Sleep, screen time, sedentary lifestyle impact HRQoL in youth

Longer screen times, shorter sleep, and less exercise all seem to worsen health-related quality of life (HRQoL) among kids and teens, according to a recent Hong Kong study.

“Time allocation in children and adolescents is highly associated with their HRQoL,” the researchers said. “Advice and guidance on screen time allocation in children and adolescents should be provided at the levels of school, community, and family.”

The large-scale, cross-sectional, population-based study surveyed children and adolescents in Hong Kong aged 6–17 years. HRQoL was measured using the Paediatric Quality of Life Inventory (PedsQL) and the child-friendly, five-level version of EuroQol’s EQ-5D, the EQ-5D-Y-5L. Independent variables included physical activity, screen time, and sleep duration assessed through a standardized questionnaire or interviews.

HRQoL was generally good according to the EQ-5D-Y-5L, which showed that 93.2 percent, 95.3 percent, and 92.5 percent of participants had “no problems” in the domains of mobility, “looking after myself,” and usual activities, respectively. In addition, 71.7 percent had no issues with pain/discomfort. [Health Qual Life Outcomes 2021;19:145]

Notably lower, 58.1 percent of respondents said that had “no problems” in the domain of feeling worried/sad/unhappy. The overall mean EQ-Visual Analogue Scale (VAS) score was 82.7; averages were 82.8 in boys and 82.6 in girls. Scores also dropped significantly with age (p<0.001).

PedsQL also showed generally good HRQoL, with mean total, psychosocial, and physical health summary scores of 80.9, 85.1, and 78.6, respectively.

To measure the level of exercise, the researchers used the International Physical Activity Questionnaire (IPAQ) and found that participants spent 312.7±223.0 minutes per day on sedentary activities and only 32.3±36.6 minutes per day on vigorous activities. Nevertheless, 67.4 percent of participants were deemed to have high levels of physical activity. Average screen time was around 5 hours during weekdays and nearly reaching 7 hours during weekdays.

Cubic spline models exhibited a significant interaction between sleep duration and EQ-VAS scores (likelihood ratio [LR], 22.5; p<0.001) as well as the total (LR, 61.5; p<0.001), physical (LR, 54.6; p<0.001), and psychosocial (LR, 47.5; p<0.001) summary scores of the PedsQL.

Screen time was likewise significantly associated with EQ-VAS (LR, 8.6; p=0.035), while time spent in moderate or vigorous activity was linked to PedsQL physical summary scores (LR, 47.5; p<0.001).

“There were increases in EQ-VAS scores, PedsQL physical summary scores, psychosocial summary scores, and total scores in children or adolescents with more time spent on moderate or vigorous activities, with less time spent using electronic devices, and with increasing sleep duration,” the researchers said.

“A well-designed cohort study with objective direct measurements such as use of wearable devices to collect real-time data on lifestyle patterns would help to clarify the relationships with HRQoL and provide more robust evidence to guide future policymaking,” they added.