Bio

Bio


Chad Ruoff, MD, RPSGT is a Clinical Assistant Professor and the Associate Fellowship Program Director at the Stanford Center for Sleep Sciences and Medicine. He is board certified in sleep medicine, obesity medicine, and internal medicine. His career in sleep medicine began as a sleep technologist in 1998 while completing his undergraduate education at Georgetown University. He received his internal medicine training at Baylor College of Medicine and then completed a sleep medicine fellowship at Stanford University in 2011 after which he joined the Stanford sleep faculty. He has developed a strong interest in the clinical evaluation and treatment of CNS hypersomnias.

Clinical Focus


  • Sleep Medicine
  • Obesity Medicine

Administrative Appointments


  • Assistant Program Director, Stanford Sleep Medicine Fellowship Program (2012 - Present)

Honors & Awards


  • Member, Alpha Omega Alpha Honor Medical Society (2010)

Professional Education


  • Fellowship:Stanford University School of Medicine (2011) CA
  • Board Certification, Obesity Medicine, American Board of Obesity Medicine (2014)
  • Board Certification: Sleep Medicine, American Board of Internal Medicine (2011)
  • Board Certification: Internal Medicine, American Board of Internal Medicine (2010)
  • Residency:Baylor College of Medicine (2010) TX
  • Medical Education:Wright State Medical School (2007) OH
  • Undergraduate Education, Georgetown University, Biology (2000)

Research & Scholarship

Current Research and Scholarly Interests


Interested in the investigation of new diagnostic tools and treatments in sleep medicine.

Clinical Trials


  • A Study of the Safety and Effectiveness of ADX-N05 for Excessive Daytime Sleepiness in Subjects With Narcolepsy Recruiting

    This is a study to evaluate the safety and effectiveness of ADX-N05 compared to placebo in the treatment of excessive daytime sleepiness in adults with narcolepsy.

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  • Effect of Liraglutide in Obese Subjects With Moderate or Severe Obstructive Sleep Apnoea: SCALE™ - Sleep Apnoea Not Recruiting

    This trial is conducted in North America. The aim of the trial is to investigate the effect of liraglutide in obese subjects with sleep apnoea.

    Stanford is currently not accepting patients for this trial.

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  • A Multicenter Study of the Efficacy and Safety of Xyrem With an Open- Label Pharmacokinetic Evaluation and Safety Extension in Pediatric Subjects With Narcolepsy With Cataplexy Recruiting

    The purpose of this trial is to assess the efficacy and safety of Xyrem in pediatrics subjects with narcolepsy that includes cataplexy.

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Teaching

Graduate and Fellowship Programs


  • Sleep Medicine (Fellowship Program)

Publications

Journal Articles


  • The Effect of Nasal Surgery on Continuous Positive Airway Pressure Device Use and Therapeutic Treatment Pressures: A Systematic Review and Meta-Analysis SLEEP Camacho, M., Riaz, M., Capasso, R., Ruoff, C. M., Guilleminault, C., Kushida, C. A., Certal, V. 2015; 38 (2): 279-?

    Abstract

    The relationship between nasal surgery and its effect on continuous positive airway pressure (CPAP) device therapeutic treatment pressures and CPAP device use has not been previously systematically examined.To conduct a systematic review and meta-analysis evaluating the effect of isolated nasal surgery on therapeutic CPAP device pressures and use in adults with obstructive sleep apnea (OSA).MEDLINE, Scopus, Web of Science, and The Cochrane Library were searched through July 15, 2014. The MOOSE consensus statement and PRISMA statement were followed.Eighteen studies (279 patients) reported CPAP data after isolated nasal surgery. Seven studies (82 patients) reported preoperative and postoperative mean therapeutic CPAP device pressures and standard deviations (SD), which reduced from 11.6 ± 2.2 to 9.5 ± 2.0 centimeters of water pressure (cwp) after nasal surgery. Pooled random effects analysis demonstrated a statistically significant pressure reduction, with a mean difference (MD) of -2.66 cwp (95% confidence interval (CI), -3.65 to -1.67); P < 0.00001. Eleven studies (153 patients) reported subjective, self-reported data for CPAP use; and a subgroup analysis demonstrated that 89.1% (57 of 64 patients) who were not using CPAP prior to nasal surgery subsequently accepted, adhered to, or tolerated it after nasal surgery. Objective, device meter-based hours of use increased in 33 patients from 3.0 ± 3.1 to 5.5 ± 2.0 h in the short term (<6 mo of follow-up).Isolated nasal surgery in patients with OSA and nasal obstruction reduces therapeutic CPAP device pressures and the currently published literature's objective and subjective data consistently suggest that it also increases CPAP use in select patients.

