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Screen time and sleep problems in South Indian preschoolers: a community-based cross-sectional study
Akila Govindarajan Venguidesvarane1, Samya Varadarajan2, Muthukumar Rajamohan1
1Department of Community Medicine, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Insights
Nearly two in five South Indian preschool children experience sleep problems, strongly linked to excessive screen time, especially in bed. A threshold of 2.4 hours of daily screen time predicts these issues, guiding interventions.
Area of Science:
- Pediatric Sleep Medicine
- Public Health Research
- Child Development
Background:
- Sleep problems are prevalent in preschool-aged children, impacting their development and well-being.
- Screen time has emerged as a potential environmental factor influencing childhood sleep patterns.
Purpose of the Study:
- To determine the prevalence of sleep problems in South Indian children aged 2-5 years.
- To investigate the association between screen time and sleep problems.
- To identify a predictive threshold for screen time related to sleep disturbances.
Main Methods:
- A population-based cross-sectional study involving 523 children aged 2-5 years in South India.
- Sleep problems assessed using a validated screening tool (bedtime problems, daytime sleepiness, night awakenings, sleep regularity, snoring).
- Receiver operating characteristic (ROC) analysis used to determine the optimal screen time threshold.
Main Results:
- 39.6% of children experienced sleep disturbances, with irregular sleep, bedtime resistance, and night awakenings being most common.
- Excessive screen time (≥2.4 hours/day) was identified as a significant predictor (ROC analysis: AUC=0.800).
- Other associated factors included screen use in bed, smaller family size, reduced physical activity, shorter birth spacing, lower socioeconomic status, and maternal screen time.
Conclusions:
- Sleep problems affect a substantial proportion of preschool children in South India, with excessive screen time being a primary contributor.
- This study establishes an ROC-derived screen time threshold, offering a valuable tool for identifying at-risk children.
- Findings support targeted parental education and preventive strategies to promote healthy sleep habits in young children.
Objectives:
To estimate the prevalence of sleep problems among children aged 2-5 years residing in South India, assess its association with screen time and identify a predictive screen time threshold.
Design:
Population-based cross-sectional study.
Setting:
Field practice areas in rural and urban centres of a medical college in South India.
Participants:
In total, 523 children aged 2-5 years were selected by simple random sampling.
Primary Outcome Measures:
Sleep problems were assessed using the validated bedtime problems, excessive daytime sleepiness, awakenings during the night, regularity of sleep and snoring sleep screening tool. Sociodemographic and behavioural factors, including screen time, were also examined. The optimal predictive screen time cut-off was identified using receiver operating characteristic (ROC) analysis.
Results:
Sleep disturbances were reported in 39.6% of children (95% CI 35.5% to 43.8%). The most common sleep problems were irregular sleep (22.2%), bedtime resistance (20.8%) and night awakening (19.9%). Multivariate logistic regression showed strong associations between sleep problems and screen use in bed (adjusted OR (AOR) = 3.8; 95% CI 2.4 to 6.1), excess screen time (AOR=3.3; 95% CI 1.8 to 6), smaller family size (AOR=3.1; 95% CI 1.5 to 6.1), reduced physical activity (AOR=2.6; 95% CI 1.6 to 4.2), shorter birth spacing (AOR=1.8; 95% CI 1.1 to 2.8), lower socioeconomic status (AOR=1.8; 95% CI 1.2 to 2.8) and maternal screen time>2 hours/day (AOR=1.6; 95% CI 1.04 to 2.6). ROC analysis identified ≥2.4 hours per day of screen time as the optimal threshold for predicting sleep problems (area under the curve=0.800; sensitivity, 73.9% and specificity, 77.2%).
Conclusion:
In this large population-based study, two of the five preschool children experienced sleep problems, with excess screen time, particularly screen use in bed, being the key contributing factor. This is one of the few Indian studies to establish an ROC-derived screen time threshold for identifying sleep problems. These findings can guide targeted parental advice and early preventive strategies to promote healthy sleep in preschool children.
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