Journal Article

Sleep Quality as a Mediator of Internet Gaming Disorder and Executive Dysfunction in Adolescents: Cross-Sectional Questionnaire Study

Moshel, Michoel L, Thomasius, Rainer, Paschke, Kerstin, Warburton, Wayne

2025

Overview

Internet gaming disorder (IGD) has been associated with impairments in executive functioning, particularly inattention and impulsivity. Sleep quality has separately been linked to both gaming behavior and cognitive performance, yet its role as a mediating factor in this relationship is underexplored. This study aimed to determine whether sleep quality mediates the relationship between IGD symptoms and executive dysfunction in adolescents, specifically focusing on the domains of inattention and hyperactivity or impulsivity. A reverse mediation model was also tested to explore the bidirectional nature of these relationships. A representative sample of 1000 adolescents (539/1000, 53.9% males), aged between 12 and 17 years (mean 14.52, SD 1.64), completed validated self-report measures of IGD symptoms, executive dysfunction, and sleep quality. Structural equation modeling was used to test direct and indirect effects with age and gender included as covariates. Of the sample, 2.4% (24/1000) met criteria for IGD (875/1000, 87.5% males), and 22.6% (226/1000) met criteria for chronic sleep reduction. Among those with IGD, 54.2% (542/1000) also experienced chronic sleep reduction. In model A (IGD → Sleep → Executive Dysfunction), IGD symptoms were associated with poorer sleep quality (a=0.32, 95% CI 0.19-0.44), which in turn were associated with greater executive dysfunction (b=0.05, 95% CI 0.01-0.10). The indirect effect was significant (a×b=0.02, 95% CI 0.01-0.04), and sleep quality was a partial mediator. In the reverse model (model B), executive dysfunction was associated with poorer sleep quality (a=0.15, 95% CI 0.06-0.25), which subsequently was associated with higher IGD symptoms (b=0.11, 95% CI 0.07-0.16); indirect effect a×b=0.02, 95% CI 0.01-0.04. Simple slope analysis showed that IGD symptoms were associated only with executive dysfunction at average or poor levels of sleep quality. At higher levels of sleep quality, this relationship was no longer significant. The results of this study suggest that sleep quality may be an important intermediary mechanism by which IGD might contribute to executive dysfunction and provide a basis for the development and implementation of strategies that target sleep issues in IGD. Prospective longitudinal research is needed to examine the directionality of the relationships between IGD, sleep quality, and executive dysfunction longitudinally.

• Publisher: Journal of Medical Internet Research,JMIR Publications
• Subject: Adolescent / Analysis / Child / Clinical Information and Decision Making / Cross-Sectional Studies / Executive Function / Executive function (Psychology) / Female / Health aspects / Humans / Insomnia and Sleep Hygiene / Internet / Internet Addiction Disorder - physiopathology / Internet Addiction Disorder - psychology / Kids' and Adolescents' Use of Technology / Male / Mediation / Methods / Online gambling / Original Paper / Problematic Internet Use, Online Gambling and Game Addiction / Psychological aspects / Screen Time for Children and Adolescents / Sleep / Sleep Medicine / Sleep Monitoring, Sleep Quality, Sleep Disorders / Sleep Quality / Social aspects / Surveys and Questionnaires / Teenagers / Video Games / Youth