Abstract
The alteration in circadian typology and insomnia were prevalent among both Individuals with IGD and those with attention deficit hyperactivity disorder (ADHD), the most comorbid psychiatric disorder of IGD. This study aimed to evaluate the relationships between circadian typologies, insomnia, and internet gaming disorder (IGD) and how ADHD affects this relationship. We recruited three groups of 69 young adults: an IGD group, a control group comprising age- and sex-matched nongamers, and a group of gamers without IGD through diagnostic interviews. The participants with IGD exhibited lower composite scale of morningness (CSM) scores and thus a higher eveningness preference In addition, the score of Pittsburgh insomnia rating scale—20-item version (PIRS_20) was significantly higher among those with IGD. The participants with IGD and ADHD exhibited lower CSM scores but higher PRIS_20 scores than the participants with IGD but without ADHD. The present findings indicate that participants with IGD exhibited a tendency of eveningness preference and experienced more severe insomnia. ADHD exacerbated the eveningness preference and insomnia of individuals with IGD. Close attention should be paid to sleep problems in individuals with IGD, particularly to those with ADHD.
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Introduction
Gaming technology has advanced considerably in recent decades, and the Internet becoming accessible to more people has led to Internet gaming disorder (IGD) becoming a global mental health concern. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) presents criteria for diagnosing IGD1 and the principal symptom is stated as being persistent and recurrent engagement in online gaming leading to impairment or distress that has clinical significance. Excessive Internet gaming has been found by scholars to associate with maladaptive gaming beliefs and to have negative psychological consequences, including problems in interpersonal impairment, and depression2,3,4. Because inadequate or nonrestorative sleep can remarkably reduce a person’s quality of life, understanding the association between IGD and sleep is crucial. Research has indicated that IGD is related to low sleep quality, limited sleep time, and subjective insomnia5,6,7. Insufficient experimental evidence is currently available regarding the sleep patterns of individuals with IGD. Therefore, understanding circadian typologies among individuals with IGD is essential.
Circadian typologies of IGD
The circadian rhythm of individuals is expressed using chronotypes or circadian typologies, which cover a continuum between morningness and eveningness8. Individuals’ preferences for the timings of sleep and wakefulness are classified into the morning, intermediate, and evening types. The sleep–wake schedules of individuals with morningness preference are considerably more regular than those of individuals with eveningness preference9. Circadian rhythmicity is reportedly associated with addiction8. Cross-sectional research has revealed that a significant correlation exists between eveningness preference and increased compulsive Internet usage10,11. Research that involved 532 students revealed mobile phone or computer usage before sleep to be negatively and positively correlated with morningness preference and the late chronotype, respectively12. Moreover, a 1‐year longitudinal study determined that in children and adolescents, disturbed circadian rhythm was prospectively predicted by Internet addiction13. How Internet addiction, electronic media use, and circadian rhythmicity are interconnected has been the subject of much research, but attention has been lacking in regards to the relationship in adults of circadian typology with IGD; thus, research is required on this relationship.
Insomnia in individuals with IGD
Studies have determined how sleep problems are related to social media use on mobile phones4,12,14 and Internet addiction13,15. Lam (2014) reported correlations among sleep problems6, problematic Internet usage, and online gaming addiction in their systematic review. Further, under objective device assessment, gaming or social media use was associated with low physical activity and low sleep quality16. IGD is assumed to be closely related to sleep problems. In numerous cross-sectional studies4,17, IGD has been discovered to be positively correlated with sleep disruption and insomnia. In addition, the amount of time a person spends gaming was found to significantly negatively correlate with insomnia, fatigue, rise time, and bedtime in adults18. Studies have investigated IGD by using nonstandard approaches (such as questionnaires), and this may have led to functional impairment being defined in a limited manner and IGD severity being overestimated. Therefore, the relationship between IGD and insomnia should be evaluated through diagnostic interviews.
