JPediatr(RioJ).2017;93(6):545---547
www.jped.com.br
EDITORIAL
Sleep
and
electronic
media
exposure
in
adolescents:
the
rule
of
diminishing
returns
夽
,
夽夽
Sono
e
exposic
¸ão
à
mídia
eletrônica
em
adolescentes:
a
lei
dos
rendimentos
decrescentes
David
Gozal
UniversityofChicago,BiologicalSciencesDivision,PritzkerSchoolofMedicine,DepartmentofPediatrics,Chicago,UnitedStates
Electronic media has nowpervasively invaded our house-holdsandonegroup ofindividualsthathasclearlybeen a majorandearlyadopterofsuchdisruptivetechnologyisthe adolescentagegroup.Theissueofscreenandmedia expo-sureasapotentially adverseriskfactor tohealthhasnow beenenunciatedforquitesometime,1andyetdespitesuch
ominouscorrelates,thereisstillongoingdebateastothe potentialconsequences of electronicmediatoadolescent well-being.Childreningeneral,andmorespecifically ado-lescents,spendmoretimeconnectedtomediathantoany other dailyactivity.Ithas beenestimated thatthe media exposurerevolvesaroundsevenhoursperday.2,3Oneofthe
majorissueswithsuchmediaabundanceisthefactthateven 12yearsago,mostofthedevicesalreadyresidedinthe bed-rooms oftheadolescents:two-thirds hadatelevision set, one-halfhadaVCR,DVDplayerorvideo-gameconsole,and >30%hadInternetaccessor acomputerin theirbedroom. Itisthereforenotsurprisingthatsuchplethoraofbedroom devicesand enhanced connectivityare likelytoinfluence adolescentbehaviorsinmanypossibleandpotentially diver-gentdirections.
Increased media access will affect youth not only by reducing or compromising the time they would need to
DOIoforiginalarticle:
http://dx.doi.org/10.1016/j.jped.2016.12.004
夽 Pleasecitethisarticleas:GozalD.Sleepandelectronicmedia
exposureinadolescents:theruleofdiminishingreturns.JPediatr (RioJ).2017;93:545---7.
夽夽SeepaperbyAmraetal.inpages560---7.
E-mail:dgozal@uchicago.edu
spend doing their school homework or sleeping, but also bypotentiallyaffecting theirbeliefsandbehaviors. Social learning theory postulates that learning is predicated on observation and imitation of behaviors by peers, or even by relatingto fictivesituations such as moviesor games. Inthis context, super peer theory hasclearly shown that themediamayoperateaspowerfulbestfriends,withthe caveat that risky behaviors may be misinterpreted and adopted as if they were de facto normative and socially acceptable.4 Before generalizing the effects of media as
untowardto adolescents,we shouldpoint outthat expo-surestomediamayalsohaveimportantbeneficialeffects. Indeed,themediacanexertpowerfulpro-socialand educa-tionaleffects,wherebyadolescentscanlearnanti-violence approaches,fosterempathyandtolerancebehaviorstoward peopleofother ethnicities,and alsoenhance therespect for their elders and other authoritative figures in their lives.4,5Furthermore,mediaexposurecanpromotehealthy
behaviors, adherence to treatment in chronic disorders, and promote learning through educational programs and sociallyintegratedweb-basedtrainingopportunities. There-fore,whatconstitutesexcessivemediaexposureortypeof mediaexposurethatwillbedetrimentaltoanygiven adoles-centisreflectedbythedelicatebalancebetweenbeneficial aspectsofmediaweighedagainstthepotentialharmful con-sequencesof suchexposures.Forexample, recentstudies fromChina have shown a small effect of screen time on thepresenceofmentalhealthproblemsinadolescents,but alsoindicatedthatsucheffectissmallandthatnodefinite cut-offscreentimedurationcanbeidentified.6,7
In thisissue of theJournal, Amra etal. examined the association between portable telephone use in the late
http://dx.doi.org/10.1016/j.jped.2017.04.002
546 GozalD
eveninghoursandsleeppatternsaswell asdaytime func-tioning and physical activity.8 The authors indicated that
moreextended useofthephoneafter9pmincreasedthe riskforpoorersleepquality,moreproblemsduringdaytime functioning,andreducedlikelihoodofengaginginphysical activity.Althoughthestudywasexclusivelyrelianton ques-tionnairesanddidnotperformanyobjectivemeasurements, theiroverallfindingsareclearlyalignedwiththoseof previ-ouslypublishedstudies.9Ishouldremarkthatexperimental
sleeprestrictioninadolescentsandyoungadultsislikelyto translateintoreduceddaytimeperformanceintheabsence oftheperceptionofsomnolence,10,11anissuethatwasnot
exploredbyAmraetal.8
Brightlightexposureduringtheearlynightperiod, par-ticularly when enriched with light in the blue spectrum, as is the case of most modern device screens, imposes immediate effects on both physiological and behavioral measures.12,13Incomparisontodarkness,brightlight
expo-sure decreases sleepiness, promotes increased alertness, and also attenuates the melatonin-induced reduction in core body temperature. Such effect will lead to delayed sleeponsetandcurtailed sleep,at least duringweekdays (i.e., school days) with futile attempts to catch-up dur-ing weekends. These irregular sleep patterns have been implicatedincurtailedsleepduration,alongwithmetabolic dysfunction, obesity, and excessive caffeine consumption amongschool-agechildren.14,15Furthermore,daytime
per-formancehasalsobeenimpairedalongwiththeemergence of daytime somnolence (not necessarily recognized and acknowledged by youth),11 which further exacerbatesthe
use of caffeinated beverages.16 Such patterns are
partic-ularly prominent during weekdays duringthe school year, whentheearlierclassstarttimesappeartobeanadditional burden to the cumulative sleep debt that is pervasively present among adolescents.17 As mentioned earlier, the
potentialconsequencesof sleeprestrictionin adolescents havebeenextensivelyexploredinexperimentalsettings.18
Althoughadolescentsshowedtheanticipatedemergenceof sleepinessfollowingsleeprestriction,reducedperformance wasdetected in only a subset of complex neurocognitive functions, including abstract problem solving, verbal flu-ency, and creativity, as well as computational processing speed. However, simpler tasks or routine tasks, such as sustainedauditoryandvisualattentionandshort-term ver-bal memory, remained intact. Notwithstanding, difficulty withmulti-tasking and enhanced susceptibility to depres-sivemoodstatesand increasedriskfor motorvehicleand otheraccidentsmaywellrepresentthechallengestypically encountered in adolescents’daily lives, and performance may be challenged in the context of curtailed sleep.19,20
When these variables are considered together, no easily implementablesolutionscometomind.Thereis nodoubt thateffortstolimitorreducescreentimeexposures, espe-ciallyaroundbedtimehours,shouldberecommendedatthe individuallevel.21Inaddition,theimplementationofschool
start times and schedules aiming to address some of the issuesrevolvingaroundadolescent sleepand itsmodifiers shouldproveastepintherightdirection.22
Insummary,thereisnodoubtthatthemorereductions insleepoccurinthelifeofanyadolescentsinthecontext ofamisguidedefforttoincreasetheirsocialengagements, educationalperformance or any other laudable goal, the
less‘‘bangforthebuck’’theywillreap---theruleof dimin-ishingreturns!Sleephealthawarenessandimplementation areachievable,buttheyarenotonelateeveningportable phonecallaway...
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
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