J Korean Med Sci.  2023 Dec;38(49):e413. 10.3346/jkms.2023.38.e413.

Association Between Electronic Device Use at Bedtime and COVID-19 Vaccine-Related Adverse Events During the COVID-19 Pandemic in Korean Adults: A Nationwide Cross-Sectional Population-Based Study

• Kang KW
• Kim J
• Kim KT
• Kim MK
• Cho YW
• obotSECotKSRS

• KMID: 2549177
• DOI: http://doi.org/10.3346/jkms.2023.38.e413

Abstract

Background
The coronavirus disease 2019 (COVID-19) pandemic has led to heightened mood disturbances linked to increased electronic device use at bedtime (EUB). General anxiety may contribute to an increased likelihood of experiencing nocebo responses, which have been reported to be associated with COVID-19 vaccine-related adverse events (CAEs). However, no related studies have been conducted to examine this association to date.
Methods
We executed a nationwide cross-sectional study to explore these correlations during the pandemic. Using data from the 2022 National Sleep Survey of South Korea, we analyzed the sleep health of 4,000 adults aged 20–69 years between January and February 2022. Shift workers and those with severe sleep disorders were excluded. Participants with EUB more than four days a week were labeled as high frequency EUB, and those reporting CAEs after both vaccine doses were marked as having a presence of CAEs. The survey also included details about anthropometric data, socioeconomic status, and sleep status.
Results
Of the 3,702 participants, 92.6% had received two or more vaccine doses, with 41.2% experiencing CAEs. Furthermore, 73.7% had a high EUB frequency. Factors associated with CAE reporting included younger age, female sex, and high EUB frequency, while heavy alcohol use was found to be less likely to be associated with CAE reporting. Notably, a high EUB frequency was significantly associated with reported CAEs (odds ratio, 1.223; 95% confidence interval, 1.028–1.455; P = 0.023).
Conclusion
A nationwide online survey conducted in South Korea during the pandemic found that individuals who engaged in the relatively frequent use of electronic devices during bedtime had worse sleep quality and increased COVID-19-related adverse events compared with those using these devices less frequently. These findings have the potential to enhance our understanding of the impact of the use of electronic devices at bedtime on health.

Keyword

COVID-19 Vaccine; Nocebo Effect; Adverse Events; Smartphone; Epidemiological Study

Figure

• 

  Fig. 1 Differences in self-reported sleep satisfaction according to the frequency of electronic device use at bedtime. The percentage ratio (B/A) of self-reported sleep satisfaction was compared between participants (A) who reported using electronic devices at bedtime less frequently (< 4 days/week) and those (B) who reported using electronic devices at bedtime more frequently (≥ 4 days/week).EUB = electronic device use at bedtime.

Reference

1. Islam M. Link between Excessive smartphone use and sleeping disorders and depression among South Korean university students. Healthcare (Basel). 2021; 9(9):1213. PMID: 34574987.

2. Statista. Ownership rate of smartphones in South Korea from 2011 to 2021. Updated 2022. Accessed June 1, 2023. https://www.statista.com/statistics/777726/south-korea-smartphone-ownership/ .

3. Wacks Y, Weinstein AM. Excessive smartphone use is associated with health problems in adolescents and young adults. Front Psychiatry. 2021; 12:669042. PMID: 34140904.

4. Weinstein A, Siste K. Editorial: excessive and problematic smartphone usage. Front Psychiatry. 2022; 13:972613. PMID: 35935433.

5. Zou Y, Xia N, Zou Y, Chen Z, Wen Y. Smartphone addiction may be associated with adolescent hypertension: a cross-sectional study among junior school students in China. BMC Pediatr. 2019; 19(1):310. PMID: 31484568.

6. Pera A. The psychology of addictive smartphone behavior in young adults: problematic use, social anxiety, and depressive stress. Front Psychiatry. 2020; 11:573473. PMID: 33101087.

7. Elhai JD, Levine JC, Dvorak RD, Hall BJ. Non-social features of smartphone use are most related to depression, anxiety, and problematic smartphone use. Comput Human Behav. 2017; 69:75–82.

8. Elhai JD, Dvorak RD, Levine JC, Hall BJ. Problematic smartphone use: a conceptual overview and systematic review of relations with anxiety and depression psychopathology. J Affect Disord. 2017; 207:251–259. PMID: 27736736.

9. Geng Y, Gu J, Wang J, Zhang R. Smartphone addiction and depression, anxiety: the role of bedtime procrastination and self-control. J Affect Disord. 2021; 293:415–421. PMID: 34246950.

10. Panova T, Carbonell X. Is smartphone addiction really an addiction? J Behav Addict. 2018; 7(2):252–259. PMID: 29895183.

