Shorter sleep duration predicts altered next-day physiologic, behavioral, and corticolimbic responses during fear extinction recall in youth.

backgroundInsufficient sleep is prevalent in youth and associated with elevated anxiety risk, yet the neurobiological mechanisms linking sleep to anxiety remain poorly understood. One potential pathway involves impaired fear extinction recall-a process critical for effective fear regulation. Further, fear extinction recall relies on corticolimbic circuitry and has been shown to change dynamically during adolescence. Here, we examined whether acute sleep duration was associated with conditioned fear responses and corticolimbic activation during recall in youth.

methodsOne hundred youth (ages 10-17) completed a validated Pavlovian fear extinction and recall paradigm across two days. Acute sleep duration was self-reported. Conditioned fear was assessed via skin conductance responses (SCRs), subjective fear ratings, and behavioral avoidance. A subsample (n = 64) underwent functional magnetic resonance imaging (fMRI) during the recall phase.

resultsShorter sleep duration was associated with higher anxiety symptoms, elevated SCRs, and reduced behavioral avoidance during recall, controlling for age, sex, and prior fear learning. Neuroimaging analyses revealed that shorter sleep duration was linked to lower activation in the amygdala and right postcentral gyrus during recall.

conclusionsInadequate sleep may disrupt physiological, behavioral, and neural processes supporting fear regulation, possibly through impaired consolidation and/or retrieval of extinction memories and altered behavioral avoidance. These findings identify fear extinction recall as a potential pathway linking insufficient sleep to anxiety vulnerability in youth, and highlight the importance of sleep for the consolidation and retrieval of therapeutic learning (e.g., during exposure-based treatments).