Objective <p>This study aimed to identify potential categories of negative body image among adolescent orthodontic patients and further examine the relationship between these categories and sleep quality.To provide evidence for clinical psychological intervention.</p> Methods <p>A total of 322 adolescent orthodontic patients were randomly selected from six stomatological hospitals in Jiangsu and Zhejiang provinces, China, between June 2024 and February 2025. A field survey was conducted using a general information questionnaire, the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4R), the Pittsburgh Sleep Quality Index (PSQI), and the Body Image Scale (BISS). Data were analyzed using latent profile analysis, χ² tests, and logistic regression.</p> Results <p>Of the 322 surveys distributed, 311 valid responses were collected, yielding an effective response rate of 96.58%. The average body image score was 29.36 ± 6.13. Latent profile analysis identified three categories of body image: self-acceptance (11.90%, 37 cases), self-negative (60.77%, 189 cases), and self-critical (27.33%, 85 cases). χ² tests revealed significant differences related to gender, being an only child, education level, BMI, and SATAQ-4R scores (<i>P</i> &lt; 0.05). Logistic regression analysis indicated that female gender, self-negative, and self-critical body image types were significant risk factors for poor sleep quality in this population (<i>P</i> &lt; 0.05).</p> Conclusions <p>Adolescent orthodontic patients exhibit heterogeneous body image perceptions, with negative body image serving as a risk factor for poor sleep quality. Clinical attention should be paid to female and adolescent orthodontic patients with higher appearance anxiety or peer pressure. Early psychological assessment and combined orthodontic-psychological intervention should be used to help improve their body image cognition and sleep quality.​.</p>