Optimizing sleep health to promote physiologic resilience: identifying protective factors and longitudinal associations with stress-related biomarkers and biological aging

The National Heart, Lung, and Blood Institute awarded Emory University $100,228 on September 1, 2026, under the Cardiovascular Diseases Research program (CFDA 93.837) to conduct longitudinal research examining associations between sleep health, protective factors against psychosocial adversity, and stress-related biomarkers including allostatic load and epigenetic age acceleration.

The project analyzes multidimensional sleep health—encompassing regularity, satisfaction, alertness, timing, efficiency, duration, and absence of disorder—as a determinant of cardiovascular and overall physiologic resilience. The research identifies protective buffers such as social support that mitigate the impact of psychosocial adversity on sleep quality and leverages longitudinal data to establish temporal relationships between sleep health dimensions and biological aging markers, with focus on populations at highest risk of poor sleep outcomes and adverse health events.

Work is performed at Emory University in Atlanta, Georgia, with a period of performance from September 1, 2026, through August 31, 2028. The award is classified as a Project Grant, an assistance type supporting competitive research training and investigator-initiated studies in cardiovascular and pulmonary sciences under NHLBI's portfolio.

Abstract

/summary sleep health (SH), a multidimensional construct encompassing regularity, satisfaction, alertness, appropriate timing, efficiency, adequate duration, and the absence of disorder, is a pillar of health. Over one-third of U.S. Adults experience inadequate SH, and more than 20 million have obstructive sleep apnea (OSA). Yet, sleep disorders like OSA are underrecognized and pose a major public health threat. Inadequate SH and OSA are linked to cardiovascular disease, the leading cause of death in the U.S. Of note, a composite measure of optimal SH-including actigraphy, questionnaires, and polysomnography (PSG) measures of sleep architecture and OSA severity-is associated with a 25% lower hazard of mortality compared to non-optimal SH, underscoring the value of capturing multiple dimensions of sleep in relation to health. Sleep is sensitive to psychological, social, and environmental factors. Psychosocial adversity, understood as the social and psychological challenges that may result in stress, is recognized as a harmful determinant of SH. Yet, most determinants research focuses on risk rather than protective factors of SH. Few studies have explored buffers (e.g., social support) that mitigate the impact of psychosocial adversity on SH. Emerging physiological mechanisms linking SH to morbidity and mortality include allostatic load (AL) and epigenetic age acceleration (EAA). AL captures dysregulation in the cardiovascular, nervous, and immune systems, while EAA reflects DNA methylation patterns associated with older biological age and increased mortality risk. Yet, temporal associations remain understudied, particularly among populations at highest risk of poor SH and adverse outcomes. To address these gaps, this project leverages longitudinal data from the nhlbi-sponsored multi-ethnic study of atherosclerosis (mesa).the overarching goals of this F31 training grant proposal are to (1) conduct research on modifying the adverse effects of adversity on SH and to examine SH within a resilience framework in relation to physiological markers of stress. (2) further, conducting this research will increase my proficiency in advanced statistical methods applicable to sleep and circadian research. In aim 1 (n=2230), we will test whether social support modifies associations between psychosocial adversity and composite multidimensional SH scores, with data from actigraphy (regularity, timing, efficiency, duration), questionnaires (satisfaction, alertness), and polysomnography (%N3, %REM, AHI). In aim 2 (n~800), we will assess optimal SH as a protective factor by estimating longitudinal associations between SH scores and outcomes, AL and EAA over 10 years. We hypothesize that adversity-SH associations will be weaker among those with high social support and that optimal SH will be associated with lower AL and EAA over time. This research aims to inform future resilience-focused interventions that leverage optimal SH to preserve health and longevity, especially for those experiencing disproportionate psychosocial adversity and health burdens. Support from this prestigious predoctoral training fellowship is vital to my development as an independent investigator in sleep and circadian science.