entire issue [pdf 12.7 mb] - Pitt Med - University of Pittsburgh

MOTHER’S SLUMBER,SPOILED, SPELLS TROUBLEMichele Okun (Fel ’07) knows her preggos. She can even guess the exact gestationalstage of a Pitt Med writer just by looking at her (33 weeks at the timeI waddled into her office). “Glad I haven’t lost my touch,” she says. “I haven’tworked with third-trimester women in a long time.”For 10 years, Okun, a PhD assistant professor of psychiatry and psychologyand a psychoneuroimmunologist, has studied the impact of disturbedsleep on women’s health. The past few years her focus has been on weeks10 to 20 of pregnancy. This is when cells within the uterus begin to expandand remodel to conjure up that most crucial cauldron of baby-making magic:the placenta.Okun explains that throughout pregnancy, the immune system churns ina delicate balance, its demands constantly changing. Too little inflammationat the onset, and the blastocyst can’t implant properly. Too much immuneresponse at various points thereafter, and the woman’s body rejects the fetus.When the placenta is developing is the most precarious time. The mostdangerous outcomes of pregnancy—low birth weight, preterm birth, preeclampsia,you name it—are associated with heightened levels of cytokines,messenger cells that signal immune responses, during this critical interval.And what’s one common cause of climbing cytokine levels? Sleep loss,of course.Okun says that in common lore as well as in ob/gyn literature, everyoneassumes women are supposed to be cursed with crummy sleep pretty muchthe whole way through pregnancy. But in Okun’s ongoing, four-year study,which was funded by a K99/R00 grant from the NIH, she has found thatthis is, first of all, not true. (In fact, in the first trimester, about 30 percentsleep very well, and another 30 percent sleep poorly.) And secondly, it is apotentially pretty dangerous assumption. As she follows the outcomes ofthe women in her study, she’s finding that those who sleep poorly betweenweeks 10 and 20 are indeed having more complications. Eventually, Okunhopes her work will inform a new set of primer questions that ob/gyns canuse to screen for problems from the get-go—an idea that’s pregnant withpotential.HAUNTINGSleep affects health, which affects sleep. It’s a complicatedmess to sort out, which is why most academic medical centers’sleep programs have single-disease foci. But Pitt’s sleepthink tank is different, says Martica Hall, associate professorof psychiatry and psychology and of clinical and translationalscience. “I think it’s fair to say in Pittsburgh we’ve createdthe most diverse set of studies investigating the bidirectionalrelationship between sleep and health.”Hall, who came to Pitt for her PhD in biopsychology in1995, was the first of Pitt’s sleep peeps to study physicalhealth, and she’s proud to have fostered what’s now a verybig interest in this giant, sprawling family of researchers. “It’sa big sandbox, and we’re having a lot of fun.”Hall’s particular interest is how stress affectssleep, which, in turn, affects stress, and how thatwhole ugly cycle has a way of throwing our healthfor a loop. She’s studied how acute and chronicstress stymie sleep and health in a number of populations:adolescents, young adults, parents of sickchildren, people with insomnia or depression, caregivers,elders in bereavement. In measuring heartratevariability—a sign of a healthy ticker capableof adapting to a changing environment—Hall hasshown that everyone, even healthy young collegekids, do worse by this measure when they’re introducedto acute stress before they hit the hay. “I callit haunting,” she says.As principal investigator on the ancillary sleepstudy to the NIH’s Study of Women’s Health Acrossthe Nation, Hall conducted the first multisite studyto understand who develops sleep disturbancesduring menopause and why. So far, she and her collaboratorshave published numerous papers to thisend, on everything from the intricate dance betweenhormones, hot flashes, and brain activity duringsleep to how factors like marriage affect sleep.One factor that’s clearly accounting for significantdifferences is race. African American women havethe highest risk for persistent sleep disturbances,she’s found—even when you control for stress level,hot flashes, health complaints, medication, environment,depression, worries about money, and more.However, there’s something “very intriguing”going on that doesn’t yet add up, she says.“If you look at brain waves in African Americanwomen, they do not sleep as deeply as whitewomen, but their periphery tells a different story.Their heart rate variability during sleep is more idealthan that seen in whites. So now we are taking astep back to try and better understand more aboutrace differences in nocturnal physiology. Because weactually know very little.”18 PITTMED