11. Olson JA, Sandra DA, Colucci ÉS, Al Bikaii A, Chmoulevitch D, Nahas J, et al. Smartphone addiction is increasing across the world: a meta-analysis of 24 countries. Comput Human Behav. 2022; 129:107138.

12. Huckins JF, daSilva AW, Wang W, Hedlund E, Rogers C, Nepal SK, et al. Mental health and behavior of college students during the early phases of the COVID-19 pandemic: longitudinal smartphone and ecological momentary assessment study. J Med Internet Res. 2020; 22(6):e20185. PMID: 32519963.

13. Zhang MX, Chen JH, Tong KK, Yu EW, Wu AM. Problematic smartphone use during the COVID-19 pandemic: its association with pandemic-related and generalized beliefs. Int J Environ Res Public Health. 2021; 18(11):5724. PMID: 34073562.

14. Wang PY, Chen KL, Yang SY, Lin PH. Relationship of sleep quality, smartphone dependence, and health-related behaviors in female junior college students. PLoS One. 2019; 14(4):e0214769. PMID: 30943270.

15. Carter B, Rees P, Hale L, Bhattacharjee D, Paradkar MS. Association between portable screen-based media device access or use and sleep outcomes: a systematic review and meta-analysis. JAMA Pediatr. 2016; 170(12):1202–1208. PMID: 27802500.

16. Zhang MX, Wu AM. Effects of smartphone addiction on sleep quality among Chinese university students: the mediating role of self-regulation and bedtime procrastination. Addict Behav. 2020; 111:106552. PMID: 32717501.

17. Paik SH, Park CH, Kim JY, Chun JW, Choi JS, Kim DJ. Prolonged bedtime smartphone use is associated with altered resting-state functional connectivity of the insula in adult smartphone users. Front Psychiatry. 2019; 10:516. PMID: 31474880.

18. Rod NH, Dissing AS, Clark A, Gerds TA, Lund R. Overnight smartphone use: A new public health challenge? A novel study design based on high-resolution smartphone data. PLoS One. 2018; 13(10):e0204811. PMID: 30325929.

19. Appleton SL, Reynolds AC, Gill TK, Melaku YA, Adams R. Waking to use technology at night, and associations with driving and work outcomes: a screenshot of Australian adults. Sleep (Basel). 2020; 43(8):zsaa015.

20. Zhang C, Zeng P, Tan J, Sun S, Zhao M, Cui J, et al. Relationship of problematic smartphone use, sleep quality, and daytime fatigue among quarantined medical students during the COVID-19 pandemic. Front Psychiatry. 2021; 12:755059. PMID: 34858229.

21. Bhat S, Chokroverty S. Sleep disorders and COVID-19. Sleep Med. 2022; 91:253–261. PMID: 34391672.

22. Deng Y, Ye B, Yang Q. COVID-19 Related emotional stress and bedtime procrastination among college students in china: a moderated mediation model. Nat Sci Sleep. 2022; 14:1437–1447. PMID: 36033906.

23. Meaklim H, Junge MF, Varma P, Finck WA, Jackson ML. Pre-existing and post-pandemic insomnia symptoms are associated with high levels of stress, anxiety, and depression globally during the COVID-19 pandemic. J Clin Sleep Med. 2021; 17(10):2085–2097. PMID: 33985647.

24. Haas JW, Bender FL, Ballou S, Kelley JM, Wilhelm M, Miller FG, et al. Frequency of adverse events in the placebo arms of COVID-19 vaccine trials: a systematic review and meta-analysis. JAMA Netw Open. 2022; 5(1):e2143955. PMID: 35040967.

25. Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience. 2007; 147(2):260–271. PMID: 17379417.

26. Barsky AJ, Saintfort R, Rogers MP, Borus JF. Nonspecific medication side effects and the nocebo phenomenon. JAMA. 2002; 287(5):622–627. PMID: 11829702.

27. Solís Arce JS, Warren SS, Meriggi NF, Scacco A, McMurry N, Voors M, et al. COVID-19 vaccine acceptance and hesitancy in low- and middle-income countries. Nat Med. 2021; 27(8):1385–1394. PMID: 34272499.

28. Webster RK, Weinman J, Rubin GJ. A systematic review of factors that contribute to nocebo effects. Health Psychol. 2016; 35(12):1334–1355. PMID: 27657801.

29. Bhat S, Pinto-Zipp G, Upadhyay H, Polos PG. “To sleep, perchance to tweet”: in-bed electronic social media use and its associations with insomnia, daytime sleepiness, mood, and sleep duration in adults. Sleep Health. 2018; 4(2):166–173. PMID: 29555130.

