NIH Research Conference on Sleep and the Health of Women

This special section of the Journal of Women's Health highlights the 2018 Research Conference on Sleep and the Health of Women that took place in Bethesda, Maryland, on October 16–17, 2018. The conference showcased over a decade of federally funded research investigating sleep and circadian rhythms as a fundamental requirement for life, and how they contribute to the health of women. Sleep deficiency (i.e., insufficient sleep duration, quality, timing, and regularity)¹ is prevalent in the general population and associated with a range of adverse health conditions, including obesity, diabetes, cardiovascular disease, substance abuse, cognitive impairment, and depression.^2–4 The sex differences in these conditions have been under-represented in sleep research. Thus, the conference assembled diverse groups of stakeholders, including researchers, medical professionals, societies focused on the health of women, and the interested public, to highlight current science regarding the health risks, societal burden, and treatment options associated with the identification and management of sleep deficiency and sleep disorders in women. Presentations and stakeholder panel discussions addressed critical questions on the role of sleep in women's health, presented advances in the recognition and treatment of sleep disorders in women, and identified gaps and opportunities where future work should focus to promote healthy sleep in women and girls. This event constituted a novel collaborative partnership between the National Center on Sleep Disorders Research (NCSDR) of the National Heart, Lung, and Blood Institute (NHLBI), the NIH Office of Research on Women's Health (ORWH), and the HHS Office on Women's Health (OWH), and participating members of the transNIH Sleep Research Coordinating Committee.*

The conference was organized to capture three overarching frameworks:

• (1)Highlight research advances, focusing on:

• (a) The burden of sleep deficiency and sleep disorders on women in the United States

• (b) Sleep-related health disparities among women

• (c) Biological mechanisms underlying sex differences in sleep

• (d) Societal/cultural/environmental issues underlying gender differences in sleep.

• (2)Stimulate translation of research advances for the purpose of:

• (a) Improving health care practice

• (b) Informing policy

• (c) Developing public health programs and educational campaigns

• (d) Improving sleep health using cross-sector approaches.

• (3)Identify critical gaps in research as well as barriers to implementation or adoption of existing knowledge, such as:

• (a) Limitations of current research, and gaps in our knowledge about sleep deficiency and disorders in women

• (b) Identify underlying social, cultural, environmental, and biological factors that affect sleep in women

• (c) Create treatment options specific and appropriate for women

• (d) Develop and improve diagnostic tools and criteria for sleep disorders in women

• (e) Evidence needed to translate current knowledge into practice.

Articles in this special section represent selected topics from the conference ranging from sleep across the lifespan to interventions to address sleep disturbances in women. The first article focuses on the risk of sleep deficiency in women of childbearing age and describes how social ecological modeling, accounting for family, social, and environmental context in which sleep occurs, is important when defining healthy sleep in women. The second article addresses the contribution of sleep deficiency to health disparities in under-represented populations and discusses the problem of sleep deficiency in minority populations—particularly African American and Latina women; potential approaches to improving sleep health in vulnerable populations; and how disparities in sleep beginning in early childhood could persist throughout adulthood, and potentially affect the trajectory of health and well-being.

The third article discusses what is known about the role of sleep and circadian rhythms in alcohol use disorders during adolescence and early college years and emphasizes future opportunities for research in alcohol abuse and sex differences. The fourth article reviews and proposes a model explaining why women's adaptation to traumatic stress may be different than that of men, including the role that cycling hormones and differences in sleep play in the development of post-traumatic stress and other stress-related disorders. The fifth article summarizes the scope of cardiovascular disease in women, the link between sleep disturbance in cardiovascular outcomes during pregnancy, and the development of hypertension through the lifespan in women. The final article in this special section focuses on interventions to manage sleep deficiency and sleep disorders, particularly the utilization of hypnosis as a treatment for poor sleep in menopausal women.

Other important topics regarding risk presentation and intervention in women that are not covered in this special section but available in the recorded videocast (links hereunder) include:

• the extent to which sex hormones and hormonal regulation impact sleep and sleep pathobiology across the lifespan;

• the under-recognition and misdiagnosis of sleep disorders in women and girls;

• the role of genetic and lifestyle risk factors, including depression prevalence and pain perception;

• the under-representation of women in addiction research;

• the link between sleep and Alzheimer's disease and other dementias;

• sleep and circadian rhythms in the gut microbiota and the impact on metabolic outcomes;

• the association of shift work with increased incidence of breast cancer; and

• complementary approaches, such as mindfulness meditation and yoga, as effective interventions to manage sleep deficiency and sleep disorders.

Although substantial progress has been made over the past decade, gaps remain in basic knowledge about sex and gender differences in sleep and sleep disorders. Women encounter unique challenges to obtaining healthy sleep and addressing their sleep issues based on a range of factors that include sex differences in the brain, effects of cycling sex hormones, gender identification, sexual preference, high exposure rates to stress and trauma, differences in symptoms and clinical presentation, inability to access care, disparities in diagnosis and treatment, and differences in social and family roles.

Opportunities to improve sleep in women should include public health strategies that address poor quality and insufficient sleep, and aim to shift cultural attitudes toward acceptance of sleep as an essential health behavior. Education and inexpensive screening tools are needed to target earlier diagnosis, and a more diverse sleep health workforce is necessary to address the needs of the populations they serve. Sleep researchers must employ multidisciplinary team-science approaches to advance discovery and implementation of best sleep practices in conditions that impact women the most including heart disease, cancer, pregnancy, arthritis, osteoporosis, substance-use disorders, depression, anxiety, menopause, obesity, and diabetes. The field needs a better understanding of how stress and resilience play a role in disturbed sleep and how to practice trauma-informed care. Development and testing of novel behavioral and complementary approaches are needed and financial barriers to accessing integrative medical approaches must be addressed.

