UNLABELLED: This study aimed to identify individual differences in adolescents' electronic device usage patterns and explore their unique associations with sleep disturbances. From May to June 2019, students from 18 middle schools in Fuzhou were invited to fill out questionnaires about sleep health and electronic device usage, including screen time, usage timing, usage purpose, pre-sleep usage, and the presence of devices in bedrooms. Latent class analysis was employed to identify distinct usage patterns, and their associations with sleep disturbances were subsequently explored. Four usage patterns were identified among a total of 19,229 adolescents: (1) "minor exposure-learning," (2) "weekends dominance-game playing," (3) "weekends and pre-sleep dominance-learning," and (4) "excessive exposure-game playing." Compared to Pattern 1, a higher likelihood of insufficient sleep was found during weekdays and weekends in Pattern 3 (weekdays-odds ratio (OR) 1.15, 95% confidential interval (CI) 1.0-1.28
weekends-OR 1.19, 95% CI 1.09-1.30) and Pattern 4 (weekdays-OR = 1.48, 95% CI 1.31-1.68
weekends-OR = 1.40, 95% CI 1.27-1.53) but only during weekends in Pattern 2 (OR = 1.18, 95% CI 1.07-1.30). Besides, Patterns 2-4 were related to delayed bedtime, insomnia symptoms, and recurrent sleep paralysis or nightmares. CONCLUSION: Four electronic device usage patterns were found among adolescents. Compared with the pattern of minimal screen exposure and a learning purpose, other patterns were more likely to be associated with sleep disturbances. These findings carry significant implications for healthy electronic device usage and potential strategies to improve adolescents' sleep health. WHAT IS KNOWN: • As screen use among adolescents increases, promoting healthy digital habits is crucial for reducing sleep disruptions and enhancing well - being. • Existing recommendations on adolescents' electronic device use mainly focus on usage duration and lack systematic advice. WHAT IS NEW: • Latent class analysis (LCA) identified four electronic device usage patterns among Chinese adolescents, based on screen time, usage timing, purpose, pre-sleep usage, and device presence in bedrooms. • Reducing usage, especially pre-bedtime, using devices for education, and keeping them out of the bedroom were less linked to sleep issues.