30. Dissing AS, Andersen TO, Jensen AK, Lund R, Rod NH. Nighttime smartphone use and changes in mental health and wellbeing among young adults: a longitudinal study based on high-resolution tracking data. Sci Rep. 2022; 12(1):8013. PMID: 35570230.

31. Kim J, Kang KW, Kim KT, Cho YW. Prevalence of restless legs syndrome during the 2019 coronavirus disease pandemic in South Korea: a nationwide cross-sectional population-based study. Front Neurol. 2022; 13:1101711. PMID: 36619937.

32. Jung JG, Kim JS, Yoon SJ, Lee S, Ahn SK. Korean alcohol guidelines for primary care physicians. Korean J Fam Pract. 2021; 11(1):14–21.

33. AlShareef SM. The impact of bedtime technology use on sleep quality and excessive daytime sleepiness in adults. Sleep Sci. 2022; 15(Spec 2):318–327.

34. Exelmans L, Van den Bulck J. Bedtime mobile phone use and sleep in adults. Soc Sci Med. 2016; 148:93–101. PMID: 26688552.

35. Thomée S. Mobile phone use and mental health. a review of the research that takes a psychological perspective on exposure. Int J Environ Res Public Health. 2018; 15(12):2692. PMID: 30501032.

36. Kroese FM, Evers C, Adriaanse MA, de Ridder DT. Bedtime procrastination: a self-regulation perspective on sleep insufficiency in the general population. J Health Psychol. 2016; 21(5):853–862. PMID: 24997168.

37. Meng D, Zhao Y, Guo J, Xu H, Fu Y, Ma X, et al. Time perspective and bedtime procrastination: the role of the chronotype-time perspective relationship. Nat Sci Sleep. 2021; 13:1307–1318. PMID: 34335066.

38. Morin CM, Bjorvatn B, Chung F, Holzinger B, Partinen M, Penzel T, et al. Insomnia, anxiety, and depression during the COVID-19 pandemic: an international collaborative study. Sleep Med. 2021; 87:38–45. PMID: 34508986.

39. Doan LP, Nguyen LH, Do HN, Nguyen TT, Vu LG, Do HP, et al. Protecting mental health of young adults in COVID-19 pandemic: roles of different structural and functional social supports. PLoS One. 2022; 17(11):e0276042. PMID: 36331981.

40. Magalhã P, Cruz V, Teixeira S, Fuentes S, Rosário P. An exploratory study on sleep procrastination: Bedtime vs. while-in-bed procrastination. Int J Environ Res Public Health. 2020; 17(16):5862. PMID: 32823500.

41. Scott AJ, Webb TL, Martyn-St James M, Rowse G, Weich S. Improving sleep quality leads to better mental health: a meta-analysis of randomised controlled trials. Sleep Med Rev. 2021; 60:101556. PMID: 34607184.

42. Yasugaki S, Okamura H, Kaneko A, Hayashi Y. Bidirectional relationship between sleep and depression. Neurosci Res. 2023.

43. Chi S, Ko MS, Lee JH, Yi HS, Lee MS. Smartphone usage and sleep quality in Korean middle school students during the COVID-19 pandemic. Psychiatry Investig. 2022; 19(9):722–728.

44. He JW, Tu ZH, Xiao L, Su T, Tang YX. Effect of restricting bedtime mobile phone use on sleep, arousal, mood, and working memory: a randomized pilot trial. PLoS One. 2020; 15(2):e0228756. PMID: 32040492.

45. Fuentes B, Kennedy K, Killgore W, Wills C, Grandner M. 0010 Bed sharing versus sleeping alone associated with sleep health and mental health. Sleep. 2022; 45(Suppl 1):A4.

46. Geers AL, Clemens KS, Faasse K, Colagiuri B, Webster R, Vase L, et al. Psychosocial factors predict COVID-19 vaccine side effects. Psychother Psychosom. 2022; 91(2):136–138. PMID: 34736267.

47. Urakawa R, Isomura ET, Matsunaga K, Kubota K, Ike M. Impact of age, sex and medical history on adverse reactions to the first and second dose of BNT162b2 mRNA COVID-19 vaccine in Japan: a cross-sectional study. BMC Infect Dis. 2022; 22(1):179. PMID: 35197017.

48. Solopov PA. COVID-19 vaccination and alcohol consumption: justification of risks. Pathogens. 2023; 12(2):163. PMID: 36839435.

49. Maeng SJ, Kim KH, Kang JH. The impact of social supports on the excessive alcohol use of the middle-aged adults in South Korea: do all types of social supports have positive effects on excessive alcohol users? Int J Environ Res Public Health. 2022; 19(19):12624. PMID: 36231924.

50. Winskel H, Kim TH, Kardash L, Belic I. Smartphone use and study behavior: a Korean and Australian comparison. Heliyon (Lond). 2019; 5(7):e02158.