Relationships of attention deficit hyperactivity disorder with circadian typologies and insomnia in individuals with IGD
Studies have reported the relationship between IGD and attention deficit hyperactivity disorder (ADHD)19,20,21. Gentile22 found that those exhibiting pathological video-gaming behaviors during adolescence were at 2.77-times higher risk of an ADHD diagnosis than those who did not exhibit such behaviors. Various models have been developed to describe the ADHD–IGD relationship. A positive correlation was found between IGD and ADHD, particularly for the inattention subscale, in the systematic review conducted by Dullur et al.19. Furthermore, sleep and circadian rhythm problems in children and adults with ADHD have attracted research attention. Individuals with ADHD exhibit more frequent circadian and sleep disorders, a delayed circadian rhythm or later chronotype, and a shorter sleep time than those without the disorder23,24. One study identified that circadian rhythm and sleep problems may be causatively related to ADHD25. Thus, ADHD appears to affect the relationships between circadian typologies, insomnia, and IGD. Consequently, a study examining the effects of ADHD on IGD and sleep patterns is required.
Aims of this study
The present study had the following two aims: (1) to examine whether circadian typologies, insomnia, and IGD are correlated in three groups: regular gamers, gamers with IGD, and a control group (nongamers); and (2) to investigate the relationships of ADHD with circadian typologies and insomnia among individuals with IGD. We formulated the following hypotheses: (1) circadian typologies and insomnia are associated with IGD; (2) individuals with IGD experience more severe insomnia and exhibit a stronger tendency for eveningness preference than do those without IGD; and (3) ADHD moderates the relationships between circadian typologies, insomnia, and IGD. In contrast to other relevant studies, a group of regular gamers was included. The inclusion of these individuals made it possible to understand the effects of gaming or addiction to gaming on circadian typologies and insomnia.
Methods
Participants
From April 2017 to February 2018, we placed advertisements on campuses and university bulletin boards to recruit participants, who were placed in one of three groups on the basis of whether they were gamers and had IGD. These groups were a control group (those who did not game online), an IGD group, and a regular gamer group (those who did game online but did not have IGD). The participants in the three groups were matched in terms of age and sex. For the IGD group, the inclusion criteria were as follows: (1) age of 20–38 years and more than 12 years of education; (2) engaging in ≥ 4 h (weekdays) and ≥ 6 h (weekends) per day of online video game activity; and (3) gaming online in a consistent pattern for more than 2 years. This corresponded to more than half of these participants’ free time being spent on online gaming and this pattern having been exhibited for a long duration. A psychiatrist conducted interviews with those who met these criteria and used the DSM-5 diagnostic criteria for IGD1 determine whether they had IGD.
The screening criteria for the control and regular gamer groups as well as the IGD DSM-5-based diagnostic interview process are detailed in Ko et al.26. The diagnostic interviews consisted of (1) the Mini International Neuropsychiatric Interview (Chinese version) to ensure that none of the potential participants had bipolar I disorder, substance abuse disorder, or a psychotic disorder and (2) taking of history to ensure that none had an intellectual disability, brain injury, or a severe physical disorder. This study recruited 69 participants per group, meaning 207 in total. The participants had to provide informed consent to be included26.
Measures
Diagnosis of adult ADHD
A psychiatrist evaluated all the participants for adult ADHD in accordance with the relevant DSM-5 criteria. The psychiatrist determined whether the participants had exhibited various ADHD symptoms prior to the age of 12 years. A participant who fulfilled at least five inattention or hyperactivity and impulsivity criteria received a diagnosis of adult ADHD.
Composite scale of morningness
The Composite Scale of Morningness (CSM) is a Likert-type scale with 13 items and is widely adopted to determine whether an individual has morningness or eveningness preference9. Individuals can be divided into three categories in accordance with their CSM score, which ranges from 13 to 55 (corresponding to extreme eveningness and morningness, respectively): morning type (CSM score ≥ 44), intermediate type (CSM score between 23 and 43); and evening type (CSM score ≤ 22). A higher CSM score indicates a self-perception of an early bedtime and a high level of morning activity. The CSM has a Cronbach’s α value of 0.8727 in the original study and 0.84 in this presenting study.
