Dr. Martica Hall’s Groundbreaking Research Ties Sleep to Effects on Physical Health
Martica Hall, PhD, Professor of Psychiatry, doesn’t spend her days forging new ground in oil field exploration like her father did, but she certainly is doing so in the field of dreams we call sleep. Dr. Hall was born in Venezuela and her dad’s work as a geologist in the oil business kept her family overseas, living in Bolivia, Argentina, Venezuela and Colombia, until she moved to Miami for high school. Likely inheriting her dad’s adventurous and inquisitive spirit, Dr. Hall has made it her life’s work to probe unanswered questions about sleep and its effects on physical health. “A geologist, my dad looked for oil in remote and often unmapped locations throughout South America—places others had not thought to explore. Perhaps some of his pioneering spirit has stuck with me as I search for answers to outside-the-box questions about sleep and health,” she said. And she has not come up empty-handed—her quest to bring together the once disparate fields of behavioral medicine and sleep medicine has led Dr. Hall to become one of the leading experts in this field.
A Wake-Me-Up Moment. Dr. Hall’s interest in the field of sleep medicine began when she was in graduate school, studying stress and the immune system with her mentor, Andrew Baum, PhD, a leader in psychoneuroimmunology research. At that time, research on the links between psychological stress, the immune system, and health focused primarily on mechanisms that occurred or happened to be assessed during wakefulness such as reactivity to psychological stress and coping styles. Her own work focused on intrusive thoughts as a mechanism that sustains psychological stress in the long term, increasing vulnerability to stress-related decrements in health. Dr. Hall experienced a wake-me-up moment when a chance conversation with a neuroscience postdoc, who was studying rapid eye movement sleep and long-term potentiation, got Dr. Hall thinking about sleep as a pathway through which psychological stress might impact the immune system. In the pre-internet days of the early 1990’s, Dr. Hall ran a search of the National Library of Health Medicine database and, to her surprise, found few publications on sleep and the immune system. Yet, the literature that Dr. Hall did manage to find was intriguing. A sophisticated and methodical research program led by Dr. James Krueger, in collaboration his postdoctoral fellows, Drs. Mark Opp and Linda Toth, demonstrated strong bi-directional associations between sleep and the immune system. These data reinforced Dr. Hall’s hunch that sleep might be an important link between psychological stress, the immune system, and health. Hooked, Dr. Hall knew she wanted to follow this line of inquiry. After finishing her PhD in Biological and Health Psychology at the University of Pittsburgh, she moved across campus to the Department of Psychiatry, for postdoctoral training in clinical sleep medicine.
Exploring the Frontiers of Sleep Medicine. Dr. Hall joined the Department of Psychiatry faculty in 1998 after completing her postdoctoral fellowship with Daniel Buysse, MD, UPMC Endowed Chair in Sleep Medicine. In the ensuing 20 years, Dr. Hall’s program of research has continued to evolve and probe questions about how psychological stress affects sleep and how stress-related sleep disturbances, in turn, affect health across the lifespan. Her work has shaped the fields of behavioral medicine and sleep research, introducing innovative methods and analytic strategies, including her pioneering work in ambulatory polysomnography and wrist activity, which allow researchers to evaluate habitual and ecologically-valid sleep, and the study of heart rate variability during sleep, which provides continuous and non-invasive measures of autonomic nervous system activity during sleep, which is important for understanding mechanisms through which disturbed sleep influences cardiovascular disease, diabetes, and accelerated biological aging. In addition to the six R01/U01 grants on which Dr. Hall is currently working, she has led or collaborated on more than 15 National Institutes of Health- (NIH-) funded grants. This work has contributed to the establishment of clinical sleep medicine as an integral part of the biomedical field and to prioritization of sleep research funding at the NIH. Her current grants include the following:
Sleep in Retirement Study (The SIR Study) - The National Institute on Aging- (NIA-) funded Sleep in Retirement (SIR) Study looks at what Dr. Hall calls the biological “scarring” of shift work, or the long-term effects of shift work on physiology and health that persist into retirement. Current estimates suggest that more than 15 million Americans regularly work at night, in permanent or rotating night shift positions. “The problem is that we are biologically adapted to function on the 24-hour cycle of day and night, with sleep occurring at night. Yet, we are a society that runs 24 hours a day,” said Dr. Hall. “Men and women who work shifts that occur when their body is telling them that it should be asleep suffer biological consequences that may cast a long biological shadow.” With Dr. Buysse, the study’s co-principal investigator, Dr. Hall is examining these individuals’ cardiovascular and metabolic health and the integrity of their sleep and circadian systems. “Virtually any health problem you can think of is more prevalent in those who have worked shifts throughout their career. The increased morbidity and mortality in shift workers is astounding,” said Dr. Hall. In addition, she and Meryl Butters, PhD, Associate Professor of Psychiatry, have extended the scope of the SIR Study to collect pilot data on the long-term effects of shift work on neuropsychological functioning and risk for Alzheimer’s Disease.
