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Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
For authors, the manuscripts can be uploaded online through an easily navigable portal, on other hand, reviewers appreciate the systematic handling of all manuscripts. The way JCDR has emerged as an effective medium for publishing wide array of observations in Indian context, I wish the editorial team success in their endeavour"



Dr Bhanu K Bhakhri
Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018



Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dematolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018



Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018



Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018



Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018



Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata



Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018



Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018



Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018



Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011



Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2024 | Month : April | Volume : 18 | Issue : 4 | Page : CC01 - CC06 Full Version

Effect of Smartphone usage during Night Time on Sleep Patterns of Young Adults: A Cross-sectional Observational Study

Published: April 1, 2024 | DOI: https://doi.org/10.7860/JCDR/2024/66874.19291

Safa Hyder, Sudhir Shankar Mane, Mohammed Abdul Hannan Hazari, Mehnaaz Sameera Arifuddin

1. MBBS Student, Deccan College of Medical Sciences, Kanchanbagh (PO), Hyderabad, Telangana, India. 2. Senior Resident, Department of Orthopaedics, Government Medical College, Siddipet, Telangana, India. 3. Professor and Head, Department of Physiology, Deccan College of Medical Sciences, Kanchanbagh (PO), Hyderabad, Telangana, India. 4. Professor, Department of Physiology, Deccan College of Medical Sciences, Kanchanbagh (PO), Hyderabad, Telangana, India.

Correspondence Address :
Dr. Mehnaaz Sameera Arifuddin,
Professor, Department of Physiology, Deccan College of Medical Sciences, Kanchanbagh (PO), DMRL ‘X’ Roads, Hyderabad-500058, Telangana, India.
E-mail: mehnaaz@deccancollegeofmedicalsciences.com

Abstract

Introduction: Excessive smartphone usage among adolescents and young adults has been consistently linked to poor sleep. Moreover, smartphone overuse has been associated with daytime tiredness, longer sleeps latency, and reduced sleep duration. The significance of addressing poor sleep among adolescents and young adults is underscored by recent research linking it to adverse physical and psychological health outcomes, such as mood disturbances, impaired cognitive function, and increased risk incidence of hypertension and diabetes.

Aim: To evaluate the effects of smartphone usage on sleep quality among individuals using Pittsburgh Sleep Quality Index (PSQI) and hypnogram data.

Materials and Methods: In this cross-sectional observational study, sleep patterns were assessed using the PSQI questionnaire and Prime Nap sleep tracker app (version 1.1.4). The study was conducted by Deccan College of Medical Sciences, Hyderabad, Telangana, India. The data was collected in the form of a hypnogram and the study was conducted in the participants’ homes (under domicile conditions) in the city of Hyderabad, Telangana, India from March 2020 to April 2020. A total of 60 participants (both male and female) in the age group of 15-25 years were recruited and divided into two groups: one comprising 30 individuals with regular prolonged exposure to smartphone screens at night, and the other consisting of 30 individuals who experienced minimal or no smartphone exposure once they prepared to sleep. Descriptive statistics were applied to the collected data using Microsoft Excel and IBM Statistical Package for Social Sciences (SPSS) for Windows version 25.0.

Results: Adding up the average scores of the seven factors gives a global PSQI score from 0 to 21, with 0-4 indicating good sleep and 5-21 indicating poor sleep. Among those who used smartphones regularly at night time, 20 participants (66.67%) had PSQI score >5 and poor sleep quality, 24 participants (80%) had prolonged sleep latency, 18 participants (60%) had poor sleep duration, 27 participants (90%) had sleep disturbances, and 22 participants (73.33%) had increased daytime dysfunction. Hypnogram abnormalities were seen in >15 participants (50%) of subjects.

Conclusion: The prevalence of smartphone addiction is widely acknowledged in the medical literature, highlighting the need for its assessment, especially among adolescents and young adults. The study reveals that poor sleeping habits among participants were attributable either to a lack of awareness or neglect. By recognising the importance of adequate sleep, improvement in the quality of daily activities can be made by reducing daily screen time, consequently alleviating both physical and mental stress. Furthermore, the findings have implications for individuals whose work involves prolonged exposure to computer screens, especially during night time.