    View details for DOI 10.5665/sleep.4414

    View details for Web of Science ID 000348757800016

    View details for PubMedID 25325439

  • Periorbital Edema Secondary to Positive Airway Pressure Therapy Case Reports in Ophthalmological Medicine Dandekar, F., Camacho, M., Valerio, J., Ruoff, C. 2015: 3

    View details for DOI 10.1155/2015/126501

  • Narcolepsy and Predictors of Positive MSLTs in the Wisconsin Sleep Cohort SLEEP Goldbart, A., Peppard, P., Finn, L., Ruoff, C. M., Barnet, J., Young, T., Mignot, E. 2014; 37 (6): 1043-1051

    Abstract

    To study whether positive multiple sleep latency tests (MSLTs, mean sleep latency [MSL] ≤ 8 minutes, ≥ 2 sleep onset REM sleep periods [SOREMPs]) and/or nocturnal SOREMP (REM sleep latency ≤ 15 minutes during nocturnal polysomonography [NPSG]) are stable traits and can reflect incipient narcolepsy.Cross-sectional and longitudinal investigation of the Wisconsin Sleep Cohort Study.Adults (44% females, 30-81 years) underwent NPSG (n = 4,866 in 1,518 subjects), and clinical MSLT (n = 1,135), with 823 having a repeat NPSG-MSLT at 4-year intervals, totaling 1725 NPSG with MSLT studies. Data were analyzed using linear mixed-effects models, and the stability of positive MSLTs was explored using κ statistics.Prevalence of a nocturnal SOREMP on a NPSG, of ≥ 2 SOREMPs on the MSLT, of MSL ≤ 8 minutes on the MSLT, and of a positive MSLT (MSL ≤ 8 minutes plus ≥ 2 SOREMPs) were 0.35%, 7.0%, 22%, and 3.4%, respectively. Correlates of a positive MSLT were shift work (OR = 7.8, P = 0.0001) and short sleep (OR = 1.51/h, P = 0.04). Test-retest for these parameters was poor, with κ < 0.2 (n.s.) after excluding shift workers and short sleepers. Excluding shift-work, short sleep, and subjects with negative MSLTs, we found one undiagnosed subject with possible cataplexy (≥ 1/month) and a NPSG SOREMPs; one subject previously diagnosed with narcolepsy without cataplexy with 2 NPSG SOREMPs and a positive MSLT, and two subjects with 2 independently positive MSLTs (66% human leukocyte antigen [HLA] positive). The proportions for narcolepsy with and without cataplexy were 0.07% (95% CI: 0.02-0.37%) and 0.20% (95% CI: 0.07-0.58%), respectively.The diagnostic value of multiple sleep latency tests is strongly altered by shift work and to a lesser extent by chronic sleep deprivation. The prevalence of narcolepsy without cataplexy may be 3-fold higher than that of narcolepsy-cataplexy.Goldbart A, Peppard P, Finn L, Ruoff CM, Barnet J, Young T, Mignot E. Narcolepsy and predictors of positive MSLTs in the Wisconsin Sleep Cohort. SLEEP 2014;37(6):1043-1051.

