Lack of sleep is associated with internet use for leisure

Diversity of purposes of use, time spent online, and depression among older Chinese Internet users

Objectives: Previous studies on the associations between Internet use and older people's depression have mostly focused on single types of online activities, especially online social engagement. The current study investigated the diversity of purposes of Internet use and its interaction with the time spent online in shaping older Chinese Internet users' depression.

Method: A sample of 974 Internet users aged 60 and above was adopted from the 2020 China Family Panel Studies wave. We adopted a latent class analysis (LCA) to explore the diverse purposes of internet usage.

Results: The participants were classified into three distinct types: socializers, basic users, and maximizers. Basic users and maximizers use the Internet for various purposes, despite different intensities; socializers use the Internet only to keep connected with families and friends. Compared with basic users and maximizers, a longer time spent online among socializers was significantly associated with a higher level of depression.

Conclusion: This study calls for a closer examination of online profiles among older Internet users; more attention should be paid to the potential harms of excessive Internet use for social reasons only among older adults. Practitioners should enhance older Internet users' digital literacy to maximize the wide-range benefits of Internet use and reduce potential health inequality.

Association Between Internet Use, Sleep, Cognition and Physical Activity Levels During COVID-19 Lockdown

Purpose

The purpose of this study was to compare internet usage, sleep, cognition and physical activity in college professors and collegiate students during COVID-19 lockdown and to study the association of internet overuse with sleep quality, cognition and physical activity during the COVID-19 lockdown.

Methods

A sample of 125 participants {professors (n = 52) and collegiate students (n = 73)} was recruited from Jamia Hamdard, New Delhi, India. Criteria for inclusion were college professors and collegiate students who uses internet. Both the groups were assessed for internet usage (Internet Addiction Test), sleep quality (Pittsburgh Sleep Quality Index), cognition (Cognitive Failure Questionnaire) and physical activity (Global Physical Activity Questionnaire) via google forms.

Results

There was a significant difference for internet usage (p < 0.05), sleep quality (p = 0.032), cognition (distractibility, p = 0.019) and physical activity in college professors and collegiate students. It has been also reported that there was a significant association of internet usage with sleep quality and cognition and sleep quality with cognition.

Conclusion

Students have more problematic internet usage, bad sleep quality, more cognitive failures and less physical activity than college professors during pandemic lockdown. It has been also observed that problematic internet usage has correlation with sleep quality, cognition and physical activity.

Development and validation of mathematical nomogram for predicting the risk of poor sleep quality among medical students

Background

Despite the increasing prevalence of poor sleep quality among medical students, only few studies have identified the factors associated with it sing methods from epidemiological surveys. Predicting poor sleep quality is critical for ensuring medical Students' good physical and mental health. The aim of this study was to develop a comprehensive visual predictive nomogram for predicting the risk of poor sleep quality in medical students.

Methods

We investigated medical Students' association with poor sleep quality at JiTang College of North China University of Science and Technology through a cross-sectional study. A total of 5,140 medical students were randomized into a training cohort (75%) and a validation cohort (25%). Univariate and multivariate logistic regression models were used to explore the factors associated with poor sleep quality. A nomogram was constructed to predict the individual risk of poor sleep quality among the medical students studied.

Results

31.9% of medical students in the study reported poor sleep quality. We performed multivariate logistic analysis and obtained the final model, which confirmed the risk and protective factors of poor sleep quality (p < 0.05). Protective factors included the absence of physical discomfort (OR = 0.638, 95% CI: 0.546-0.745). Risk factors included current drinking (OR = 0.638, 95% CI: 0.546∼0.745), heavy study stress (OR = 2.753, 95% CI: 1.456∼5.631), very heavy study stress (OR = 3.182, 95% CI: 1.606∼6.760), depressive symptoms (OR = 4.305, 95% CI: 3.581∼5.180), and anxiety symptoms (OR = 1.808, 95% CI: 1.497∼2.183). The area under the ROC curve for the training set is 0.776 and the area under the ROC curve for the validation set is 0.770, which indicates that our model has good stability and prediction accuracy. Decision curve analysis and calibration curves demonstrate the clinical usefulness of the predictive nomograms.

Conclusion

Our nomogram helps predict the risk of poor sleep quality among medical students. The nomogram used includes the five factors of drinking, study stress, recent physical discomfort, depressive symptoms, and anxiety symptoms. The model has good performance and can be used for further research on and the management of the sleep quality of medical students.

