In this issue of Psychosomatic Medicine, we present a special collection of papers on stress, sleep, and health, in honor of the enormous contributions to the field by the late Dr. Martica Hall, an Associate Editor for this journal as well as a past president of the American Psychosomatic Society. The editors for this issue, Drs. Wendy M. Troxel, Julian F. Thayer, and Daniel J. Buysse, pay tribute to Tica in their introduction and provide a brief overview of the articles. As they note, Dr. Martica Hall’s legacy endures through the continued growth and evolution of the study of the complex interplay among sleep, stress, and health and the ongoing work of the many researchers she influenced.

Pages 213–215; https://doi.org/10.1097/PSY.0000000000001309

Occupational burnout has been associated with increased risk of coronary heart disease. Von Känel et al. investigated whether poor sleep quality is associated with impaired coronary microvascular function in male physicians (n = 60), a professional group at increased risk for burnout. The prevalence of poor sleepers was 40 percent in the burnout group and 10 percent in the control group. In male physicians with occupational burnout, poor global sleep quality was associated with reduced endothelium-dependent coronary microvascular function, suggesting a mechanism by which burnout may affect cardiovascular health.

Pages 216–226; https://doi.org/10.1097/PSY.0000000000001269

Tracy et al. examined whether behavioral-social rhythms (i.e., stability in the timing of key daily routine behaviors) are associated with cardiovascular disease (CVD) risk factors in retired night-shift workers and retired day workers (n = 154). Behavioral-social rhythms were related to CVD risk factors in retired adults regardless of prior night-shift work exposure. Older retired workers may benefit from education and interventions designed to increase behavioral-social rhythm regularity.

Pages 227–233; https://doi.org/10.1097/PSY.0000000000001287

Posttraumatic stress symptoms (PTSS) and sleep disturbance are multidimensional and prevalent among patients and caregivers affected by cancer. Tsai et al. examined the differential associations of each PTSS symptom cluster with distinct sleep markers in patients with cancer and their sleep-partner caregivers (n = 138 dyads). Unique PTSS symptom clusters, particularly arousal and reactivity, as well as negative cognitions and mood, were associated with distinct sleep markers individually and dyadically in this vulnerable population.

Pages 234–243; https://doi.org/10.1097/PSY.0000000000001283

Good sleep quality and duration are important for biological restoration and promotion of psychological well-being. Optimism may facilitate or result from sufficient sleep, but questions remain as to directionality. Monroe et al. tested how optimism is associated with levels of and variability in sleep quantity and quality in midlife and older women (n = 199). Baseline optimism was associated with higher sleep quality and lower intraindividual variability in sleep quantity. In turn, higher average sleep quality (but not quantity) was associated with higher optimism at the end of the study.

Pages 244–251; https://doi.org/10.1097/PSY.0000000000001281

Evidence links perceptions of positive social relationships with improved sleep quality and efficiency across the lifespan. Less is known about the directionality of these effects. Dickman et al. studied the bidirectional between- and within-person associations of loneliness and emotional support in daily life with measures of sleep (n = 389). Individuals with higher loneliness and lower emotional support on average reported poorer sleep quality and efficiency. However, within-person analysis found opposite effects. Day-to-day fluctuations in perceptions of social relationships may have an impact on the following night’s sleep, and vice versa.

Pages 252–260; https://doi.org/10.1097/PSY.0000000000001291

Wen et al. examined the daily associations of sleep quality, duration, and efficiency with next-day expectations of stress and positive experiences, and whether expectations were related to end-of-day daily physical symptoms (n = 600). Across two daily life studies, sleep that was better, longer, and/or more efficient (compared to one’s usual) was related to lower next-morning expectations for stress and higher expectations for positive events and pleasantness.

Pages 261–271; https://doi.org/10.1097/PSY.0000000000001303

Suicide is a leading cause of postpartum mortality, yet there is limited understanding of why and when suicide attempts may occur. Kaliush et al. examined associations among sleep, emotion dysregulation, and desire to live during the perinatal transition, as these factors may contribute to risk of postpartum suicide. Multilevel change-as-outcome models were built to examine changes in attractor dynamics among the factors, as well as whether sleep-emotion dysregulation differed based on participants’ desires to live (n = 94). Among risk factors, sleep health in particular warrants further exploration as a key factor in the emergence of postpartum suicide risk.

Pages 272–282; https://doi.org/10.1097/PSY.0000000000001297

Sleep disturbance is a hallmark of posttraumatic stress disorder (PTSD). Poor sleep after combat-related trauma can also predict subsequent PTSD. Less is known about the association between sleep duration and PTSD symptoms after acute coronary syndrome (ACS). Cornelius et al. examined the bidirectional relationship after ACS (n = 1145) and found that short sleep duration and PTSD symptoms were mutually reinforcing across the first year after ACS evaluation. Sleep, PTSD symptoms, and their relationship should be considered in the post-ACS period.