Pittsburg insomnia rating scale—20-item version
The original version of the Pittsburg Insomnia Rating Scale comprises 60 self-report items; this study used the 20-item version (PIRS_20), which measures daytime and nighttime distress symptoms (12 items); sleep parameters (4 items); and sleep depth, quality, and regularity (4 items) in the preceding week28,29. Each item in the PIRS_20 is scored on a 4-point Likert scale ranging from 0 (not at all bothered) to 3 (severely bothered). The total score is in the range 0–60, and a participant thus had more severe insomnia when there score was higher. We considered a cutoff score of 20 to indicate clinical insomnia28. The test–retest reliability and Cronbach’s alpha of the PIRS_20 are 0.92 and 0.95, respectively30. Its Cronbach’s alpha is 0.94 in this presenting study.
Chen Internet addiction scale—gaming version
The self-report Chen Internet Addiction Scale (CIAS) evaluates the following aspects of Internet addiction: withdrawal, tolerance, time management, compulsive use, and problems with health and interpersonal relationships31. The scale’s 26 items are evaluated on a 4-point Likert scale ranging from 1 to 4. The CIAS—gaming version (CIAS-G) is a modified version of the CIAS that is used to determine to what degree individuals are addicted to online gaming. The Cronbach’s α of the CIAS-G is 0.9632, and the total score varies between 26 and 104. A participant was defined as having more severe IGD when they had a higher CIAS-G score.
After the psychiatrist conducted diagnostic interviews with the participants to identify adult ADHD, the participants completed the CIAS-G, PIRS_20, and CSM.
Statistical analysis
Chi-square analysis was employed to evaluate the association between circadian typologies and IGD was analysed. Fisher's exact test is used when one or more expected numbers in the cell are less than 5. Analysis of variance and Tukey’s honestly significant difference post hoc comparison were used to compare the ages, CSM scores, PIRS_20 scores, and CIAS-G scores of the three groups.
To evaluate the associations of the CSM and PIRS_20 scores with IGD when controlling for sex and age, we employed forward regression analysis. Correlations between the CSM, PIRS_20, and CIAS-G scores were evaluated through Pearson’s analysis.
Independent-samples t tests were used to identify differences in the CSM and PIRS_20 scores between the IGD groups with and without ADHD.
Ethics
The purposes and methods of this research were explained in detail to all the participants, and informed consent was then acquired from them. We obtained approval for the present study from Kaohsiung Medical University Hospital’s Institutional Review Board. All methods were performed in accordance with the relevant guidelines, regulations, and the Declaration of Helsinki. No participant in this study is a minor, whose informed consent must have been obtained from a parent and/or legal guardian.
Results
The final analysis involved all 207 participants. Of these participants, 162 (78.3%) and 45 (21.7%) were men and women, respectively. Each of the three groups comprised 54 men and 15 women.
Analysis of variance revealed the IGD group to have the lowest CSM scores, followed by the regular gamer group and control group (F = 42.40, p < 0.001). These findings thus indicated that the IGD group had a stronger eveningness preference than the remaining participants. The IGD group was found to have significantly more severe insomnia than the remaining participants (F = 40.66, p < 0.001) as well as significantly more severe IGD than the regular gamer and control groups (F = 357.58, p < 0.001; Table 1).
Forward logistic regression analysis of the associations of IGD (the IGD group vs. the control group) with circadian typologies and insomnia was performed (Table 2). The results indicated significant associations of CSM score (Wald χ2 = 19.73; p < 0.001; odds ratio (OR) = 0.84; 95% confidence interval (CI) [0.78, 0.91]) and PIRS_20 score (Wald χ2 = 16.44; p < 0.001; OR = 1.09; 95% CI [1.05, 1.13]) with IGD when controlling for age and sex. This result suggested that the participants with IGD tended to exhibit eveningness preference and insomnia.
