-173e-4f9b-8518-5d36a2a8df59

Janssen, Xanne, Martin, Anne, Hughes, Adrienne, Hill, Catherine, Kotronoulas, Grigorios and Hesketh, Kathryn (2019) Associations of screen time, sedentary time and physical activity with sleep in under 5s: A systematic review and meta-analysis. Sleep Medicine Reviews. (doi:10.1016/j.smrv.2019.101226).

Record type: Article

Abstract

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.

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Sleep review Manuscript_Janssen - Accepted Manuscript
Restricted to Repository staff only until 1 November 2020.
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Accepted/In Press date: 23 October 2019
e-pub ahead of print date: 1 November 2019

Identifiers

Local EPrints ID: 435451
URI: https://eprints.soton.ac.uk/id/eprint/435451
ISSN: 1087-0792
PURE UUID: 4dc8dfd7-dcb2-4391-8158-57e623745ee5
ORCID for Catherine Hill: ORCID iD orcid.org/0000-0003-2372-5904

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Date deposited: 06 Nov 2019 17:30
Last modified: 07 Nov 2019 01:37

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Contributors

Author: Xanne Janssen
Author: Anne Martin
Author: Adrienne Hughes
Author: Catherine Hill ORCID iD
Author: Grigorios Kotronoulas
Author: Kathryn Hesketh

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