Structural Brain Correlates of Insufficient Sleep in Adolescents: A Narrative Review of MRI Evidence

Insufficient sleep represents a public health challenge affecting the majority of adolescents in industrialized societies, with fewer than 30% of high school students obtaining the recommended 8-10 h of nightly sleep. Chronic effects of insufficient sleep have been shown to affect a myriad of functions including brain development, metabolism, mental health, school performance, and social relationships. While these biological and functional consequences of adolescent insufficient sleep have been addressed in prior reviews, no review has systematically examined the effects of insufficient sleep on structural brain development. Herein, we address this gap by reviewing the growing magnetic resonance imaging (MRI) literature linking adolescent sleep patterns to brain morphology. This review systematically synthesizes study findings from MRI sequences spanning diffusion tensor imaging (DTI), voxel-based morphometry, and structural volumetrics, including gray matter, white matter, and cortical thickness as it relates to sleep duration, sleep regularity, and sleep quality. In summary, results from these studies link insufficient sleep to measurable alterations in white matter microstructure, cortical thickness, and gray matter volume during adolescence, establishing detectable effects of brain morphology during a period of heightened neurobiological vulnerability. Protecting adolescent sleep represents an investment in both immediate well-being and long-term health outcomes extending into adulthood.