Khalifa et al.

Middle East Current Psychiatry (2023) 30:97 Middle East Current

https://doi.org/10.1186/s43045-023-00371-9
Psychiatry

RESEARCH Open Access

The impact of smartphone addiction

on attention control and sleep in Egypt—an
online survey
Dalia Khalifa1, Rehab Magdy2, Doaa Mahmoud Khalil3, Mona Hussein4, Ahmed Yehia Ismaeel5,
Shaden Adel1, Nadine Abdelhamied6, Mohamed Adel Abdeltwab7, Mazen Eltaweel8, Alaa M. Essam4,
Amira Hassan3, Mona Ali4, Esraa Mohamed Naguib6, Samar Fares9, Hadeer Mohammed Abd El‑Aziz2,
Alzahraa Ghareeb Eweis10, Sara Desouki11 and Mennat‑Allah Tarek1*   

Abstract
Background The widespread use of smartphones makes it imperative for researchers to study the adverse effect
of smartphone addiction. We aimed to study the risk factors of smartphone addiction, insomnia, and attention deficit
among smartphone users among a sample of Egyptian adolescents and adults.
Methods An online survey was disseminated among Egyptian social media groups. Participants were requested
to complete Smartphone Addiction Scale-Short Version (SAS-SV), Insomnia Severity Index (ISI) scale, and attention
control scale (ACS).
Results Two-thousand seven-hundred sixteen responded to our survey with a mean age of 31.4 ± 10.3 years. Smart‑
phone addiction was documented in 2386 (87.8%) participants, with a median daily time for smartphone use of 5 h
(IQR: 3–7). A significant association was found between smartphone addiction and younger age, higher educational
levels, and urban residency (unadjusted or adjusted). Binary logistic regression analysis showed that the only factor
affecting the probability of moderate to severe insomnia was the higher SAS-SV score, either unadjusted (OR = 1.1,
95% CI: 1.08–1.1) or adjusted (OR = 1.09, 95% CI: 1.08–1.11). Multiple linear regression analysis showed that higher
scores on SAS-SV (P < 0.001) and ISI (P < 0.001), being female (P < 0.001), and being of rural residency (P = 0.025)
were associated with lower total scores on ACS. On the other hand, older age (P < 0.001) and longer intervals
between smartphone cessation and bedtime (P = 0.004) were found to increase the attention score.
Conclusion Smartphone addiction is prevalent in Egypt, which deserves special concern as it may have negative
consequences such as insomnia and poor attention control, particularly in younger age groups.
Keywords Smartphone addiction, Insomnia, Attention control

*Correspondence:
Mennat‑Allah Tarek
[email protected]
Full list of author information is available at the end of the article

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which
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Khalifa et al. Middle East Current Psychiatry (2023) 30:97 Page 2 of 8

