OBJECTIVES: Adequate sleep is essential for healthy development during middle childhood, yet many school-aged children do not meet recommended sleep duration. Excessive screen exposure and inconsistent bedtime schedules are modifiable behaviors associated with inadequate sleep. This study examined whether bedtime consistency accounted for the association between screen time and short sleep duration among U.S. children ages 6-11 years. METHOD: Secondary analysis of the 2021-2022 National Survey of Children's Health was conducted using weighted data for primary regression models and a supplemental unweighted mediation decomposition. Screen time (ST) was categorized as 0 hours, <1 hour, 1 hour, 2 hours, and ≥3 hours. Bedtime consistency (BC) was dichotomized as consistent or inconsistent. Short sleep duration (SSD) was defined as <9 hours per night. Logistic regression models examined associations between ST and BC, BC and SSD, and whether BC served as an indirect pathway linking ST and SSD. RESULTS: < .001). Consistent BC was associated with lower odds of SSD (aOR 0.39, 95% CI 0.32-0.48). The association between ST and SSD was attenuated and not statistically significant in the supplemental mediation decomposition after accounting for BC. Bootstrapped mediation decomposition indicated a statistically significant indirect association between ST and SSD through BC (B = -0.021, 95% CI -0.025 to -0.017). CONCLUSIONS: BC functions as a behavioral pathway linking screen exposure to inadequate sleep in middle childhood.
Knowlden et al. (2026) studied this question.