This issue comprises select articles from the conference, each of which focuses on a specific aspect of sleep health in women, thus providing a summary of the current state-of-the-field and opportunities for the future.

Videocast Links

DAY 1: https://videocast.nih.gov/summary.asp?Live=28213&bhcp=1

DAY 2: https://videocast.nih.gov/summary.asp?Live=28217&bhcp=1

Conference Executive Committee

• Michael J. Twery, PhD, National Center on Sleep Disorders Research, NHLBI, NIH

• Marishka K. Brown, PhD, National Center on Sleep Disorders Research, NHLBI, NIH

• A. Gretchen Buckler, MD, MPH, CDR USPHS, NIH Office of Research on Women's Health, NIH

• Brittany M. Perrotte, MPH, Office on Women's Health, Office of the Assistant Secretary for Health, HHS

• Aaron D. Laposky, PhD, National Center on Sleep Disorders Research, NHLBI

Participating transNIH Sleep Research Coordinating Committee Members

• Inna Belfer, MD, PhD, National Center for Complementary and Integrative Health, NIH

• Rina Das, PhD, National Institute on Minority Health and Health Disparities, NIH

• Michelle Hamlet, PhD, National Institute of Nursing Research, NIH

• Yejun (Janet) He, PhD, National Institute of Neurological Disorders and Stroke, NIH

• Todd S. Horowitz, PhD, National Cancer Institute, NIH

• Nancy Jones, PhD, National Institute on Minority Health and Health Disparities, NIH

• Miroslaw Mackiewicz, PhD, National Institute on Aging, NIH

• Lanay Mudd, PhD, National Center for Complementary and Integrative Health, NIH

• Soundar Regunathan, PhD, National Institute on Alcohol Abuse and Alcoholism, NIH

• Dana Greene-Schloesser, PhD, Office of Behavioral and Social Sciences Research, NIH

• Karen Teff, PhD, National Institute of Diabetes and Digestive and Kidney Diseases, NIH

• Aleksandra Vicentic, PhD, National Institute of Mental Health, NIH

• Dan Xi, PhD, (NCI) National Cancer Institute, NIH

NIH Staff

• Cheryl Anne Boyce, PhD, National Heart, Lung, and Blood Institute, NIH

• Rebecca Campo, PhD, National Heart, Lung, and Blood Institute, NIH

• Catherine Stoney, PhD, National Heart, Lung, and Blood Institute, NIH

• Xenia Tigno, PhD, National Heart, Lung, and Blood Institute, NIH

• Joanna Watson, PhD, National Cancer Institute, NIH

• Sung Sug (Sarah) Yoon, RN, PhD, National Institute of Nursing Research, NIH

Conference Speakers

• Fiona Baker, PhD, SRI International

• Ruth Benca, MD, PhD, University of California, Irvine

• Suzanne Bertisch, MD, MPH, Harvard Medical School

• Ghada Bourjeily, MD, Brown University

• Jason Carter, PhD, Michigan Technological University

• Mary Carskadon, PhD, Brown University

• Janine Clayton, MD, Director, NIH Office of Research on Women's Health

• Stacie Daugherty, MD, University of Colorado

• David Dinges, PhD, University of Pennsylvania

• Lisa Dubay, PhD, ScM, Senior Fellow, Health Policy Center at the Urban Institute

• Shobhan Gaddameedhi, MSc, PhD, Washington State University

• Gary Gibbons, MD, Director, National Heart, Lung, and Blood Institute, NIH

• Nicole Greene, Acting Director, U.S. Department of Health and Human Services Office on Women's Health

• Monika Haack, PhD, Harvard Medical School

• Brant Hasler, PhD, CBSM, University of Pittsburgh

• Christina Hoven, PhD, Columbia University

• Chandra Jackson, PhD, MS, National Institute of Environmental Health Sciences, NIH

• Hadine Joffe, MD, MSc, Harvard Medical School

• George Koob, PhD, Director, National Institute on Alcohol Abuse and Alcoholism, NIH

• Vanessa Leone, PhD, University of Chicago

• Jennifer L. Martin, PhD, FAASM, VA Greater Los Angeles, University of California, Los Angeles

• Regina Davis Moss, PhD, MPH, MCHES, Associate Executive Director of Public Health Policy and Practice, American Public Health Association

• Jason Ong, PhD, Northwestern University

• Julie Otte, PhD, RN, OCN, Indiana University

• Eliseo J. Perez-Stable, MD, Director, National Institute of Minority Health and Health Disparities, NIH

• Gina Poe, PhD, University of California, Los Angeles

• Tiffany Powell-Wiley, MD, MPH, FAHA, National Heart, Lung, and Blood Institute, NIH

• Alberto Ramos, MD, MSPH, FAASM, University of Miami

• Elizabeth Repasky, PhD, Roswell Park Comprehensive Cancer Center

• Norman Ruby, PhD, Stanford University

• Nancy Schmieder Redeker, PhD, RN, FAHA, FAAN, Yale University

• Katherine Sharkey, MD, PhD, Brown University

• Natalie Shaw, MD, MMSc, National Institute of Environmental Health Sciences, NIH

• Michael T. Smith, MA, PhD, The Johns Hopkins University

• Stacey D. Stewart, President, March of Dimes

• Esra Tasali, MD, University of Chicago

• C. Grace Whiting, JD, President and Chief Executive Officer, National Alliance for Caregiving

• Jennifer Wider, MD

• Candy Wilson, PhD, APRN, WHNP-BC, Uniformed Services University of the Health Sciences

• Kenneth Wright, PhD, University of Colorado Boulder

Disclaimer

The opinions expressed in this article are the author's own and do not reflect the view of the National Institutes of Health, the Department of Health and Human Services, or the United States government.