Keywords

Sleep duration, Sleep latency, Sleep quality

Introduction
Sleep is an essential biological need for all higher life forms, including humans, and its absence can have serious physiological and psychological consequences (1). Today’s children and young adults are increasingly using smartphones, and this trend has coincided with a rise in poor mental health among children and young adults. The significance of addressing poor sleep in this population is underscored by recent research linking it to adverse physical and psychological health outcomes, such as mood disturbances, impaired cognitive function, and increased risk incidence of hypertension and diabetes. Specifically, smartphone use near bedtime has been linked to disturbances in circadian rhythm, reduced Total Sleep Time (TST), and overall poorer sleep quality. Despite widespread health warnings about the detrimental effects of smartphone use on sleep, many adults still use their phones during the night and close to bedtime (2). Individual sleep requirements vary, but continuous disruptions to sleep are likely to interfere with normal biological restitution during night time. The concepts of technological addiction (3) and internet addiction (4),(5) emerged in the 2000s, leading to the began to label problematic or dysfunctional smartphone use as an addiction (6). Various theoretical frameworks have been proposed to understand internet addiction, including the cognitive-behavioural model of pathological internet use (7) and a model of generalised internet addiction (8).

The present study evaluates the effects of smartphone usage on sleep quality among individuals aged 15-25 years. Despite the high prevalence of sleep-related issues among students, their consultation rates for sleep problems are low, emphasising the need for increased awareness and prevention efforts. Furthermore, poor sleep has been associated with worse academic performance, which can result in dropout or underemployment (9). Hence, public health must establish accurate screening measures for identifying sleep disturbances and disorders in this population. According to Lemola S et al., smartphone ownership among adolescents is associated with delayed bedtimes, but not with altered sleep duration (10). Additionally, Wood AW et al., concluded that electromagnetic radiation emitted by mobile phones 30 minutes before sleep was found to delay the onset of melatonin production which in turn might affect sleep (11). Light from Light-Emitting Diode (LED) backlit smartphone screens causes suppression of melatonin secretion which reduces sleepiness (12). A third proposed mechanism is emotional arousal. Smartphones facilitate communication and can lead to receiving both positive and negative news, or even communicating a conflict between people which might increase emotional arousal at night, therefore, affecting sleep (13). Research suggests that using a smartphone at bedtime can disturb sleep and subsequently impact the productivity of employees the following day (14).

The main objective of this study was to qualitatively analyse sleep patterns using hypnogram data and Pittsburgh Sleep Quality Index (PSQI) and compare the sleep patterns of individuals with minimal or no smartphone usage to those with prolonged night time usage. The secondary objective was to gather information about participants’ smartphone usage habits and their awareness of factors that may affect sleep quality.
Material and Methods
This cross-sectional observational study was conducted in Hyderabad, Telangana from March 2020 to April 2020. The study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Institutional Review Board (IRB No.: 2020/31/006), and written informed consent was obtained from all participants.

Inclusion criteria: Individuals in the age group 15-25 years were selected. Subjects with android smartphones equipped with accelerometers for sleep tracking and also who slept alone on a bed, preferably in a separate room were included for the study.

Exclusion criteria: Individuals with self-reported or medically diagnosed sleep disorders, those with psychiatric disorders and those with alcohol, smoking, or drug (sleeping pills) addictions were excluded from the study.

Sample size: Participants were recruited through convenience sampling, and the study took place in participants homes (domicile recording). A convenience sample of 60 participants was chosen for the study. The participants were divided into two groups: one with 30 individuals having regular prolonged exposure (>30 minutes) to smartphone screens at night, and the other with 30 individuals having minimal (<30 minutes) or no smartphone exposure before sleep. With a sample size of 30 in each group, the central limit theorem suggests that the distribution of the sample means will be approximately normal, regardless of the population distribution, meeting the normality assumption for statistical tests (15).

Study Procedure

The PSQI questionnaire (16) was sent via online message to the participants along with instructions on how to operate the sleep application. Participants were assured of the strict confidentiality of their responses and personal details. The PSQI consists of seven core indicators: sleep duration, sleep disturbance, sleep latency, daytime dysfunction due to sleepiness, sleep efficiency, overall sleep quality, and sleep medication use (Table/Fig 1). Each component was scored from 0 to 3, with 3 indicating the greatest dysfunction. The scores are summed to obtain a total score (global score) ranging from 0 to 21, with higher scores indicating poorer sleep quality. A score of 0-4 indicates good sleep, while 5-21 indicates poor sleep.

Additional data included information on the participants regular exposure to a smartphone screen at night and, if applicable, the number of hours of exposure to a smartphone screen. Knowledge about the reasons for smartphone usage at night was also collected.

