Multimodal Neuroimaging Signature of Sleep Problems Predicts Preadolescent Mental Health Trajectories

Sleep-related problems (SRP) in childhood are common and clinically relevant yet their underlying neural mechanisms and links to future mental health outcomes remain poorly understood. Here, we investigated how distinct dimensions of SRP relate to multimodal brain structure and function in preadolescents, and whether these neural signatures predict trajectories of mental health difficulties. We employed multivariate mapping to investigate the relationship between structural and functional brain network patterns and various dimensions of SRP in the Adolescent Brain Cognitive Development (ABCD) dataset. Moreover, we explored whether and how the identified multimodal brain signatures could predict the trajectory of internalizing and externalizing behavior difficulties over a two-year follow-up. Our multivariate analysis revealed two robust dimensions of SRP: a general sleep disturbance dimension and a hypersomnolence and parasomnia dimension. Each was associated with partially distinct patterns of brain morphology and functional connectivity, consistent with their differential alignment along the hierarchical organization of cortical neurodevelopment maps. However, both dimensions shared common disruptions in the somatosensory, attention, and default mode networks. We further observed that only these neural patterns associated with the general sleep disturbance dimension predict the longitudinal trajectories of internalizing/externalizing symptoms. Our findings enhance the understanding of the neurobiological mechanisms underlying dimensions of SRP in preadolescence and could inform brain-based intervention and treatment programs to improve sleep-related and mental health-related outcomes across development.