Background beginning of the survey. It took about 10 to 15 min to

The great development in the hardware and software of answer the questionnaire.
smartphones has become beyond imagination. Mod- The first section included questions about sociode-
ern smartphones combine the functions of digital cam- mographic data such as age, gender, education, and
eras, portable media players, and GPS navigation units. medical history. The second section was about smart-
The recent generations of smartphones have the tasks phone use in which Smartphone Addiction Scale-Short
of high-resolution touch screens and web browsers that Version (SAS-SV) was demonstrated. Three additional
can easily display standard web pages. One can simply questions were included in the second section, includ-
access any information he wants at any place or time. It ing daily time spent on smartphones in hours, the
has many other advantages, such as entertainment, social interval between smartphone cessation and bedtime
media access, and health monitoring. So, many people in minutes, and, finally, choosing which applications
became extremely interested in owning smartphones [1]. the participant spends the most time on: social media,
In 2019, Apple and Google collectively announced that games, or videos. The third section included the Insom-
there were more than 3.4 billion Apple or Google smart- nia Severity Index and attention control scale.
phone users [2].
Smartphone addiction was uniquely emphasized in
research as being especially concerning. Generally, it Smartphone Addiction Scale‑Short Version (SAS‑SV) [11]
is more or less similar to Internet addiction. It has four The SmartphoneAddiction Scale-Short Version is
main components: compulsive behaviors, tolerance, widely used to measure smartphone addiction. It was
functional impairment, and withdrawal [3]. A study con- developed by Kwon et al. [11] and consisted of 10 items
ducted in Riyadh on 2367 university students revealed describing the problematic use of smartphones. Each
that 27.2% of the participants spent more than 8 h daily question is answered on a 6-point scale ranging from
using their smartphones [4]. In another Lebanese study 1 = “strongly disagree” to 6 = “strongly agree.” An exam-
conducted on 688 university students, about 49% of the ple question is “ I will never give up using my smart-
participants reported smartphone use more than 5 h per phone even when my daily life is greatly affected by it.”
day [5]. A sum score is between 10 and 60, with higher scores
Problematic attachment to smartphones was associ- indicating higher smartphone addiction. Cutoff scores
ated with poor social engagement [6]. Laramie (2007) are set at 31/60 for men and 33/60 for women to indi-
reported that excessive reliance on mobile phones was cate the presence of smartphone addiction [11]. SAS-
associated with social anxiety [7]. Additionally, smart- SV has been proven reliable and valid in the Arabic
phone addiction was found to be related to multiple population [12].
psychopathological disorders, including anxiety, depres-
sion, and poor sleep quality [8, 9]. Furthermore, excessive
smartphone was reported to negatively impact cognitive Insomnia Severity Index (ISI) scale [13]
function, especially attention [10]. The insomnia severity index is a self-report measure for
This work aimed to investigate the risk factors of smart- insomnia formed of seven questions that assess the dif-
phone addiction among a sample of Egyptian adolescents ferent components of insomnia, including the follow-
and adult smartphone users. The second objective was ing: (1) falling asleep problems, (2) interrupted sleep,
to study the risk factors of insomnia and attention deficit (3) early awaking, (4) sleep satisfaction, (5) functional
among smartphone users. impairment due to sleep problems, (6) how noticeable
to others, and (7) emotional distress. Each question is
answered using a 5-point scale ranging from 0 (none) to
Methods 4 (very severe). Total scores range from 0 to up to 28, and
A cross-sectional online questionnaire survey was con- the higher scores indicate increasing severity of symp-
ducted using different social network applications from toms (scores 0–7 denotes an absence of insomnia, 8–14
5th January 2023 until 5th April 2023. A Google Form, for sub-threshold insomnia, 15–21 for moderate insom-
divided into three sections, was disseminated among nia, and 22–28 for severe insomnia) [13]. The ISI is used
Egyptian groups on Facebook and WhatsApp applica- in screening and diagnosis, according to the criteria for
tions. Adolescents and adults were only allowed to par- insomnia in the Diagnostic and Statistical Manual of
ticipate in the survey. Participants under 12 years old Mental Disorders, Fourth Edition (DSM-IV) and Inter-
and those suffering from chronic medical illness were national Classification of Sleep Disorders (ICSD). It also
requested to omit the survey. The purpose, background showed good reliability and validity among the Arab pop-
of the survey, and data consent were provided at the ulation [14].
Khalifa et al. Middle East Current Psychiatry (2023) 30:97 Page 3 of 8