Pages 283–288; https://doi.org/10.1097/PSY.0000000000001279

Lee et al. examined changes in sleep health phenotypes over time and related these to the risk of chronic conditions (n = 3683). Analysis identified four sleep health phenotypes: good sleepers, insomnia sleepers, weekend catch-up sleepers, and nappers. Insomnia sleeping was related to an increased number of total chronic conditions, with higher risk for cardiovascular disease, diabetes, depression, and frailty. Nappers were at increased risks for diabetes, cancer, and frailty. Weekend catch-up sleeping was not associated with chronic conditions. Findings indicated heightened risk of chronic conditions involved in suboptimal sleep health phenotypes.

Pages 289–297; https://doi.org/10.1097/PSY.0000000000001288

Sleep research often uses averaged measures that may overlook patterns of sleep consistency in individuals over time. Gao et al. examined intra-individual variability (IIV) in sleep using questionnaires and actigraphy monitoring (n = 799). Subjective measures underestimated sleep IIV. Both measures indicated that race/ethnicity, stress, and poor time management increased risk for worse sleep IIV. Worse sleep IIV was also associated with poorer sleep quality, independent of average sleep duration. Promoting sleep consistency is therefore important to promoting sleep health.

Pages 298–306; https://doi.org/10.1097/PSY.0000000000001301

Woo et al. examined the association of individual sleep health and a composite score for levels of hemoglobin A1c (HbA1c) and depressive symptoms among African American adults with type 2 diabetes (n = 257). Better multidimensional sleep health was associated with lower depressive symptoms. Neither composite sleep health scores nor individual sleep dimensions were associated with hemoglobin A1c (HbA1c). Longitudinal research is needed to determine the causal association between multidimensional sleep health and depressive symptoms.

Pages 307–314; https://doi.org/10.1097/PSY.0000000000001298

Abdallah et al. compared financial hardship and self-reported sleep quality among Black women with or without systemic lupus erythematosus (SLE) (n = 402). Adjusting personal financial factors to meet needs was positively associated with an increase in poor sleep quality in participants with SLE. Overall, no associations between financial hardships and sleep quality were observed for the women without SLE. Economic interventions for Black women with SLE who experience financial hardships may help improve their overall health and quality of life.

Pages 315–323; https://doi.org/10.1097/PSY.0000000000001296

Fuller-Rowell et. al. examined measures of sleep as moderating variables in the association between discrimination and mental health problems in adults (n = 874). Greater consistency in sleep duration from night to night and fewer overall sleep problems were found to mitigate risk of mental health problems among adults, particularly in contexts where discrimination was prevalent. Attention to sleep and sleep variability is warranted to lessen the adverse mental health consequences of discrimination among adults.

Pages 324–333; https://doi.org/10.1097/PSY.0000000000001305

Stigma is commonly experienced by individuals with lung cancer because of presumptions by others that smoking behavior may have caused it. Little is known about the mechanisms through which lung cancer stigma predicts adverse outcomes. Williamson et al. tested across 12 weeks whether sleep disruption mediated relationships between stigma and patient-reported outcomes (n = 108). Individuals with lung cancer demonstrated pronounced sleep disruption, which mediated relationships between indicators of lung cancer stigma and distress and physical symptoms at study entry. These findings illuminate sleep disruption as a pathway through which lung cancer stigma may contribute to poorer outcomes.

Pages 334–341; https://doi.org/10.1097/PSY.0000000000001299

Poor sleep is associated with cardiometabolic morbidity and premature mortality. Emerging evidence suggests that vagus nerve functioning, as indexed by high-frequency heart rate variability (HF-HRV), is associated with and may contribute to poor sleep. Cribbet et al. tested associations between vagus nerve functioning in HF-HRV, measured during sleep, and subjective sleep complaints four years later (n = 143). Lower sleep HF-HRV predicted worse sleep four years later, highlighting the importance of vagus nerve functioning in adaptability and health.

Pages 342–348; https://doi.org/10.1097/PSY.0000000000001302

Paoletti et al. examined interactions of attachment anxiety, attachment avoidance, heart rate variability (HRV), and sleep quality in older adults (n = 171). High attachment anxiety affected health, while high attachment avoidance with poor self-regulatory capacity was associated with adverse health outcomes indexed by HRV. High trait HRV mitigated adverse effects of attachment insecurity on sleep quality, indicating that greater self-regulatory capacity may buffer stressors.

Pages 349–358; https://doi.org/10.1097/PSY.0000000000001295