To examine patterns of adolescent video gaming and their effects on sleep and behavior across age groups in high income countries (HICs) and Low-middle income countries (LMICs).

Excessive video gaming is increasingly recognized as a potential risk factor for poor sleep, decreasing performance efficiency and behavioral difficulties. This study aims to examine patterns of adolescent video gaming and their effects on sleep and behavior across age groups in high income countries (HICs) and Low-middle income countries (LMICs)

A cross-sectional online survey, with convenience sampling was conducted targeting age population from 12-22 to 627 adults. A 17-item questionnaire assessing gaming frequency, duration, sleep habits and academic performance was distributed. Data was anonymized to be used later for SPSS analysis. Data collection was done from December 2024 to May 2025

Of the 627 respondents, 325 (51.8%) were from HICs and 302 (48.2%) from LMICs. The mean age of respondents was 17.3 years. Adolescents in HICs reported longer and more frequent gaming sessions (36.3% played several times weekly; average 1–2 hours), while those in LMICs more often played rarely (28.8%) and for <1 hour. Across both groups, most reported 5–8 hours of nightly sleep; however, common complaints included difficulty falling asleep (40.8%), morning fatigue (47.4%), and daytime sleepiness (27.4%). Notably, over 60% perceived no adverse consequences, yet 21.7% reported lack of focus and 16.7% reported strong gaming cravings. Age-stratified analysis revealed adolescents <18 years were more likely to game daily, with greater sleep disruption, particularly early awakening in HICs and morning fatigue or headaches in LMICs.

Adolescents in both cohorts engage in regular gaming, with distinct differences in duration and frequency. Although most reported no overt harm, a significant minority experienced sleep and cognitive disturbances consistent with problematic gaming. These findings highlight the need for awareness among parents, educators, and healthcare providers