Association of Screen Time with Sleep Duration in School-Aged Children; a Nationwide Propensity Score‑Matched Analysis: The CASPIAN‑V Study

Shahrzad Mortazavi, Mohammadesmaeil Motlagh, Mostafa Qorbani, Nafiseh Mozafarian, Ramin Heshmat, Roya Kelishadi


Background: This study aims to determine the association of sleep duration with screen time in children and adolescents.

Study design: A matched case-control study.

Methods:  This nationwide study was conducted in 2015 among 14,274 students aged 7-18 years, and one of their parents who lived in 30 provinces in Iran. Data collection was performed using questionnaires and physical examination. Watching television and working with computer were categorized into two groups (<2 h/day and ≥2 h). Moreover short sleep duration was defined as sleep duration ≤ 8 h/day. The analysis was conducted based on the propensity score using a matched case–control study design. Data analysis was performed by a conditional logistic regression.

Results: Overall, 14,274 students and one of their parents completed the survey (participation rate: 99%). Mean (standard deviation) age of students was 12.3 (3.2) years, and the frequency of short sleep was (4672) 33.5% .In total, 54.3% of students watched TV ≥2 h/day and  9% of those used a computer ≥2 h/day in their leisure time. In the multivariate model, Individuals who watched TV ≥2 h/day had significantly higher odds of short sleep (OR 1.13, 95% CI 1.03, 1.24), and individuals who worked with computer ≥2 h/day had significantly higher odds of short sleep (OR 1.65, 95% CI 1.40, 1.94).

Conclusion: This study revealed significant association between watching TV and using computer during leisure time with insufficient sleep. Public awareness should be provided regarding the adverse effects of screen use on sleep. Developing special guide lines and educational school programs on restricting screen time and increasing physical activities should be considered as a health priority for children and adolescents.


Children; Adolescents; Propensity score; Screen time; Sleep duration

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