Attention control scale (ACS) [15] Results

Attentional control was measured by attention control This study included 2716 participants with a mean age
scale. The scale consists of 20 items that assess the ability of 31.4 ± 10.3 years. The majority of participants were
to control attention, resist distraction, and put attentional females (75.5%), more than half of the participants were
priorities. It includes two main components: attention university graduates, and urban residents were 77.9% of
focusing (9 items) and attention shifting (11 items). Each the participants (Table 1).
item was rated on a 4-point scale ranging from 1 = “not The total score on SAS-SV was 40.9 ± 7.6. Smart-
at all” to 4 = “always” in which the higher scores indicate phone addiction was documented in 2386 (87.8%) par-
more attentional control (9). The scale was found to have ticipants, and the median time spent on smartphones
sufficient internal reliability and predictive utility [16] was 5 (IQR: 3–7). The median interval between smart-
and has also shown good validity [17]. phone cessation and bedtime was 15 (IQR: 0–15) min.
The commonest used applications were social media
(66.4%), followed by games (30%), and then videos
Ethical statement (3.5%). This study showed a significant association
All participants were provided with their electronic between smartphone addiction and younger age, higher
informed consent before participating in the study. This educational levels, and urban residence, either unad-
study was approved by the ethical committee of the Fac- justed or adjusted for each (Table 2).
ulty of Medicine, Beni-Suef University, number FMB- The median insomnia severity index score was 10
SUREC/04012023/Khalil, following the Declaration of (IQR: 6–14); it was absent in 863 (31.8%), subthreshold
Helsinki and the Cdes of Federal Regulations with no. in 1256 (46.2%), moderate in 544 (20.0%), and severe in
FWA00015574. 53 (2.0%). Binary logistic regression analysis (adjusted
and unadjusted) for predicting risk factors for insom-
nia showed that the only factor affecting the probability
Sample size calculation of moderate to severe insomnia was the higher smart-
The sample size was calculated using EpiCalc 2000, ver- phone addition score, either adjusted or unadjusted.
sion 1.02, 1997, based on a 59.57% prevalence rate of Still, the interval between smartphone cessation and
smartphone addiction [18] and an alpha level of signifi- bedtime was only associated with moderate to severe
cance of 0.05. To test a null hypothesis of 64%, a total insomnia in univariate analysis (Table 3).
sample size of at least 2213 participants was required to The mean total score of the attention control scale
achieve a statistical power of 99%. After adding 20% to was 49.7 ± 6.7. The mean score of attention-focusing
compensate for potential nonresponse, the minimum domain was 21.9 ± 4.5, while the mean score of atten-
required sample size was estimated at 2657. tion-shifting domain was 27.9 ± 3.8. The correlations
between the total scores of ACS and its two domains
with other scores are presented in Table 4.
Statistical analysis
We used SPSS to present the scale variables with nor-
mal distribution as mean and standard deviation and the
non-normally distributed variables as median and inter-
quartile range. The categorical variables were presented Table 1 Baseline characteristics of the studied participants
as frequency and relative frequency (%). The unadjusted Characteristics Values (n = 2716) (n, %)
odds ratio was calculated using univariate binary logis-
tic regression analysis and the chi-squared test, while Age (mean ± SD) 31.4 ± 10.3
the adjusted models were done using multivariable Sex
binary logistic regression analysis. Comparison between Male 666 (24.5%)
the studied subgroups regarding the scale variables was Female 2050 (75.5%)
reported using an independent T-test for parametric data Education
and a Mann–Whitney U-test for nonparametric data. Until preparatory 54 (2.0%)
Linear correlation was done to detect the correlation Secondary 223(8.2%)
between the ACS score and the other scores, and then University 1583 (58.3%)
multiple linear regression analysis was done for adjust- Postgraduate 856 (31.5%)
ment for age, sex, residence, and education in the pres- Residence
ence of the studied scores. The P-value was considered Urban 2116 (77.9%)
significant at less than 0.05. Rural 600 (22.1%)
Khalifa et al. Middle East Current Psychiatry (2023) 30:97 Page 4 of 8

Table 2 Binary logistic regression analysis (adjusted and unadjusted) for prediction of risk factors for smartphone addiction
Characteristics Nonaddict (n = 330) Addict (n = 2386) Unadjusted OR Adjusted OR