How circadian typologies, insomnia, and IGD severity were interrelated in the IGD group was analysed using Pearson’s correlation. In this group, CSM score exhibited a significantly negative correlation with PRIS_20 score (r = − 0.38; p = 0.001), whereas IGD severity exhibited a positive correlation with sleep quality (r = 0.42; p = 0.001).
We thoroughly evaluated the differences in circadian typologies and insomnia severity between those in the IGD group with and without ADHD. The numbers of participants from the IGD group with and without ADHD were 35 and 34, respectively. The ADHD data are detailed in a previous report related to the comorbidities of IGD33.
The CSM and PRIS_20 scores were significantly lower (t = 2.32, p = 0.02, Cohen’s d = 0.56) and significantly higher (t = 2.51, p = 0.02, Cohen’s d = 0.60), respectively, among those with IGD and ADHD than among those with IGD but not ADHD. ADHD was thus concluded to have had exacerbating effects on circadian typologies and insomnia severity in the IGD group (Table 3).
Discussion
The correlations among insomnia, circadian typologies, ADHD, and IGD were investigated in this study. We now describe our main findings. First, the IGD group experienced more severe insomnia than the regular gamer and control groups. Second, the participants with IGD exhibited the tendencies of eveningness preference and poor sleep quality. Third, ADHD exerted exacerbating effects on circadian typologies and insomnia severity in the IGD group.
Relationships among circadian typologies, gaming behavior, and IGD
The regular gamer group exhibited a stronger eveningness preference than did the control group. In several cross-sectional studies, stronger eveningness preference has been discovered to be associated with more frequent Internet or social media use and gaming behavior11,12,34. The blue light emitted by mobile phones and computer screens block melatonin secretion and delay the phases of the circadian clock, thereby resulting in disruption of the circadian time structure35. A study suggested that exciting gaming affects sleep latency and rapid eye movement sleep36. We discovered that gaming behavior contributes to eveningness preference, providing further support to other studies’ findings.
The results also indicated that compared with the regular gamer group, the IGD group exhibited a stronger tendency of eveningness preference (Table 1). In a longitudinal study, Chen and Gau13 found that Internet addiction prospectively predicts disturbance in the circadian rhythm of adolescents and children13. In a systematic review, Kristensen et al.37 reported that problematic gaming has significant associations with nocturnal awakening37, the eveningness chronotype, and delayed sleep phase disorder. Furthermore, the circadian gene plays a role in addiction8. An animal study indicated that rats are more vulnerable to cocaine’s reinforcement effect at midnight than in the morning38. Thus, people who are prone to staying awake and playing video games at midnight could be more vulnerable to the reinforcing pleasure of gaming. We found that gaming behavior and addiction to gaming are associated with eveningness preference, again adding support for other findings.
IGD–insomnia relationship
Individuals who exhibit Internet addiction or pathological Internet usage are more likely to have insomnia as well as to have daytime sleepiness and poor sleep quality6,15. Many cross-sectional studies have reported similar observations regarding IGD, suggesting an association of addictive gaming with sleep disturbances, including less time spent asleep and sleep quality deterioration12,17,39. In agreement with the aforementioned results, the present results indicate that individuals with IGD experience more severe insomnia than do those without IGD (Table 2). Moreover, IGD severity is positively correlated with insomnia (Table 3). This finding is consistent with the evidence that higher IGD severity is associated with higher insomnia severity4. Sleep displacement may be the mechanism underlying the IGD– insomnia association. IGD may cause a reduction in sleep duration, daytime sleepiness, or sleep deprivation39, all of which subsequently lead to insomnia and desynchronization35. The duration of playing a video game is negatively correlated with sleep quality5. In addition, exposure to bright light before sleep causes the production of melatonin to be suppressed in the human body, which can contribute to delayed sleep onset40. Thus, excessive engagement in Internet gaming may lead to insomnia.
On the other hand, psychiatric comorbidity, such as depressive or anxiety disorder, is associated with GD33. For example, problematic gaming has been reported to associate with depression and stress41. Further, both stress42 and depression43 could contribute to insomnia. Thus, psychiatric comorbidity might play an interplay role between GD and insomnia and should be an important issue in future studies to understand the association between GD and insomnia.