Behavioral and psychosocial predictors of depression in Bangladeshi medical students: a cross-sectional study

BACKGROUND

Depression, stress, and anxiety were found in a large number of medical undergraduate students, indicating a neglected aspect of their psychology that required immediate attention. The goal of this study was to find out the prevalence of depression among medical students, as well as potential psychosocial and behavioral predictors for depression.

METHODS

This cross-sectional study was conducted from July to November 2021 among 840 randomly selected medical students from four medical colleges using stratified random sampling. Data were collected using a semi-structured, self-administered questionnaire and were analyzed through the SPSS v.23 software. Multiple regression was performed to assess the effect of several behavioral and psychosocial factors on depression.

RESULTS

Among the 840 study participants, 55.7% (n= 468) were female and 44.3% (n= 372) were male. According to the data, the prevalence of depression, anxiety, perceived stress among medical students was found to be 28.8%, 65% and 85% respectively. A strong link was found between depression and anxiety, stress, poor sleep quality, poor academic performance, and a negative social and romantic relationship status.

CONCLUSIONS

A significant number of medical students are depressed. In order to prevent and treat depression, medical students should be screened for depression and its associated factors.

The Comparative Efficacy of Treatments for Children and Young Adults with Internet Addiction/Internet Gaming Disorder: An Updated Meta-Analysis

Internet gaming disorder (IGD) is a formal mental disorder leading to bad outcomes for children and adolescents. This study comprehensively compared the estimated effect of various pharmacotherapy and psychosocial interventions for IGD from randomized controlled trials (RCT) through updated meta-analysis, using meta-regression. A search of PubMed/MEDLINE, Cochrane Library, and Airiti Library between 2000 and 2017 was conducted for various IA/IGD intervention modalities. A total of 124 studies from 29 selected papers involving 5601 children and young adults with IA/IGD were found. Meta-analyzing the pooled standardized mean difference (SMD) revealed a preliminary random effect of 1.399 with a 95% confidence interval of 1.272–1.527, suggesting highly effective treatment of IA/IGD. After adjusting for the confounding risks of age, publication year, type of subjects, and type of study, this study revealed that combining pharmacotherapy with cognitive behavioral therapy (CBT) or multi-level counseling (MLC) was the most effective treatment option. Using a scale of time spent online or a severity of IA symptoms scale was a more effective measurement, with p-values = 0.006 and 0.002, respectively. IA/IGD patients with comorbid depression showed worse outcomes than youth with another comorbidity. The corresponding model goodness-of-fit indices were τ² = 1.188; I²-Residual = 89.74%; and Adjusted-R² = 16.10%. This systematic review indicates that pharmacotherapy combined with CBT or MLC might be an effective therapeutic strategy for youth with gaming disorder.

Leisure-time and study-time Internet use and dietary risk factors in Korean adolescents

BACKGROUND

Prolonged screen time is associated with an increased risk of obesity in adolescents. However, little is known about whether Internet use is also associated with dietary risk factors including consumption of obesogenic foods.

OBJECTIVES

In this study, we examined the associations of leisure-time and study-time Internet use with dietary risk factors in Korean adolescents using nationally representative survey data.

METHODS

We conducted a cross-sectional analysis among 54,416 middle and high school students in the Korea Youth Risk Behavior Web-based Survey 2015. Participants were asked to report the average duration of leisure-time and study-time Internet use, days of skipping breakfast, and frequency of fruit, vegetable, instant noodle, fast-food, chip/cracker, and sugar-sweetened beverage (SSB) intakes. We performed multivariable logistic regression to estimate ORs and 95% CIs for the relations between duration of Internet use and dietary risk factors, accounting for complex survey sampling and adjusting for potential confounders.