Age (mean ± SD) 33.4 ± 12.7 31.1 ± 9.9 0.98 (0.97 ± 0.99)* 0.97 (0.96–0.98)*
Sex
Male 78 (11.7%) 588 (88.3%) Reference Reference
Female 252 (12.3%) 1798 (87.7%) 0.9 (0.7–1.2) 0.87 (0.66–1.1)
Education
Until preparatory 15 (27.8%) 39 (72.2%) Reference Reference
Secondary 47 (21.1%) 176 (78.9%) 1.4 (0.7–2.8) 2 (0.99–4.1)
University 175 (11.1%) 1408 (88.9%) 3.1 (1.7–5.7)* 4.5 (12.3–8.5)*
Postgraduate 93 (10.9%) 763 (89.1%) 3.2 (1.7–5.9)* 5.3 (2.7–10.3)*
Residence
Urban 243 (11.5%) 1873 (88.5%) 1.3 (1.004–1.7)* 1.5 (1.1–1.9)*
Rural 87 (14.5%) 513 (85.5%) Reference Reference
*
P-value is significant

Table 3 Binary logistic regression analysis (adjusted and unadjusted) for prediction of risk factors for insomnia
Characteristics No and subthreshold Moderate and severe Unadjusted Adjusted
(n = 2119) (n = 597) OR OR

Age (mean ± SD) 31.7 ± 10.4 30.5 ± 9.7 0.989 (0.980–0.998)* 0.996 (0.986–1.007)
Sex
Male 541 (81.2%) 125 (18.8%) Reference Reference
Female 1578 (77.0%) 472 (23.0%) 1.3 (1.03–1.6) 1.1 (0.89–1.4)
Education
Until preparatory 44 (81.5%) 10 (18.5%) Reference Reference
Secondary 170 (76.2%) 53 (23.8%) 1.4 (0.6–2.9) 1.4 (0.6–2.9)
University 1224 (77.3%) 359 (22.7%) 1.3 (0.6–2.6) 1.02 (0.5–2.2)
Postgraduate 681 (79.6%) 175 (20.4%) 1.1 (0.6–2.3) 0.94 (0.4–2.0)
Residence
Rural 477 (79.5%) 123 (20.5%) Reference Reference 1.1 (0.9–1.4)
Urban 1642 (77.6%) 474 (22.4%) 1.1 (0.9–1.4)
SAS-SV (mean ± SD) 39.9 ± 7.5 44.9 ± 7 1.1 (1.08–1.1)* 1.09 (1.08–1.11)*
Interval between smartphone cessa‑ 15 (0–15) 0 (0–15) 0.993 (0.989–0.997)* 0.999 (0.995–1.003)
tion and bedtime
Median (IQR)
Most used applications
Social media 1409 (78.1%) 395 (21.9%) Reference Reference
Videos 77 (80.2%) 19 (19.8%) 0.9 (0.5–1.5) 1.2 (0.67, 1.9)
Games 633 (77.6%) 183 (22.4%) 1.03 (0.8–1.3) 1.1 (0.9, 1.4)
Time spent on the smartphone (hours)
Median (IQR) 5 (3.6) 6 (4.8) 1.1 (1.1–1.2)* ––––––
SAS-SV Smartphone Addiction Scale-Short Version
*
P-value is significant

Multiple linear regression analysis for predicting associated with lower total scores on ACS. On the other
risk factors affecting the total score of the ACS showed hand, older age and longer intervals between smartphone
that higher smartphone addiction, higher insomnia cessation and bedtime were found to increase the atten-
score, being female, and being of rural residency were tion score (Table 5).
Khalifa et al. Middle East Current Psychiatry (2023) 30:97 Page 5 of 8

Table 4 Correlation between the scores of attention domains and its total score with the other scores
Independent variables Attention shifting Attention focusing Attention total score
r p-value r p-value r p-value

SAS-SV total score − 0.105 < 0.001* − 0.379 < 0.001* − 0.305 < 0.001*
Time spent on smartphone − 0.013 0.507 − 0.158 < 0.001* − 0.111 < 0.001*
Interval between smartphone cessa‑ 0.072 < 0.001* 0.148 < 0.001* 0.136 < 0.001*
tion and bedtime
ISI total score − 0.142 < 0.001* − 0.330 < 0.001* − 0.292 < 0.001*
SAS-SV Smartphone Addiction Scale-Short Version, ISI Insomnia Severity Index scale
*
P-value is significant