Effects of ADHD on the circadian typologies and insomnia severity of those with IGD
According to the results presented herein, ADHD has exacerbating effects on circadian typologies and insomnia in those with IGD. Systematic reviews confirmed that IGD is positively correlated with the inattention subscale of the ADHD scale19 or hyperactivity symptoms20. Individuals with ADHD have been discovered to exhibit a shorter sleep time, a later chronotype or delayed circadian rhythm, and more frequent circadian and sleep disorders compared with those without ADHD23,24,44. A study found that in a subgroup of patients with ADHD, circadian rhythm played a causative role in issues with sleep23,25. Online gaming has been associated in one previous study with volume changes in the ventral striatum, which is a crucial brain region that implements the brain’s reward mechanisms, as well as with changes in brain regions that have been found to participate in impulse control, sensory-motor coordination, attention and control, emotional regulation, and motor functions45. Online gaming was suggested by Park et al.21 to possibly be a method of self-medication for patients with IGD and attentional problems21. The complex sleep–ADHD relationship may be related to neuroanatomical and functional overlap between regions of the brain that participate in sleep regulation, arousal, and attention46. In addition, ADHD and delayed circadian rhythm may be associated with genetics and have a shared etiology24. Because ADHD exerts exacerbating effects on circadian typologies and insomnia severity in those with IGD, the sleep problems and ADHD symptoms of adults with IGD should be carefully evaluated in clinical settings.
Limitations
Regarding this study’s limitations, first, inadequate statistical power was achieved because of the small sample, which was caused by the strict inclusion criteria. Second, only the data from diagnostic interviews and questionnaire surveys were analysed. The use of questionnaires may have resulted in the severity of various factors being underestimated. Third, this study involved cross-sectional research; thus, understanding causes and effects was difficult. Last, the severity of IGD is assessed by the CIAS-gaming version, but not by international scales, such as Internet Gaming Disorder Test (IGDT-10)47, Internet Gaming Disorder Scale-Short Form (IGDS9-SF)48, and Gaming Disorder Test (GDT)49. Evaluating this presenting topic by using an international scale might contribute to the comparison between different regions over the world.
Conclusion
In this study, we discovered that adults with IGD were more likely to experience eveningness and insomnia compared with regular gamers and the controls. Moreover, ADHD was found to exert exacerbating effects on circadian typologies and insomnia severity in those with IGD. If effective interventions are to be designed for individuals with IGD, scholars should investigate this disorder from various perspectives. Strategies implemented for early IGD intervention are critical for improving sleep problems. Future studies can adopt different perspectives to overcome the limitations of the present study, such as casual relationships, and thus discover directions for IGD interventions.
Data availability
The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.
References
American Psychiatric Association D.-T. F. Diagnostic and Statistical Manual of Mental Disorders: DSM-5™ 5th edn. (American Psychiatric Publishing Inc., 2013).
Kakul, F. & Javed, S. Internet gaming disorder: An interplay of cognitive psychopathology. Asian J. Soc. Health Behav. 6, 36–45 (2023).
Stetina, B. U., Kothgassner, O. D., Lehenbauer, M. & Kryspin-Exner, I. Beyond the fascination of online-games: Probing addictive behavior and depression in the world of online-gaming. Comput. Hum. Behav. 27, 473–479. https://doi.org/10.1016/j.chb.2010.09.015 (2011).
Wong, H. Y. et al. Relationships between severity of internet gaming disorder, severity of problematic social media use, sleep quality and psychological distress. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph17061879 (2020).
Akçay, D. & Akçay, B. D. The effect of computer game playing habits of university students on their sleep states. Perspect. Psychiatr. Care 56, 820–826. https://doi.org/10.1111/ppc.12497 (2020).
Lam, L. T. Internet gaming addiction, problematic use of the internet, and sleep problems: A systematic review. Curr. Psychiatry Rep. 16, 444. https://doi.org/10.1007/s11920-014-0444-1 (2014).