RESULTS

Prolonged leisure-time Internet use (≥241 compared with 1-60 min/d) was associated with higher prevalence of frequent skipping breakfast (OR: 1.39; 95% CI: 1.29, 1.49), low intakes of fruits (OR: 1.27; 95% CI: 1.18, 1.36) and vegetables (OR: 1.43; 95% CI: 1.33, 1.55), and high intakes of instant noodles (OR: 1.87; 95% CI: 1.74, 2.02), fast-food (OR: 1.63; 95% CI: 1.49, 1.78), chips/crackers (OR: 1.37; 95% CI: 1.24, 1.52), and SSBs (OR: 1.63; 95% CI: 1.52, 1.75). Prolonged study-time Internet use (≥121 compared with 1-60 min/d) was inversely associated with prevalence of low fruit (OR: 0.94; 95% CI: 0.88, 1.00) and vegetable (OR: 0.91; 95% CI: 0.85, 0.98) intakes but was positively associated with high intakes of instant noodles (OR: 1.10; 95% CI: 1.03, 1.19) and chips/crackers (OR: 1.13; 95% CI: 1.04, 1.23). The overall associations remained consistent in analyses stratified by sex, grade, region, parental co-residence, perceived household income, perceived stress level, physical activity, and obesity status.

CONCLUSIONS

Our data suggest that prolonged Internet use, particularly during leisure time, is associated with less healthful dietary behaviors in Korean adolescents.

Exploration of the Socioecological Determinants of Hong Kong Workers' Work-Life Balance: A Grounded Theory Model

BACKGROUND

Although a growing body of research has investigated the theoretical and empirical models of work-life balance (WLB), the propositions of this phenomenon remain nonunified. Thus, a grounded theory approach was adopted to explore the viewpoints of workers regarding WLB and its determinants and consequences.

METHODS

Individual face-to-face interviews were conducted to investigate the attitudes and experiences of Hong Kong workers towards WLB, in which 50 workers were interviewed. All data of interviews were transcribed verbatim and coded into five levels of the socioecological framework (i.e., intrapersonal level, interpersonal level, organisational level, community and government policy).

RESULTS

The grounded theory model established that work-life balance and personal context mutually affected each other, and work-life balance was unidirectionally affected by the environmental context. The ability to maintain a continual satisfied physical and mental states among multiple roles under the emergence of unexpected environmental factors was proposed as the definition of work-life balance.

CONCLUSIONS

The findings of this study offer essential research insights into the importance of WLB, the dynamic features for workers to sustain balance and constructing a reliable and exhaustive assessment model for work-life balance for future studies.

Changes in Dietary Habits and Exercise Pattern of Korean Adolescents from Prior to during the COVID-19 Pandemic

This study aimed to investigate changes in the exercise pattern and dietary habits in adolescents during the COVID-19 pandemic. The 12–18-year-old population in the Korea Youth Risk Behavior Web-Based Survey data of 2019 and 2020 was enrolled. The exercise pattern and dietary habits of 105,600 participants (53,461 in the 2019 group and 52,139 in the 2020 group) were compared. The odds ratios (ORs) for the dietary habits and exercise pattern of the 2020 group compared to the 2019 group were analyzed using multiple logistic regression analysis with complex sampling. The odds of eating fruit, drinking soda, drinking sweet drinks, and consuming fast food were lower in the 2020 group than in the 2019 group (all p < 0.001). The odds of eating breakfast were higher in the 2020 group than in the 2019 group (all p < 0.001). The 2020 group showed lower odds of frequent vigorous and moderate aerobic exercise and higher odds of frequent anaerobic exercise than the 2019 group (all p < 0.001). During the COVID-19 pandemic, adolescents consumed less fruit, soda, and sweet drinks, while they had more breakfast. The frequency of aerobic exercise was lower, while the frequency of anaerobic exercise were higher during the COVID-19 pandemic period.

Relationships Between Internet Use and Sleep Duration in Chinese Adults: A Cross-Sectional Study

Purpose

Most studies that examined the relationship between internet use and sleep were conducted mainly in children and adolescents, and we know little about the use of internet among adults. The purpose of this study is to understand the internet use patterns of Chinese adults and to measure their associations with sleep duration from variety, frequency and type.

Methods

A total of 19,730 samples were selected from 2018 data of the China Health and Retirement Longitudinal study. Internet usage was obtained by specific questions, and the range of sleep period was grouped according to recommendations from the National Sleep Foundation. Kruskal–Wallis H-test and the chi-squared test were used for basic descriptive analysis, and multinomial logistic regression was used to analyze the relationships between internet use and sleep duration. Stata version 15.0 was used for data cleaning, and SPSS version 20.0 was used for statistics analysis.

