Bedtime Inconsistency, Sugary Drink Consumption, and Anxiety Among a Nationally Representative Sample of U.S. Children.

BACKGROUND

Bedtime consistency is a family-regulated routine associated with children's sleep and emotional well-being. Irregular bedtimes may co-occur with unhealthy dietary behaviors, including sugar-sweetened beverage consumption, which has been linked to child anxiety and obesity risk. However, population-level studies examining these behaviors across both mental and physical health outcomes remain limited.

METHODS

Data were drawn from the 2024 National Survey of Children's Health and restricted to children aged 3-17 years. Design-based logistic regression models examined associations between bedtime inconsistency, sugary drink consumption, anxiety, and overweight or obesity (≥85th percentile). Analyses accounted for complex survey design and adjusted for age group, sex, and race or ethnicity. Sensitivity analyses incorporated socioeconomic, family, and behavioral characteristics.

RESULTS

Children with inconsistent bedtimes had higher odds of frequent sugary drink consumption (aOR = 2.51, 95% CI: 2.10-3.00) and moderate consumption (aOR = 1.46, 95% CI: 1.23-1.72). Frequent sugary drink consumption was associated with higher odds of anxiety (aOR = 1.28, 95% CI: 1.10-1.49). Bedtime inconsistency remained associated with anxiety in demographic-adjusted (aOR = 1.89, 95% CI: 1.63-2.18) and fully adjusted sensitivity analyses (aOR = 1.54, 95% CI: 1.33-1.79). Bedtime inconsistency was associated with overweight or obesity in demographic-adjusted models but was attenuated following expanded adjustment. In contrast, sugary drink consumption remained associated with overweight or obesity across model specifications.

CONCLUSIONS

Bedtime inconsistency was consistently associated with anxiety, whereas sugary drink consumption demonstrated more robust associations with overweight or obesity. These findings suggest that sleep-related routines and dietary behaviors may represent distinct, modifiable correlates of child mental and physical health.