Screen Time Exposure and Altered Sleep in Young Children With

Epilepsy
Ying-Ying Lin, MSN, RN1, Wang-Tso Lee, PhD, MD2, Hsiao-Ling Yang, PhD, RN3, Wen-Chin Weng, PhD, MD4,
Chien-Chang Lee, PhD, MD5, Suh-Fang Jeng, ScD, PT6, & Shao-Yu Tsai, PhD, RN7,*
1 Graduate in Woman, Child & Mental Health Nursing Program, School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
2 Professor, Department of Pediatric Neurology, National Taiwan University Children’s Hospital, Taipei, Taiwan
3 Assistant Professor,  School of Nursing,  College of Medicine,  National Taiwan University,  Adjunct registered nurse,  National Taiwan University
Hospital, Taipei, Taiwan
4 Assistant Professor, Department of Pediatric Neurology, National Taiwan University Children’s Hospital, Taipei, Taiwan
5 Associate Professor, Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
6 Professor, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
7 Lambda Beta-at-Large, Professor, School of Nursing, College of Medicine, National Taiwan University, Adjunct Supervisor, National Taiwan University
Hospital, Taipei, Taiwan

Key words Abstract

Actigraphy, children, epilepsy, screen time,
sleep Purpose: To examine the association between daily screen time exposure
and both sleep patterns (sleep onset, sleep offset, and nighttime, and daily
Correspondence sleep durations) and sleep disturbances among a clinical sample of children
Dr. Shao-Yu Tsai, School of Nursing, National with epilepsy.
Taiwan University, No 1, Sec 1, Jen-Ai Rd, Design: A cross-sectional actigraphic sleep study.
Taipei, Taiwan 10051.
Methods: A convenience sample of 141 children with epilepsy (1.5–6
E-mail: stsai@ntu.edu.tw
years of age) was recruited from an outpatient pediatric neurology clinic
Accepted March 26, 2020 of a university-affiliated children’s hospital in northern Taiwan. Participat-
ing families completed questionnaires and reported children’s screen time
doi:10.1111/jnu.12558 use, with children wearing an actigraphy monitor for 7 days to assess
sleep patterns. Multivariable linear regression analyses were conducted to
examine the association of screen time exposure with the child’s sleep
patterns and sleep disturbance scores.
Findings: Mean minutes per day of screen time exposure was 89.79 ±
83.94 min, with 62 parents (44.0%) reporting their child having >1 hr
of screen time daily. Mean daily sleep duration was 9.26 ± 1.01 hr, with
106 children (93.0%) sleeping <10 hr in a 24-hr period. In multivariate
regression models, daily screen time exposure of >1 hour was associated
with 23.4-min later sleep onset (b = 0.39, p = .02), 20.4-min later sleep
offset (b = 0.34, p = .04), and more severe sleep disturbances (b = 2.42,
p = .04).
Conclusions: In toddlers and preschool-age children with epilepsy, daily
screen time exposure is greater and sleep duration is shorter than the
recommended amount, with increased screen time exposure associated with
disturbed sleep.
Clinical Relevance: Parents need to be informed about the possible ad-
verse impact of screen time exposure on children’s sleep and health as
well as the importance of limiting screen time exposure to <1 hr per day
for their toddlers and preschool-age children with epilepsy.

Early childhood sleep disturbances are among the most
frequent concerns reported by parents and caregivers.
They are a highly prevalent condition documented by
large-scale cross-cultural studies, affecting 10% to 76%
of children worldwide during the first 6 years of life
(Mindell, Sadeh, Kwon, & Goh, 2013; Mindell, Sadeh,
Wiegand, How, & Goh, 2010). Sleep disturbances are
more common and more severe among children with
epilepsy than among typically developing children or
among children with minor medical problems (Ekinci,

352 Journal of Nursing Scholarship, 2020; 52:4, 352–359.

© 2020 Sigma Theta Tau International