Associations of sleep with gray matter volume and their implications for academic achievement, executive function and intelligence in children with overweight/obesity

Background Children with overweight/obesity have poorer sleep and smaller gray matter volume (GMV) than normal-weight children. No studies have investigated the associations of objectively-assessed sleep and GMV in children with overweight/obesity, or their implications for academic and cognitive outcomes. Objectives To explore the associations of sleep behaviors with GMV in the whole brain and particularly the hippocampus as a region of interest independent of sedentary time (SED) and physical activity; and to assess whether GMV in the associated regions was related to academic achievement, executive function and intelligence quotient (IQ). Methods Ninety-six children with overweight/obesity (10 +/- 1 year) were included. Sleep behaviors were assessed with accelerometers. GMV was acquired by magnetic resonance imaging. Academic achievement, executive function and IQ were assessed with separate tests. Analyses were adjusted for sex, peak height velocity and parent education as well as SED and physical activity. Results Earlier wake time, less time in bed, wakening after sleep onset (WASO) and WASO occurrences were associated with higher GMV in eight cortical brain regions (k:56-448,P's < .001). Longer total sleep time, higher sleep efficiency and less WASO time were associated with higher GMV in the right hippocampus (beta:0.187-0.220,P's < .05). The inferior temporal, fusiform, supramarginal, and postcentral gyri, the superior parietal cortex, precuneus and hippocampus associated with academic achievement and/or IQ. Associations remained after adjustments for SED and physical activity. Conclusions Sleep behaviors are associated with GMV in multiple cortical regions including the right hippocampus in children with overweight/obesity, which in turn, were associated with academic achievement and IQ.