Validity and reliability: The PSQI demonstrates internal consistency and a reliability coefficient (Cronbach’s alpha) of 0.83 for its seven components. Various studies using the PSQI in diverse older adult populations internationally have validated its high reliability and validity (17),(18). The scale has also been validated in Indian languages (19),(20). The second questionnaire for optimal indicators [Annexure-1] was validated using Statistical Software for Social Sciences (SPSS, version 17.0, Chicago Inc., USA), with a Cronbach’s alpha value of 0.72. The questionnaire was collectively devised by all authors based on parameters recorded in the hypnogram and common factors known to disturb sleep.

Data entry and calculations of the PSQI component scores were conducted using Foxit Phantom PDF Standard (Foxit Software Inc, Fremont, CA, USA) downloaded on Windows 10. Data cleaning was performed before analysis. The Prime Nap sleep tracker app (version 1.1.4; Developer: Excelling Apps) was utilised for recording sleep patterns (21). Screenshots containing hypnogram data such as sleep duration, number of sleep cycles, awake time, and duration of Rapid Eye Movement (REM) sleep were sent via online messages. The hypnogram data was then transferred to a laptop.

Statistical Analysis

Data was consolidated into a Microsoft Excel spreadsheet. Descriptive statistics were presented as numbers and percentages. IBM SPSS for Windows version 25.0 was utilised.
Results
A total of 60 subjects in the age group 15-25 years were selected for the study. The mean age of the subjects was 20.77 years. Gender distribution is shown in (Table/Fig 2).

Global PSQI score: (Table/Fig 3) displays the distribution of the global PSQI score. The score ranged from 0 to 15, with a mode of 4. The mean score was 5.68, and the median score was 6.5. Among participants who used smartphones regularly at night (>30 minutes), 20 (66.67%) had a Global PSQI score ≥5, indicating poor sleep, while 10 (33.33%) had a score <5, indicating good sleep. For participants who did not use smartphones at night, 15 (50%) had a Global PSQI score ≥5, indicating poor sleep, and 15 (50%) had a score <5, indicating good sleep.

Smartphone usage and duration: Of the total participants, 52 (86.67%) used smartphones daily, while eight (13.33%) did not. Among daily users, 22 (42.31%) used smartphones minimally (0-30 minutes), and 30 (57.69%) used them for longer durations (>30 minutes) at night.

Participants used their phones at night for various activities such as checking text messages, reading news, playing games, and reading emails (Table/Fig 4). The core indicators for both groups are summarised in (Table/Fig 5).

Participants experienced daytime dysfunctions such as mood changes, drowsiness, lack of concentration, social disengagement, fatigue, memory problems, hallucinations, and paranoia, as summarised in (Table/Fig 6). The number of participants with aberrant parameters among the core indicators is depicted in (Table/Fig 7), while the results for optimal indicators are summarised in (Table/Fig 8).

Hypnograms provide a variety of sleep data, including total time, sleep time, sleep cycles, wakefulness duration, light and deep sleep, and REM duration. Hypnograms showing good and bad sleep quality are illustrated in (Table/Fig 9)a,(Table/Fig 9)b, respectively. Sleep quality can be assessed from hypnogram data, as shown in (Table/Fig 10)a for a participant with minimal smartphone usage at night, and (Table/Fig 10)b for a participant with disturbed sleep due to night time phone use. Episodes of wakefulness were higher in participants who used mobile phones regularly at night (Table/Fig 11)a compared to those with minimal night time usage (Table/Fig 11)b.
Discussion
Excessive smartphone use among adolescents and young adults has been consistently linked to poor sleep, which in turn is associated with adverse physical and psychological health outcomes. Therefore, studying the effects of smartphone usage on sleep quality among individuals aged 15-25 years is crucial. The main objective of this study was to assess the sleep quality among bedtime smartphone users and to explore the association of sleep with other cell phone variables. According to the National Sleep Foundation guidelines, young adults aged 18-25 years require 7-9 hours of sleep each night (22). The study revealed that individuals who use their smartphones more at night are at a higher risk of poor sleep quality, particularly if use exceeds 60 minutes. These findings align with international studies on adults and adolescents (13),(23),(24).

Long-term sleep quality impacts health, potentially leading to depression among adolescent students (25). A survey by Philips Healthcare in 2019 found that 62% of surveyed adults only somewhat slept well (26). In present study, only 33.33% of subjects who regularly used smartphones at night had good sleep quality, with 65% acknowledging the hazards of blue light affecting sleep. Despite this awareness, 36.67% showed good sleep quality on the hypnogram. The negative consequences of inadequate sleep are often overlooked until they reach an advanced stage. World Sleep Day, established in 2008, aims to emphasise the importance of rest. The recommended nightly sleep duration is at least six hours (27),(28). Sleep latency directly impacts sleep efficiency, with a normal range for adults being 10 to 20 minutes. A June 2020 survey reported that 48.5% of adults aged 18 to 24 experienced longer sleep latency. In current study, 80% of subjects exhibited poor sleep latency. Factors like education and employment significantly influenced smartphone usage duration (29).