Table 5 Multiple linear regression analysis for prediction of risk factors affecting the total attention score
Unstandardized coefficients t p-value 95.0% confidence interval for B
B Std. error Lower bound Upper bound

Constant 58.996 0.918 64.248 < 0.001* 57.195 60.796

Total score of SAS-SV − 0.189 0.018 − 10.474 < 0.001* − 0.224 − 0.154
Interval between smart‑ 0.014 0.005 2.890 0.004* 0.004 0.023
phone cessation and bed‑
time
Total score ISI − 0.263 0.025 − 10.437 < 0.001* − 0.313 − 0.214
Age (years) 0.046 0.013 3.572 < 0.001* 0.021 0.072
Female sex − 1.013 0.290 − 3.496 < 0.001* − 1.582 − 0.445
Educated participants 0.550 0.422 1.301 0.193 − 0.279 1.378
from university and above
Rural residence − 0.700 0.312 − 2.240 0.025* − 1.312 − 0.087
SAS-SV Smartphone Addiction Scale-Short Version, ISI Insomnia Severity Index scale
*
P-value is significant. Dummy variables for sex, education, and residence were done. Female was coded as 1, education from university and above was coded as 1,
and rural residence was coded as 1

Discussion appear more dependent on their smartphones for daily

As far as we know, this is the largest study investigating duties [23]. They also spend most of their smartphone
the relation of smartphone addiction with insomnia and time on gaming and social media apps that can help to
attention among the general Egyptian population. meet some of the needs that are often satisfied through
The current study shows that 87.8% of the participants friendships, which decrease the necessity for in-person
are smartphone addicts; this percentage is higher than interactions with peers [24], and finally, compared to
previous Egyptian and Middle Eastern studies, which older age groups, they are more receptive to embracing
demonstrated that the prevalence of smartphone addic- new technologies [11].
tion was 59.6% and 71% consecutively [18, 19]. The dif- Contrary to this finding, other studies revealed that
ference between the smartphone addiction percentage in older people are likelier to be smartphone addicts [25,
the current study and those studies may be due to the dif- 26]. Lane [25] also found that a high educational level
ference in the target group. Both targeted a special popu- predicts smartphone addiction, similar to our research
lation (university students), while we targeted a general findings. This can be attributed to increased stress related
population sample. to studying, which mediates smartphone addiction [27],
This study found that smartphone addiction is signifi- and people with higher educational levels tend to plan
cantly higher among younger age groups, which aligns academic activities through smartphones [28]. However,
with many studies that stated a significant negative cor- a study by Luk et al. [29] found a lower risk of smartphone
relation between age and smartphone addiction [20, 21]. addiction in subjects with higher levels of education.
The increased smartphone use time in adolescence and Furthermore, we discovered a significant association
early adulthood, which may lead to problematic use, between high smartphone addiction and insomnia, indi-
can be explained by a lack of parental supervision and cating that smartphone addiction raises the likelihood of
guidance at this age [22]; they have less self-control and developing insomnia. This research finding is supported
Khalifa et al. Middle East Current Psychiatry (2023) 30:97 Page 6 of 8

