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.