Insufficient sleep and excess weight status contribute to adverse health outcomes across the lifespan, including risk for cardiometabolic disease as well as impairments in psychosocial functioning.

Cross-sectional data suggest that children with overweight/obesity are more likely to experience sleep disturbances than their non-overweight peers. Although the nature of this association is likely bidirectional, prospective studies indicate that sleep impacts body weight regulation through multiple physiological and psychological pathways. In particular, alterations in sleep are related to greater energy intake and reduced diet quality in children. Mechanisms explaining the association between sleep and eating behavior are poorly understood but may include brain activation patterns related to the processing of different cues in the environment.

A limitation of prior research on mechanisms is that much of it has been conducted in adults and in laboratory settings, thereby calling into question the ecological validity of the findings. Alternatively, studies on sleep patterns in children’s natural environments have relied on retrospective reporting of eating behavior, included children across the weight spectrum, and had limited focus on underlying mechanisms, particularly brain activation patterns. A clearer understanding of momentary mechanisms involved in the sleep/eating association could improve the development and/or refinement of sleep-related interventions, particularly those delivered in real-time when the risk for engaging in problematic eating behaviors is highest.

In the current study, we will be recruiting 120 children with overweight/obesity to participate in an experimental sleep protocol, the purpose of which is to better understand processes by which alterations in sleep affect eating behavior. Participants will complete a one-week assessment of typical sleep and eating patterns (week 1), followed by two weeks of sleep restriction or extension (weeks 2 and 3, separated by a 7-day wash-out). Assessment throughout the study period will involve daily actigraphy measurement of sleep patterns; repeated daily self-reports on eating behavior and behavioral assessment of cue processing; and intermittent 24-hour dietary recalls. Participants will complete the fMRI-based assessment of neural activation during a cue processing task after each week-long period of sleep restriction and extension. Overall aims are to assess short-term effects of sleep extension versus restriction on cue processing (including behavioral and neural performance) and naturalistic eating behavior.

To assess momentary mechanisms linking sleep and eating, measures of mood, eating behavior, and cognitive functioning will be collected multiple times per day in the natural environment via smartphone-based ecological momentary assessment (EMA). The EMA platform is developed and maintained by NeuroUX and includes validated questionnaires on positive and negative affect, as well as physiological, contextual, and psychological factors related to eating behavior; and a cue reactivity (go/no-go) task.

Data collected in this study are intended to clarify the timing and trajectory of changes in eating behavior and cognitive functioning as a consequence of sleep patterns. The proposed study has clear potential to advance scientific and clinical understanding of mechanisms involved in the prospective associations between sleep and eating behavior in youth and inform interventions to improve both.