Sugaya, N., Shirasaka, T., Takahashi, K. & Kanda, H. Bio-psychosocial factors of children and adolescents with internet gaming disorder: A systematic review. Biopsychosoc. Med. 13, 3. https://doi.org/10.1186/s13030-019-0144-5 (2019).
Adan, A. et al. Circadian typology: A comprehensive review. Chronobiol. Int. 29, 1153–1175. https://doi.org/10.3109/07420528.2012.719971 (2012).
Levandovski, R., Sasso, E. & Hidalgo, M. P. Chronotype: A review of the advances, limits and applicability of the main instruments used in the literature to assess human phenotype. Trends Psychiatry Psychother. 35, 3–11. https://doi.org/10.1590/S2237-60892013000100002 (2013).
Przepiorka, A., Blachnio, A. & Cudo, A. Relationships between morningness, Big Five personality traits, and problematic Internet use in young adult university students: Mediating role of depression. Chronobiol. Int. 38, 248–259. https://doi.org/10.1080/07420528.2020.1851703 (2021).
Lin, Y.-H. & Gau, S.S.-F. Association between morningness–eveningness and the severity of compulsive Internet use: The moderating role of gender and parenting style. Sleep Med. 14, 1398–1404. https://doi.org/10.1016/j.sleep.2013.06.015 (2013).
Fossum, I. N., Nordnes, L. T., Storemark, S. S., Bjorvatn, B. & Pallesen, S. The association between use of electronic media in bed before going to sleep and insomnia symptoms, daytime sleepiness, morningness, and chronotype. Behav. Sleep Med. 12, 343–357. https://doi.org/10.1080/15402002.2013.819468 (2014).
Chen, Y. L. & Gau, S. S. Sleep problems and internet addiction among children and adolescents: A longitudinal study. J. Sleep Res. 25, 458–465. https://doi.org/10.1111/jsr.12388 (2016).
Levenson, J. C., Shensa, A., Sidani, J. E., Colditz, J. B. & Primack, B. A. The association between social media use and sleep disturbance among young adults. Prev. Med. 85, 36–41. https://doi.org/10.1016/j.ypmed.2016.01.001 (2016).
Alimoradi, Z. et al. Internet addiction and sleep problems: A systematic review and meta-analysis. Sleep Med. Rev. 47, 51–61. https://doi.org/10.1016/j.smrv.2019.06.004 (2019).
Kwok, C., Leung, P. Y., Poon, K. Y. & Fung, X. C. The effects of internet gaming and social media use on physical activity, sleep, quality of life, and academic performance among university students in Hong Kong: A preliminary study. Asian J. Soc. Health Behav. 4, 36–44. https://doi.org/10.4103/shb.shb_81_20 (2021).
Altintas, E., Karaca, Y., Hullaert, T. & Tassi, P. Sleep quality and video game playing: Effect of intensity of video game playing and mental health. Psychiatry Res. 273, 487–492. https://doi.org/10.1016/j.psychres.2019.01.030 (2019).
Exelmans, L. & Van den Bulck, J. Sleep quality is negatively related to video gaming volume in adults. J. Sleep Res. 24, 189–196. https://doi.org/10.1111/jsr.12255 (2015).
Dullur, P., Krishnan, V. & Diaz, A. M. A systematic review on the intersection of attention-deficit hyperactivity disorder and gaming disorder. J. Psychiatr. Res. 133, 212–222. https://doi.org/10.1016/j.jpsychires.2020.12.026 (2021).
González-Bueso, V. et al. Association between internet gaming disorder or pathological video-game use and comorbid psychopathology: A comprehensive review. Int. J. Environ. Res. Public Health https://doi.org/10.3390/ijerph15040668 (2018).
Park, J. H. et al. Comparison of QEEG findings between adolescents with attention deficit hyperactivity disorder (ADHD) without comorbidity and ADHD comorbid with internet gaming disorder. J. Korean Med. Sci. 32, 514–521. https://doi.org/10.3346/jkms.2017.32.3.514 (2017).