by many studies which suggested that insomnia and mul- and communication apps, which make them more dis-
tiple sleep awakening, excessive daytime sleepiness, and tracted by voice calls and apps notifications, unlike men
poor sleep quality were adverse effects of smartphone who spend most of their smartphone time in playing
addiction [30–32]. games and watching movies [45].
Although the exact cause of the connection between The current study also revealed that short intervals
smartphone addiction and insomnia is not entirely between smartphone cessation and bedtime and high
understood, several possible explanations exist. For scores on ISI are risk factors for poor attention control,
example, excessive smartphone use has a stimulating and that lack of sleep can explain an impaired person’s
effect that impairs the ability to fall asleep, the decline performance during the day, which may manifest as
in melatonin hormone secretion caused by exposure to poor attention, and also, disturbance of the circadian
smartphone screen blue light affects circadian rhythm, rhythm by the blue light emitted from screen affects
and, lastly, using social media in excess right before bed cognitive performance including attention [46, 47]. This
increases emotional and psychological stress [33–35]. finding is supported by several studies that demon-
The term “attentional control” describes the capacity strated that people with good sleep quality experience
to actively manage one’s attention, including the capac- less attentional deficits and are more able to respond to
ity to focus and shift it [36]. This study reported that auditory and visual stimuli [48, 49].
subjects with higher smartphone addiction levels have The present study had some limitations. First, a
poorer control over their attention. This finding agrees cross-sectional study cannot establish a causal associa-
with many studies that showed that participants reported tion between the study variables. Also, it reflects a spe-
severe interruption when receiving smartphone notifica- cific point in time rather than conducting a longitudinal
tions [37], and only the presence of a smartphone around observation. Second, the smartphone addiction scale,
is enough to interfere with their primary task comple- Insomnia Severity Index scale, and attention control
tion [38]. Moreover, other research findings reported scale used in this study are self-report questionnaires
that participants with smartphone addiction had shorter that may inevitably include bias.
attention spans [39], delayed reaction times, and were at
higher risk of motorcar accidents because of reading and
texting while driving [40]. All of these findings are con- Conclusion
firmed by a neuroanatomical study showing that heavy The prevalence of smartphone addiction in Egypt is
smartphone users had diminished early transcranial alarming since it may have negative consequences such
magnetic stimulation-evoked potentials in the right pre- as insomnia and poor attention control, particularly in
frontal cortex compared to nonusers, which are linked to younger age groups.
self-reported attentional difficulties [10].
Acknowledgements
Despite many studies addressing the negative impact of Not applicable.
smartphone addiction on attention, some research find-
ings demonstrated the beneficial role of excessive smart- Authors’ contributions
DK was responsible for participants recruitment and study design and helped
phone usage in video game playing that helps improve draft the manuscript. RM was responsible for participants’ recruitment and
brain synchronization in areas related to visual-spatial study design and helped draft the manuscript. MH was responsible for
processing and sensory-motor coordination [41]. In participants’ recruitment and helped in drafting the manuscript. DMK was
responsible for participants’ recruitment, performed the data analysis, and
a study conducted by Bleakley et al. [42], playing video helped draft the manuscript. AYI was responsible for participants’ recruit‑
games regularly improves cognitive functions. ment. SA was responsible for participants’ recruitment. NA was responsible for
There are two ways that smartphone addiction can participants’ recruitment. MAA was responsible for participants’ recruitment.
ME was responsible for participants’ recruitment. AME was responsible for
distract attention either by internal drive (top-down) participants’ recruitment. AH was responsible for participants’ recruitment. MA
through consciously directing the attention focus to use was responsible for participants’ recruitment. EMN was responsible for partici‑
it (intense urge to use) or by the presence of external cues pants’ recruitment. SF was responsible for participants’ recruitment. HMA was
responsible for participants’ recruitment. AGE was responsible for participants’
(bottom-up), either visual (seeing someone handhelds his recruitment. SD was responsible for participants’ recruitment. MT was respon‑
smartphone), hearing the ringtone, or feeling the vibra- sible for participants’ recruitment, worked on data interpretation, and helped
tions [43, 44]. draft the manuscript. All authors thoroughly revised the manuscript’s content
before approving the final version.
Although there was no statistically significant dif-
ference between males and females in smartphone Funding
addiction in our study, we found that the female sex is The authors did not receive any funding for this work.
associated with poor attention control, which could be Availability of data and materials
because women are more likely to use social networking Authors report that the datasets used and/or analyzed during the current
study are available from the corresponding author upon reasonable request.
Khalifa et al. Middle East Current Psychiatry (2023) 30:97 Page 7 of 8

Declarations electrophysiological changes associated with smartphone use and

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1
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