Results

After screening, a total of 6346 persons were included in the analysis, of which 3148 (49.61%) were males and 3198 (50.39%) were females. Age ranged from 21 to 95 years, most persons were over 45 years old, with the median age of 56 years. Only 1180 (18.59%) participants used the internet, and almost all of them used mobile phones (1137, 96.36%), the other three types were desktop computer (232, 19.66%), laptop computer (69, 5.85%) and tablet (73, 6.19%). There were 912 (77.28%) and 268 (22.71%) participants who used only one and two or more types, respectively. In the unadjusted model, both short sleep and long sleep were associated with internet use compared with normal sleep duration (0.806 [0.708–0.918] p = 0.001; 0.345 [0.251–0.475] p < 0.000). After adjusting for all covariates, the association between long sleep and internet use still persisted (0.612 [0.433–0.865] p = 0.005), but no significant difference was found in short sleep (0.929 [0.803–1.075] p = 0.325).

Conclusion

Internet use was found to be closely associated with sleep and the duration of sleep negatively affected, which may provide new ideas for sleep hygiene recommendations and healthy media use. This conclusion needs more evidence to support.

Change of Internet Use and Bedtime among Junior High School Students after Long-Term School Closure Due to the Coronavirus Disease 2019 Pandemic

Most schools in Japan were closed in spring 2020 due to the novel coronavirus disease 2019 (COVID-19) pandemic. We investigated lifestyle and internet use among junior high school students across eight schools after long-term school closure and compared the data with those we obtained from previous surveys. In the summers of 2018, 2019, and 2020, we conducted questionnaire surveys on seventh-grade students from the same schools. In total, 2270 participants were analyzed. All questionnaires included items regarding background, bedtime, and internet use. The participants of the 2020 survey had significantly less sleepiness during classes and longer internet use times compared with those of the previous surveys. In the 2020 survey, the rate of problematic internet use (Young’s Diagnostic Questionnaire score, ≥5) was not significantly different from the results of previous surveys. The COVID-19 pandemic might have strongly influenced the sleepiness experienced by students in classes and increased the time spent using the internet since the summer of 2020. Our results indicate the need for attempts to encourage students to improve their sleep habits and moderate their media use.

Bedtime media use and sleep: evidence for bidirectional effects and associations with attention control in adolescents

OBJECTIVE/DESIGN

Bedtime media use has been associated with poor sleep and attention difficulties among adolescents, but much of this research has been cross-sectional, limiting current understanding of directionality of effects. This 2-wave prospective study tested bidirectional effects between bedtime media use and sleep measures, including time in bed, sleep onset latency, and daytime sleepiness, and further examined whether bedtime media use and sleep variables were related to attention control difficulties.

SETTING/PARTICIPANTS

Data were collected from 345 middle-schoolers (ages 12-14, 47% female) at baseline (T1) and at 6-month follow-up (T2).

MEASUREMENTS

Students self-reported their access to media devices and internet in their bedroom, bedtime media use, sleep, and attention control. Data were analyzed using cross-lagged panel modeling.

RESULTS

Greater bedtime media use (at T1) was associated with less time in bed and longer sleep onset latency at T2, controlling for T1 levels of these variables. In the case of sleep effects on bedtime media use, greater daytime sleepiness and less time in bed (at T1) were associated with greater bedtime media use at T2, controlling for T1 levels. Further, greater daytime sleepiness (at T2, controlling for T1 levels) was associated with greater attention control difficulties at T2.

CONCLUSIONS

Findings provide evidence for some reciprocal relations between bedtime media use and poor sleep in adolescents. Furthermore, higher daytime sleepiness was linked to greater attention control difficulties.

C. S, Shrestha S, Thapa DK. Internet addiction and sleep quality among adolescents in a peri-urban setting in Nepal: A cross-sectional school-based survey

Background

Excessive use of the internet among adolescents often led to later bedtimes and poor sleep quality. This study assessed the relationship between internet addiction and sleep quality among adolescents in a peri-urban setting in Nepal.

Method

This cross-sectional study employed a questionnaire survey among 390 adolescent students recruited from two schools in Kirtipur Municipality in Nepal. The Internet Addiction Test and the Pittsburgh Sleep Quality Index were used to assess internet addiction and poor sleep quality respectively. The association between internet addiction and sleep quality was analysed by logistic regression.

Results

One-fifth (21.5%) of the participants were identified with borderline internet addiction and 13.3% with possible internet addiction. Poor sleep quality was found among 31% of the participants. Internet addiction was significantly associated with poor sleep quality (OR = 1.85, p = 0.022 for borderline, and OR = 3.98, p = <0.001 for possible internet addiction compared to no internet addiction).