Gentile, D. Pathological video-game use among youth ages 8 to 18: A national study. Psychol. Sci. 20, 594–602. https://doi.org/10.1111/j.1467-9280.2009.02340.x (2009).
Bijlenga, D., Vollebregt, M. A., Kooij, J. J. S. & Arns, M. The role of the circadian system in the etiology and pathophysiology of ADHD: Time to redefine ADHD?. ADHD Atten. Deficit Hyperact. Disord. 11, 5–19. https://doi.org/10.1007/s12402-018-0271-z (2019).
Coogan, A. N. & McGowan, N. M. A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder. ADHD Atten. Deficit Hyperact. Disord. 9, 129–147. https://doi.org/10.1007/s12402-016-0214-5 (2017).
Arns, M. & Kenemans, J. L. Neurofeedback in ADHD and insomnia: Vigilance stabilization through sleep spindles and circadian networks. Neurosci. Biobehav. Rev. 44, 183–194. https://doi.org/10.1016/j.neubiorev.2012.10.006 (2014).
Ko, C. H., Lin, H. C., Lin, P. C. & Yen, J. Y. Validity, functional impairment and complications related to Internet gaming disorder in the DSM-5 and gaming disorder in the ICD-11. Aust. N. Z. J. Psychiatry 54, 707–718. https://doi.org/10.1177/0004867419881499 (2020).
Smith, C. S., Reilly, C. & Midkiff, K. Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. J. Appl. Psychol. 74, 728–738. https://doi.org/10.1037/0021-9010.74.5.728 (1989).
Moul, D., Pilkonis, P., Miewald, J., Carey, T. & Buysse, D. Preliminary study of the test-retest reliability and concurrent validities of the Pittsburgh Insomnia Rating Scale (PIRS). Sleep 25, A246–A247 (2002).
Moul, D. et al. Psychometric study of the Pittsburgh Insomnia Rating Scale (PIRS) in an initial calibration sample. Sleep 30, A343–A343 (2007).
Sateia, M. J. & Buysse, D. Insomnia: Diagnosis and Treatment (CRC Press, 2016).
Chen, S.-H., Weng, L.-J., Su, Y.-J., Wu, H.-M. & Yang, P.-F. Development of a Chinese Internet addiction scale and its psychometric study. Chin. J. Psychol. (2003).
Ko, C.-H., Yen, J.-Y., Chen, C.-C., Chen, S.-H. & Yen, C.-F. Gender differences and related factors affecting online gaming addiction among Taiwanese adolescents. J. Nerv. Ment. Dis. 193, 273–277 (2005).
Ko, C. H. et al. Psychiatric comorbidities and emotional intelligence in internet gaming disorder: Attention deficit hyperactivity disorder, major depressive disorder, generalized anxiety disorder, and social anxiety disorder. Psychiatry Clin. Neurosci. 75, 352–354. https://doi.org/10.1111/pcn.13295 (2021).
Lin, C. Y. et al. Temporal associations between morningness/eveningness, problematic social media use, psychological distress and daytime sleepiness: Mediated roles of sleep quality and insomnia among young adults. J. Sleep Res. 30, e13076. https://doi.org/10.1111/jsr.13076 (2021).
Touitou, Y., Touitou, D. & Reinberg, A. Disruption of adolescents’ circadian clock: The vicious circle of media use, exposure to light at night, sleep loss and risk behaviors. J. Physiol. 110, 467–479. https://doi.org/10.1016/j.jphysparis.2017.05.001 (2016).
Higuchi, S., Motohashi, Y., Liu, Y. & Maeda, A. Effects of playing a computer game using a bright display on presleep physiological variables, sleep latency, slow wave sleep and REM sleep. J. Sleep Res. 14, 267–273. https://doi.org/10.1111/j.1365-2869.2005.00463.x (2005).
Kristensen, J. H., Pallesen, S., King, D. L., Hysing, M. & Erevik, E. K. Problematic gaming and sleep: A systematic review and meta-analysis. Front. Psychiatry 12, 675237. https://doi.org/10.3389/fpsyt.2021.675237 (2021).
