More time awake after sleep onset is linked to reduced ventral striatum response to rewards in youth with anxiety

Background Poor sleep and anxiety disorders are highly comorbid in youth, and each predicts altered ventral striatum (VS) response to rewards, which may impact mental health risk. Contrasting evidence suggests previously reported negative associations between sleep health and VS response may be stronger or weaker in youth with anxiety, indicating sensitivity to win/loss information or blunted reward processing, respectively. We cross‐sectionally examined the role of sleep in VS response to rewards among youth with anxiety versus a no‐psychiatric‐diagnosis comparison (ND) group. We expected a group*sleep interaction on VS response to rewards but did not hypothesize directionality. Methods As part of the pretreatment battery for a randomized clinical trial, 74 youth with anxiety and 31 ND youth (ages 9–14 years; n = 55 female) completed a monetary reward task during fMRI. During the same pretreatment window, actigraphy and diary‐estimated sleep were collected over 5 days, and participants and their parents each reported participants' total sleep problems. We examined group*sleep interactions on VS response to monetary rewards versus losses via three mixed linear models corresponding to actigraphy, diary, and questionnaires, respectively. Results Each model indicated group*sleep interactions on VS response to rewards. Actigraphy and diary‐estimated time awake after sleep onset predicted reduced VS response in youth with anxiety but not ND youth. Parent‐reported sleep problems similarly interacted with group, but simple slopes were nonsignificant. Conclusions Wake after sleep onset was associated with blunted reward response in youth with anxiety. These data suggest a potential pathway through which sleep could contribute to perturbed reward function and reward‐related psychopathology (e.g., depression) in youth with anxiety.