Conclusion

Adolescents with internet addiction were more vulnerable to suffer from poor sleep quality. It is recommended that municipalities and schools should aware the adolescent students on the adverse effects of excessive internet use including poor sleep quality. The findings have implications for adolescents, parents, school authorities and researchers.

Exploring the Effects of Problematic Internet Use on Adolescent Sleep: A Systematic Review

Adolescent suse internet via several devices to gather information or communicate. Sleep, as a key factor of adolescents' development, contributes to their physical and mental health. Over the past decades insufficient sleep among adolescents has been wide spread, and one of its attributing factors is the increased availability of technology. This review aims to investigate the body of evidence regarding the impact of problematic internet use on adolescent sleep. Extensive search of databases was performed according to PRISMA guidelines for studies published within the last decade, regarding subjects aged 10-19. The final step of the search yielded 12 original studies. The quality of extracted data was evaluated with the AXIS tool, in order to estimate the risk of bias. All studies showed a negative correlation between adolescent sleep and problematic internet use. It was found to affect sleep quality and quantity and provoke insomnia symptoms. Interestingly, adolescent's sex, parental educational level, type of family and use for leisure or academic reasons appeared as affecting factors of the problematic internet use-sleep relationship. Problematic internet use has several effects on adolescents' sleep. Results of relevant studies should be embedded in educational interventions addressed to adolescents as well as parents, to eliminate the negative outcomes of problematic internet use on sleep and adolescence's health in general.

The association between internet addiction, sleep quality, and health-related quality of life among Iranian medical students

Due to the increasing use of the internet in Iranian society, especially among students, and the importance of sleep quality (SQ) and quality of life (QOL), the present study examined the relationship between QOL, SQ, and internet addiction (IA) among medical science students. In the present descriptive-analytical study, the sample comprised Saveh University of Medical Sciences students who were studying in 2019. The survey included demographic information (i.e., age, gender, place of residence, field of study, semester, marital status, smoking status, daily exercise) and the 20-item Internet Addiction Test. From 285 distributed questionnaires, 279 individuals with a mean age of 21.01 years (SD ± 3.17) completed the survey. Findings indicated that students with IA had higher mean scores on (i) all physical dimensions concerning QOL (except for the physical pain) and (ii) all psychological dimensions of QOL. The findings will help national health authorities and planners in Iran design appropriate and effective interventions to improve student health and prevent IA.

The Impact of Physical Distancing and Associated Factors Towards Internet Addiction Among Adults in Indonesia During COVID-19 Pandemic: A Nationwide Web-Based Study

INTRODUCTION

Physical distancing has encouraged the public to utilize the Internet for virtually all daily activities during the COVID-19 pandemic. This study aimed to assess the impact of COVID-19 on Internet addiction (IA) prevalence and analyzed the correlated factors during quarantine and pandemic.

METHODS

An online survey was generated, comprising of a sociodemographic section, Internet Addiction Diagnostic Questionnaire (KDAI), Symptoms Checklist-90, and Pittsburgh Sleep Quality Index. The hyperlink was disseminated through social media, companies, and universities. Overall, 4,734 adults, (mean age 31.84 ± 7.73 years old and 55.2% males) representing all 34 provinces of Indonesia, gave valid responses.

RESULTS

Point prevalence of IA during the COVID-19 pandemic was 14.4% in Indonesian adults. Online duration increased by 52% compared to before the pandemic. Physical distancing was not established as a risk of IA. Increased daily online duration, specific motivations, types of application, and having confirmed/suspected COVID-19 cases within the household were predictive of IA. All subscales of SCL-90 and PSQI were higher in the group with positive/suspect cases of COVID-19 within households and were correlated to higher scores of IA.

DISCUSSION

Physical distancing alone was not associated with an increased risk of IA. The prevalence of IA during COVID-19 was higher than the previously proposed rate among Indonesian adults, which might be related to digital activities associated with COVID-19 and the popularity of virtual socializing. Furthermore, psychopathologies and sleep disruptions were related to IA occurrences and especially prevalent in groups with proximity to COVID-19. Fear of COVID-19 contraction and rampant misinformation of COVID-19 probably contributed to these factors, which potentially harbor long-term consequences.

