The associations of screen time and physical activity with sleep health during the COVID-19 crisis

To examine the associations of screen time (ST) and physical activity (PA) with sleep health, considering mental health. This cross-sectional study began in April 2020 during the COVID-19 health crisis. Changes in ST over the past 7 days were rated on a 3-point Likert scale (1 = decrease or no increase; 2 = moderate increase; 3 = uncontrolled increase). PA over the past 7 days was also rated on a 3-point Likert scale (1 = no; 2 = yes, but not every day; 3 = yes, every day). Anxiety and depressive symptoms were assessed using the Generalized Anxiety Disorder-7 scale and the Patient Health Questionnaire-8, respectively. In total, 2036 participants were enrolled (mean age: 29.4 years; 79 % female). Longer ST was associated with worse sleep health, with an odds ratio (OR) of 1.70 (95 % confidence interval [CI]: 1.42–2.05) for a moderate increase and 3.40 (95 % CI: 2.69–4.30) for an uncontrolled increase, compared with no increase. Lower PA was also associated with worse sleep health, with an OR of 1.25 (95 % CI: 1.05–1.50) for weekly practice and 1.72 (95 % CI: 1.35–2.19) for no practice, relative to daily practice. The effects of ST and PA were cumulative. Additional adjustments for anxiety and depressive symptoms did not explain or alter the associations. ST and PA are both critical for sleep health. Interventions aimed at improving sleep should systematically consider their roles. Longitudinal studies conducted in a more stable health context are needed to confirm these findings.