An Egyptian study in 2023 highlighted that smartphone use before bedtime was linked to poor sleep quality, prolonged sleep latency, sleep maintenance issues, and shorter sleep duration compared to non users (30). Additionally, 90% of smartphone users in our study experienced sleep disturbances. The Centre for Disease Control and Prevention (CDC) recommends 7-8 hours of sleep per night for individuals aged 18-60 years (31). However, 60% of smartphone users in present study reported inadequate sleep duration. Sleep disturbances can manifest in various forms including insomnias, excessive somnolence, sleep-wake schedule disorders, and parasomnias (32). In present study, 90% of smartphone users experienced sleep disturbances. Factors like watching shows, texting, calls, or working before bed can lead to hyperarousal and poor sleep quality. Most participants used their phones before sleep to check the time, messages, and social media, as observed in an Iranian study. Only 13.33% of subjects used night mode on their phones, with 95% responding to notifications/calls during sleep, contributing to poor sleep quality (33). Lastly, a study showed that bedtime phone use correlated with later rise times, higher insomnia scores, increased fatigue, and daytime dysfunction (23). In present study, 73.33% of subjects reported daytime dysfunction.

A hypnogram serves as a qualitative tool to visualise the duration of each sleep stage and the transitions between these stages. In present study, 40% of smartphone users exhibited abnormal sleep cycles, compared to 26.67% of non users. Brief wakefulness episodes were noted in 56.67% of subjects, while 36.67% experienced longer and more frequent awakenings. Recent research highlighted a Two-fold risk of poor sleep quality for individuals using smartphones for bedtime activities lasting 16 to 30 minutes, increasing significantly for longer durations: more than three-fold for 31 to 45 minutes, 2.6-fold for 46 to 60 minutes, and a substantial 7.4-fold for durations exceeding 60 minutes. Studies also suggest that smartphone use before bedtime can disrupt sleep, affecting employee productivity the following day.

The study’s strength lies in evaluating smartphone addiction among subjects, an emerging behavioral concern globally. Incorporating PSQI allowed for the subjective assessment of sleep quality among participants. Few studies in our country have explored the sleep patterns of bedtime smartphone users with considerations like awareness of blue light and night mode. To better understand the challenges faced by individuals, the integration of self-reported data through tools like the PSQI is crucial. Coupled with the objective analysis of sleep patterns using a cost-effective hypnogram, this approach has the potential to enhance sleep patterns, improve sleep cycles, and influence associated behaviors. This presents a promising direction for further research in this field.

Limitation(s)

This study faces several limitations. Disruptions from typical routines caused by the Coronavirus Disease-2019 (COVID-19) pandemic, such as remote work, online education, reduced social interactions, and increased indoor time, may have altered participants daily lifestyles and smartphone usage habits. The reliance on self-reported data could introduce bias. The findings may not be generalised to the broader population due to convenience sampling and a small sample size. Other screen devices like tablets and computers, sleep environment factors such as mattress quality and room temperature, and socio-economic and cultural aspects specific to the region could act as confounding variables in this study.
Conclusion
This study underscores the negative impact of night time smartphone use on the sleep quality of individuals aged 15-25. Through the utilisation of the PSQI and hypnogram data, the research establishes a significant association between regular night time smartphone use and poor sleep quality. The observed issues, including increased sleep latency, decreased sleep duration, sleep disturbances, and heightened daytime dysfunction, underline the pressing need to address smartphone-related sleep disruptions in this age group. These findings provide valuable insights for future research and interventions focused on enhancing sleep hygiene and overall wellbeing among adolescents and young adults.
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DOI and Others
DOI: 10.7860/JCDR/2024/66874.19291

Date of Submission: Aug 04, 2023
Date of Peer Review: Oct 20, 2023
Date of Acceptance: Feb 12, 2024
Date of Publishing: Apr 01, 2024

AUTHOR DECLARATION:
• Financial or Other Competing Interests: The first author received the Short-Term Studentship grant (Grant No: 2020-03559) from the Indian Council of Medical Research.
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Aug 04, 2023
• Manual Googling: Oct 27, 2023
• iThenticate Software: Feb 10, 2024 (8%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7
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