Correlation Between Smartphone Addiction, Sleep Problems and Body Mass Index in School Age Children

Because they make communication and entertainment easier, smartphones have improved society and are now an essential part of daily life (Khan and Khan, 2022). As smartphone usage rises, children are more likely to be exposed in their early years (Yadav and Chakraborty, 2022). For the younger generation in their adolescence and teenage years, cellphones offer a way to engage, converse, connect with peers, and have fun. Academic achievement, emotional development, personal safety, and relationships with parents and other children are all adversely affected by excessive smartphone use (Mi et al., 2023).

Smartphones impact children's activities, and they become too attached to their smartphones, which might lead to addiction and negatively affect interpersonal relationships as well as both physical and mental well-being (Numanoğlu-Akbaş et al., 2020 and Radesky et al., 2020). Smartphone overuse results in decreased sleep quality, such as short nights' sleep and disturbed sleep patterns, as well as greater degrees of worry and despair in children (Elhai et al., 2021).

According to Numanoğlu-Akbaş et al. (2020), sleep is crucial for the developmental health of a child and normal growth since it allows the body to store energy, foster physical growth, and encourage development. Sleep is essential for brain function, metabolism, hunger control, immunological, hormonal, and cardiovascular system regulation. Also, sleep is necessary for recovery, good mental health, maintaining mood, controlling emotions, learning, and memory (Radesky et al., 2020).

Persistent sleep issues are complicated and can have negative consequences on one's general health (Elhai et al., 2021). Sleep length and quality are influenced by a number of factors, one of these factors might be the rapidly growing usage of technology, such as smartphone addiction (Punamäki et al., 2007).

Obesity is one of the biggest health issues in the world, much like excessive smartphone use, which is a clear social concern. Numerous bodily systems are impacted, and children may experience difficulties as a result. Globally, the frequency of childhood and teenage obesity has skyrocketed, rising from 5.6 to 17% among children aged 6 to 11 (Lister et al., 2023).

Obesity and children's lack of activity are the main problems in today's culture, as children's sedentary behavior has rapidly increased (Auhuber et al., 2019). According to Sanyaolu et al. (2019) and Rathnayake et al. (2014), for kids and teenagers, obesity is a public health issue because of the correlation between childhood obesity and the elevated likelihood of obesity in adulthood. Obesity causes physical, mental, and emotional health issues and lowers children's, teens', and adults' quality of life.

Obesity during infancy, youth, and adolescence can have detrimental effects on nearly all bodily systems. Polycystic ovarian syndrome, high blood pressure, diabetes, insulin resistance, dyslipidemia, liver dysfunction, renal failure, dental decay, orthopedic and mobility problems, and respiratory conditions such sleep breathing disorder and obstructive sleep apnea are among the complications for which obesity is a significant risk factor (Anderson and Chew, 2022). This study looked at the relationship between smartphone addiction, school-age children's obesity, and sleep issues.

This study was carried out as a cross-sectional observational study. One hundred and sixty children from both sexes, were recruited from elementary schools in North Giza, with between the ages of 8 and 10 years old.

Participants children were included in the study according to the following criteria; ages between 8 and 10 years old, children whose scores on Smartphone addiction scale -short version (SAS-SV) were ≥ 31for boys and ≥ 33 for girls, over weight and obese children with body mass index (BMI) percentiles ≥ 85th percentile and ≥ 95th percentile respectively, children whose scores on the Arabic version of the Children's Sleep Habits Questionnaire (CSHQ) were 41 or higher. Children were excluded if they were suffered from any disease that cause spontaneous weight gain, Children who received medications known to affect nutritional status and who have musculoskeletal or neuromuscular disorders.

Outcome measures:

Smartphone addiction was measured by SAS-SV, which is a validated scale intended to assess children's and teenagers' smartphone addiction levels (Kwon et al., 2013). It possesses internal consistency, content and concurrent validity. Ten questions about everyday activities (such as interruption, positive anticipation, departure, worldwide web-oriented relationship, overuse, and patience) made up the scale. A dimensional scale ranging from 1 to 6 was used to score each question: 6 = highly agree, 5 = agree, 4 = slightly agree, 3 = slightly disagree, 2 = disagree, and 1 = completely disagree. As a result, the total scores ranged from 10 to 60. According to De Pasquale et al. (2017), the highest values imply a high level of smartphone addiction.

The Arabic version of the CSHQ was used to measure sleep issues. One parent of each child, or an educated family member in situations where both parents were illiterate, answered the retrospective, parent-reported questionnaire. The following sleep domains-Bedtime Resistance, Sleep-Onset Delay, Sleep Duration, Sleep Anxiety, Night Wakings, Parasomnias, Sleep-Disordered Breathing, and Daytime Sleepiness-were represented by the 33 items that were divided into eight subscales (Owens et al., 2000). Additionally, the Arabic translation of CSHQ was created by De Pasquale et al. (2017). The translation has been somewhat altered to make it more suitable for use in Egyptian culture. In addition to providing demographic information, each parent was asked to rate the frequency of each item on a three-point scale ranging from "usually" (five to seven times per week) and "sometimes" (two to four times per week) to "rarely" (zero or one time per week). They were also asked to recall the child's sleep behaviors during the previous week or during a recent, more typical week if the previous week was not representative for some reason. The investigator conducted a face-to-face interview with the parent who completed the questionnaire to review their responses. Each item is scored from 1 to 3 (usually = 3, sometimes = 2, and rarely = 1). The scoring of some items (1, 2, 7, 9, 10, and 26) is reversed (usually = 1 and rarely = 3) to consistently make a higher score indicative of more disturbed sleep. The total score is computed as the sum of all the items answered on the eight subscales. The total score of 41 or higher suggests the presence of a sleep disturbance. Higher scores indicate greater overall sleep disturbance.

Standard procedures for calculating height and weight were used to calculate BMI. Using a portable stadiometer (SECA, Hamburg, Germany), children's heights were measured without shoes to the nearest 0.2 cm. Children were standing with their arms at their sides, their shoulders relaxed, their heels together, and their eyes forward. The weight was measured to the nearest 0.1 kg using an electronic scale that has been calibrated (Tanita, Tokyo, Japan). BMI (kg/m2) was computed and converted to z-scores using the CDC's suggested approach (Kuczmarski et al. 2002). BMI z-scores enable for comparisons by accounting for variations in age and gender. This study included overweight and obese children whose BMI percentiles were at least 85th and 95th, respectively.