Sleep Disturbance as a Mediator Between Digital Media Exposure and Emotional Dysregulation in Children and Adolescents: A Systematic Review and Meta-analysis

INTRODUCTION:
Recreational digital media use among children and adolescents has increased sharply and is implicated in emotional regulation problems. We systematically reviewed studies (published in 2020–2026) to examine whether sleep disturbance mediates the association between screen exposure and emotional dysregulation in youth.

METHODS:
Following PRISMA 2020, we searched seven databases (Jan 2020–Jul 2026) for English peer-reviewed human studies (systematic reviews; meta-analyses; cohort, case-control, and cross-sectional studies) on recreational screen use (non-educational) and emotional or sleep outcomes in 0–18-year-olds. We excluded educational screens and non-empirical reports. Two reviewers screened records, extracted data (participants, exposures, sleep/emotion measures), and assessed bias. We summarized the findings narratively, with meta-analysis conducted only where results were sufficiently homogeneous.

RESULTS:
Most included studies found significant associations between higher screen time and emotional/behavioral problems. A 2022 meta-analysis (87 studies, n≈159,000, age ≤12) reported correlations between screen time and externalizing (r≈0.11) and internalizing (r≈0.07) symptoms. In a US cohort (n=50,231, ages 6–17), children with ≥4 h/day of screen use had higher odds of anxiety (aOR≈1.45) and depression (aOR≈1.61). High screen exposure was also linked to sleep problems: one study found children with >4 h/day had ~3.2× higher odds of difficulty falling asleep. Formal mediation analyses were rare: one reported that sleep duration explained only ~5% of the screen–mental health link, and another found no mediation. Heterogeneity and design limitations limited pooling of estimates.

CONCLUSION:
Greater digital media exposure is modestly associated with emotional dysregulation and clearly correlates with sleep disturbance in youth. Available data suggest sleep disturbance mediates only a small part of this association. These findings are observational and do not establish causality. The highest-priority gap is the lack of longitudinal, mediation-focused studies; addressing this gap could inform interventions (e.g. screen-time limits around bedtime) to protect children’s mental health.