CONCLUSION

The current study demonstrated a high point prevalence of IA and identified several preventable factors predictive of IA during home-quarantine and COVID-19, especially in adults with confirmed/suspected COVID-19 cases within the household. However, physical distancing did not increase the odds of IA. Public health agencies should maintain physical distancing advisory while providing adaptive psychiatric education and service.

Determinants of Subjective Poor Sleep Quality in Social Media Users Among Freshman College Students

INTRODUCTION

Social media (SM) usage has increased markedly among young adults. It is linked to poor sleep quality (PSQ), a risk factor for mental and physical health concerns. This study identified the determinants of PSQ in SM users among freshman college students.

MATERIAL AND METHODS

A cross-sectional design was used and 842 students completed a self-administered questionnaire. Analyses were performed using the χ ² test to examine differences in the characteristics of poor and good sleepers and logistic regression to estimate the risk of PSQ with reference to SM usage patterns.

RESULTS

Around 75.40% (n = 635) of the participants had PSQ. There was a significant difference in the PSQ rate between males (66.3%) and females (79.3%, p < 0.001), those who were physically active (67.2%) and those who were not (82.4%, p < 0.001), those who were mentally depressed (86.5%) and those who were not (61.5%, p < 0.001), and those with anxiety (87.8%) and those without (64.3%, p < 0.001). The risk of PSQ was lower among students who used SM for education (OR = 0.65, CI = 0.42 to 0.99, p = 0.048), had higher laptop usage (OR = 0.67, CI = 0.47 to 0.96, p = 0.03), and had higher SM usage during daytime (OR = 0.46, CI = 0.32 to 0.67, p < 0.001). The risk of PSQ was higher among those who reported SM usage at bedtime (OR = 1.69, CI = 1.01 to 2.81, p = 0.046).

DISCUSSION

Among SM users, PSQ was related to sociodemographic features, lifestyle characteristics, and health-risk factors. Further research is required to confirm these findings.

Relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students

INTRODUCTION

Smartphone usage has become commonplace and impact on sleep quality among adolescents. Adolescent girls have a greater tendency toward sleep quality problems. However, relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students has not been studied.

OBJECTIVES

This study had the two goals: to investigate the relationship between female college students' sleep quality, smartphone dependence, and health-related behaviors, and to identify predictors of sleep quality.

METHODS

This study employed a cross-sectional research approach to gather 409 subjects at a junior college in southern Taiwan, and used a structured questionnaire to collect data. The questionnaire consisted of four parts: basic demographic data, the Pittsburgh Sleep Quality Index, assessment of smartphone dependence, and the Health Promoting Lifestyle Profile (HPLP). Logistic regression analysis was employed to check for any association between sleep quality and smartphone dependence or HPLP.

RESULTS

Sleep quality was significantly associated with degree of smartphone dependence, total HPLP score, and scores on the four HPLP subscales of nutritional behavior, self-actualization, interpersonal support, and stress management behavior. The lower the subjects' degree of smartphone dependence was, the better their sleep quality was. Furthermore, the degree of smartphone dependence and total HPLP score were significant predictors of sleep quality.

CONCLUSIONS

Smartphone dependence is associated with poor sleep quality among female college students. Improving health-related behaviors (nutritional behavior, self-actualization, interpersonal support, and stress management behavior) can also promote improvement in sleep quality.

Association between Problematic Internet Use and Sleep Disturbance among Adolescents: The Role of the Child's Sex

Use of the Internet has become an integral part of daily life. Adolescents are especially at a higher risk of developing problematic Internet use (PIU). Although one of the most well-known comorbid conditions of PIU is sleep disturbance, little is known about the sex disparity in this association. This school-based survey in students of grades 7⁻9 was conducted to estimate the prevalence of PIU and sleep disturbance among Chinese adolescents, to test the association between PIU and sleep disturbance, and to investigate the role of the child's sex in this association. A two-stage stratified cluster sampling method was used to recruit participants, and two-level logistic regression models were fitted. The mean Internet addiction test score was 37.2 (SD: 13.2), and 15.5% (736) met the criteria for PIU. After adjusting for control variables, problematic Internet users were at a higher risk of sleep disturbance (adjusted odds ratio = 2.41, 95% confidence interval (CI) = 2.07⁻3.19). Sex-stratified analyses also demonstrated that association was greater in girls than boys. In this respect, paying more attention to the sleep patterns of adolescents who report excessive Internet use is recommended, and this early identification may be of practical importance for schools, parents, and adolescents themselves.