Elsevier

Sleep Medicine

Volume 45, May 2018, Pages 7-10
Sleep Medicine

Brief Communication
Media consumption and sleep quality in early childhood: results from the Ulm SPATZ Health Study

https://doi.org/10.1016/j.sleep.2017.10.013Get rights and content

Highlights

  • Electronic media consumption had a moderate dose and prevalence within the current setting.

  • 39% of the parents reported that their child never used books (either read outloud or viewed themselves).

  • Electronic media consumption was associated with overall sleep quality at age three years.

  • Contrary to books, electronic media was associated with worsening sleep domains from two to three years of age.

  • Prevention of electronic media consumption seemed to be already necessary in early life.

Abstract

Background

Media use is increasingly becoming common in preschoolers and starting before the age of three years. While several studies have documented the effects of screen time on sleep duration in this age group, investigations including sleep quality are scarce and mainly cross-sectional. Moreover, they are limited by investigating sleep across broader age ranges or in older preschoolers, which may blur early effects and the ideal time for intervention.

Methods

The current study analyzed data from the Ulm SPATZ Health Study, a birth cohort study in which 1006 live newborns were recruited from the general population shortly after delivery at the University Medical Center Ulm, Southern Germany, from April 2012 to May 2013. Longitudinal data on child sleep were parent reported on the Children's Sleep Habits Questionnaire (CSHQ) at ages two and three years. Child media consumption was assessed at three years of age with different questions on electronic media and books. Statistical analyses included Kruskal–Wallis tests and multivariable linear and logistic regression models.

Results

Electronic media consumption had a moderate prevalence and dose, and prevalence of never using books appeared to be high (39%). The preliminary results indicated strong statistically significant inverse cross-sectional associations between electronic media consumption and overall sleep quality and, using longitudinal data, with worsening indicators of bedtime resistance, sleep anxiety, and daytime sleepiness.

Conclusions

This was the first larger-scale study to comprehensively investigate the effects of electronic media consumption and book reading on all CSHQ items in three-year-olds. Considering the risk of chronification, preventive efforts (eg, by effective sleep-oriented training programs) already seem necessary in early life.

Introduction

Systematic reviews have documented the association between electronic media use and poor sleep quality and inadequate sleep quantity in school-age children [1], [2], [3]. Yet, media use is increasingly becoming common in preschoolers, starting before three years of age [4], [5]. While several studies have already documented the effects of screen time on sleep duration in this age group [6], [7], [8], [9], [10], investigations into sleep quality are scarce and mainly cross-sectional [11], [12], [13], [14], [15], [16].

One longitudinal observational study conducted within the framework of a birth cohort study initiated in 1996 was confined to the evaluation of the effects of >2 h of television viewing daily and the ‘sleep problems’ subscale of the Child Behavior Checklist [12]. Another more recent longitudinal study demonstrated the effects of a healthy media-use intervention altering media content on children's sleep problems measured by the Children's Sleep Habits Questionnaire in a randomized controlled trial [17]. All of the remaining previous cross-sectional studies were limited by investigating sleep across broader age ranges or in older preschoolers, which may have blurred the early effects and ideal time for intervention [11], [13], [14], [15], [16].

In a preliminary cross-sectional analysis, the current study investigated the association between media consumption, considering electronic media and books, with overall sleep quality at the age of three years. Moreover, it used longitudinal data by investigating the association between media consumption at three years of age with worsening sleep problems between the ages of 2–3 years.

Section snippets

Methods

The Ulm SPATZ Health Study cohort contained 1006 live newborns of 970 mothers (49% of 1999 eligible families) recruited from the general population shortly after delivery at the University Medical Center Ulm, Southern Germany, from April 2012 to May 2013 [18]. Exclusion criteria were outpatient delivery, maternal age <18 years, transfer of the newborn or mother to intensive care immediately after delivery, or insufficient German language skills. The Ethics Board of Ulm University approved the

Results

Data on CSHQ and media consumption at age three years were available for 530 children. While all but one family had electronic media devices in the household, nine children owned a device such as a mobile phone or tablet PC themselves, and three other children had a TV in their bedroom. Watching TV or DVD was common, with screen time up to 1 h/day for 58.4% and >1 h/day for 13.7% of the children. Computer gaming and other computer or internet use was markedly less frequent and contributed less

Discussion

The current study was the first larger-scale study to comprehensively investigate the effects of electronic media consumption and book reading on all CSHQ items in three-year-olds. Electronic media consumption had a moderate dose and prevalence in the current setting. However, the preliminary results indicated alarming associations with overall sleep quality and worsening indicators of bedtime resistance, sleep anxiety, and daytime sleepiness.

The reported effects may have partly been driven by

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This research received intramural funding of the Medical Faculty of Ulm University.

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