Baird, T. J. & Gauvin, D. V. Characterization of cocaine self-administration and pharmacokinetics as a function of time of day in the rat. Pharmacol. Biochem. Behav. 65, 289–299. https://doi.org/10.1016/S0091-3057(99)00207-5 (2000).
Achab, S. et al. Massively multiplayer online role-playing games: Comparing characteristics of addict vs non-addict online recruited gamers in a French adult population. BMC Psychiatry 11, 144. https://doi.org/10.1186/1471-244X-11-144 (2011).
van der Lely, S. et al. Blue blocker glasses as a countermeasure for alerting effects of evening light-emitting diode screen exposure in male teenagers. J. Adolesc. Health 56, 113–119. https://doi.org/10.1016/j.jadohealth.2014.08.002 (2015).
Lee, K. Y. et al. Exploring mediational roles for self-stigma in associations between types of problematic use of internet and psychological distress in youth with ADHD. Res. Dev. Disabil. 133, 104410. https://doi.org/10.1016/j.ridd.2022.104410 (2023).
Kalmbach, D. A., Anderson, J. R. & Drake, C. L. The impact of stress on sleep: Pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J. Sleep Res. 27, e12710. https://doi.org/10.1111/jsr.12710 (2018).
Franzen, P. L. & Buysse, D. J. Sleep disturbances and depression: risk relationships for subsequent depression and therapeutic implications. Dialogues Clin. Neurosci. 10, 473–481. https://doi.org/10.31887/DCNS.2008.10.4/plfranzen (2008).
Um, Y. H., Hong, S. C. & Jeong, J. H. Sleep problems as predictors in attention-deficit hyperactivity disorder: Causal mechanisms consequences and treatment. Clin. Psychopharmacol Neurosci. 15, 9–18. https://doi.org/10.9758/cpn.2017.15.1.9 (2017).
Weinstein, A., Livny, A. & Weizman, A. New developments in brain research of internet and gaming disorder. Neurosci. Biobehav. Rev. 75, 314–330. https://doi.org/10.1016/j.neubiorev.2017.01.040 (2017).
Owens, J. A. Sleep disorders and attention-deficit/hyperactivity disorder. Curr. Psychiatry Rep. 10, 439–444. https://doi.org/10.1007/s11920-008-0070-x (2008).
Király, O. et al. Validation of the ten-item Internet Gaming Disorder Test (IGDT-10) and evaluation of the nine DSM-5 Internet Gaming Disorder criteria. Addict. Behav. 64, 253–260. https://doi.org/10.1016/j.addbeh.2015.11.005 (2017).
Poon, L. Y. J. et al. Psychometric properties of the internet gaming disorder scale-short-form (IGDS9-SF): Systematic review. J. Med. Internet Res. 23, e26821. https://doi.org/10.2196/26821 (2021).
Pontes, H. M. et al. Measurement and conceptualization of gaming disorder according to the world health organization framework: The development of the Gaming Disorder Test. Int. J. Ment. Health Addict. 19, 508–528. https://doi.org/10.1007/s11469-019-00088-z (2021).
Funding
Funding was provided by Kaohsiung Municipal Siaogang Hospital (H-109-004, H-110-006), Ministry of Science and Technology, Taiwan (MOST109-2314-B-037-081, MOST109-2629-B-037-001-MY3, MOST110-2314-B-037-062)
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Y.-J.L. drafted the manuscript. P.-C.L. and H.-Y.L. acquired and analyzed the data. J.-Y.Y. interpreted the data and contributes to the final draft. C.-H.K. designed this study and provided the final approval for the version to be published.
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Lin, Y.J., Yen, JY., Lin, PC. et al. Circadian typologies and insomnia in individuals with internet gaming disorder comorbid with attention deficit/hyperactivity disorder. Sci Rep 13, 12764 (2023). https://doi.org/10.1038/s41598-023-39462-2
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DOI: https://doi.org/10.1038/s41598-023-39462-2
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