SWAN Sleep Study. As an early career investigator in the Department of Psychiatry, Dr. Hall initiated and led an ancillary sleep study to the NIA-funded Study of Women’s Health Across the Nation (SWAN), a large, multisite study of menopause. Together with colleagues at the University of Pittsburgh, University of Michigan, Rush University, and the University of California, Davis, Dr. Hall used ambulatory polysomnography, wrist actigraphy, and self-report questionnaires to document how, and why, sleep changes during the menopausal transition and the impact of menopause-related sleep disturbances on mental and physical health. The original and competing renewal of the SWAN sleep study have led to more than 30 peer-reviewed manuscripts on sleep and health in midlife women. As a collaborator on the ongoing U01 SWAN study led by Dr. Karen Matthews, Dr. Hall has led efforts to collect wrist actigraphy data and characterize sleep health in a larger, more diverse sample of the SWAN cohort. These data will allow Dr. Hall, other SWAN investigators, and their trainees to more fully characterize the causes and consequences of menopause-related sleep disturbances as women transition from pre- to post-menopause. Given that sleep is a modifiable behavior, the work of Dr. Hall and her SWAN colleagues may identify strategies to reduce menopause-related sleep disturbances and enhance successful aging in women.
R01s in Sleep and Cardiovascular Health and Disease. Dr. Hall is collaborating on four other R01 projects funded by the National Heart Lung and Blood Institute (NHLBI) that focus on the effects of sleep on cardiovascular disease and mortality. According to Dr. Hall, each of these studies focuses on a “different piece of the puzzle of sleep and cardiovascular disease.” This first study is a collaboration with Matthew Burg, PhD at Yale University and looks at the interplay between sleep duration with hostility and anger and their interactive effects on the cardiovascular system. She collaborates on a second project with Viola Vaccarino, MD, PhD from Emory University using twin pairs from the Vietnam Era Twin Registry to study interactions among sleep and post-traumatic stress disorder and their effects on ischemic heart disease using PET imaging of the heart. In a third study led by Dr. Meredith Wallace, Drs. Hall and Buysse are working with colleagues at Harvard and the University of California, San Francisco, to apply cutting-edge statistical techniques to large, archival datasets to characterize sleep as a multidimensional construct, called sleep health, to examine the effects of sleep health on mortality in older adults. Dr. Hall’s newest R01 collaboration is with Dr. Steven A. Shea, PhD, a researcher at the Oregon Health Sciences University, in which they will use a sophisticated laboratory protocol to disentangle the effects of sleep and circadian rhythms on blood pressure in African American and European American adults, to better understand the mechanisms that underlie race differences in diurnal blood pressure and risk for hypertension.
Future Dreams. Like her father, Dr. Hall continues to dream of questions that lie just beyond our horizon of understanding. Thus far, her work has advanced our understanding of the biobehavioral processes, or mechanisms, through which sleep influences health and functioning. Dr. Hall’s work has continued to emphasize the importance of racial/ethnic differences in sleep as a means of identifying and ameliorating disparities in health, including cardiovascular disease, diabetes, and Alzheimer’s Disease. These “diseases of aging” may share common upstream mechanisms, as measured by cellular and molecular indices of accelerated aging. Dr. Hall has several new lines of research in development that build on her previous work. These projects include a collaboration with colleagues in Pittsburgh and at the University of Toronto and the University of California, Los Angeles to develop a study to evaluate the additive and synergistic effects of disturbed sleep and major depressive disorder on gene expression and cellular and molecular aging, a project examining the role of slow-wave sleep in race differences in hypertension, and an R01 proposal to follow up early signals from the SIR Study of cognitive decline in shift workers.
Much like her early inspiration drawn from Dr. Krueger’s research on sleep and the immune system, Dr. Hall’s long-term plan, or dream, is to inspire high-impact research on the pathways through which sleep influences and is influenced by health and functioning. A dedicated mentor, Dr. Hall co-directs the Translational Sleep Medicine T32 training program with Dr. Buysse and trains students across the academic continuum including undergraduates, graduate and medical students, postdocs, and junior faculty. Beyond the University of Pittsburgh, she has led national and international training workshops and has obtained numerous grants to support travel awards for trainees to attend and participate in scientific conferences. In her current capacity as President of the Academy of Behavioral Medicine Research, Dr. Hall is actively developing career and leadership development opportunities for mid-career researchers to better support and advance the next generation of behavioral medicine researchers, teachers, and policy-makers. Whether in sleep research, specifically, or behavioral medicine, more broadly, Dr. Hall dreams of training as many successful researchers as she can to carefully and persistently explore important questions that remain just over the horizon.
Dr. Hall mentors a large group of trainees in the Mechanisms and Moderators of Sleep Health Laboratory at the University of Pittsburgh. These trainees develop conceptual models which they then test using a large cache of archival data related to sleep and health. Dr. Ryan Brindle, who has just transitioned from postdoc to Assistant Professor of Psychology at Washington and Lee University, is focused on psychological stress and sleep and their effects on cardiovascular disease. Vivianne Oyefusi, a second-year medical student at the University of Pittsburgh, is evaluating race, sleep and disparities in hypertension. Marissa Bowman is a graduate student in the dual Clinical and Health Psychology Program at the University of Pittsburgh; her research with Dr. Hall is focused on the interplay between sleep, depression, and cardiovascular disease.