    View details for DOI 10.5665/sleep.3758

    View details for Web of Science ID 000337894400006

    View details for PubMedID 24882899

  • The Burden of Narcolepsy Disease (BOND) study: health-care utilization and cost findings SLEEP MEDICINE Black, J., Reaven, N. L., Funk, S. E., McGaughey, K., Ohayon, M., Guilleminault, C., Ruoff, C., Mignot, E. 2014; 15 (5): 522-529

    Abstract

    The aim of this study was to characterize health-care utilization, costs, and productivity in a large population of patients diagnosed with narcolepsy in the United States.This retrospective, observational study using data from the Truven Health Analytics MarketScan® Research Databases assessed 5years of claims data (2006-2010) to compare health-care utilization patterns, productivity, and associated costs among narcolepsy patients (identified by International Classification of Diseases, Ninth Revision (ICD9) narcolepsy diagnosis codes) versus matched controls. A total of 9312 narcolepsy patients (>18years of age, continuously insured between 2006 and 2010) and 46,559 matched controls were identified.Compared with controls, narcolepsy subjects had approximately twofold higher annual rates of inpatient admissions (0.15 vs. 0.08), emergency department (ED) visits w/o admission (0.34 vs. 0.17), hospital outpatient (OP) visits (2.8 vs. 1.4), other OP services (7.0 vs. 3.2), and physician visits (11.1 vs. 5.6; all p<0.0001). The rate of total annual drug transactions was doubled in narcolepsy versus controls (26.4 vs. 13.3; p<0.0001), including a 337% and 72% higher usage rate of narcolepsy drugs and non-narcolepsy drugs, respectively (both p<0.0001). Mean yearly costs were significantly higher in narcolepsy compared with controls for medical services ($8346 vs. $4147; p<0.0001) and drugs ($3356 vs. $1114; p<0.0001).Narcolepsy was found to be associated with substantial personal and economic burdens, as indicated by significantly higher rates of health-care utilization and medical costs in this large US group of narcolepsy patients.

    View details for DOI 10.1016/j.sleep.2014.02.001

    View details for Web of Science ID 000335917400008

  • Burden of narcolepsy disease (bond) study: Validation of using a single diagnosis code to define presence of an orphan condition in medical claims data Value in Health Villa, K., Reaven, N., Funk, S., McGaughey, K., Ohayon, M., Guilleminault, C., Ruoff, C., Black, J. 2014; 17 (3): A202–A203
  • Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep Camacho, M., Certal, V., Abdullatif, J., Zaghi, S., Ruoff, C. M., Capasso, R., Kushida, C. A. 2014

    Abstract

    To systematically review the literature for articles evaluating myofunctional therapy (MT) as treatment for obstructive sleep apnea (OSA) in children and adults and to perform a meta-analysis on the polysomnographic, snoring, and sleepiness data.Web of Science, Scopus, MEDLINE, and The Cochrane Library.The searches were performed through June 18, 2014. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was followed.Nine adult studies (120 patients) reported polysomnography, snoring, and/or sleepiness outcomes. The pre- and post-MT apnea-hypopnea indices (AHI) decreased from a mean ± standard deviation (M ± SD) of 24.5 ± 14.3/h to 12.3 ± 11.8/h, mean difference (MD) -14.26 [95% confidence interval (CI) -20.98, -7.54], P < 0.0001. Lowest oxygen saturations improved from 83.9 ± 6.0% to 86.6 ± 7.3%, MD 4.19 (95% CI 1.85, 6.54), P =0.0005. Polysomnography snoring decreased from 14.05 ± 4.89% to 3.87 ± 4.12% of total sleep time, P < 0.001, and snoring decreased in all three studies reporting subjective outcomes. Epworth Sleepiness Scale decreased from 14.8 ± 3.5 to 8.2 ± 4.1. Two pediatric studies (25 patients) reported outcomes. In the first study of 14 children, the AHI decreased from 4.87 ± 3.0/h to 1.84 ± 3.2/h, P = 0.004. The second study evaluated children who were cured of OSA after adenotonsillectomy and palatal expansion, and found that 11 patients who continued MT remained cured (AHI 0.5 ± 0.4/h), whereas 13 controls had recurrent OSA (AHI 5.3 ± 1.5/h) after 4 y.Current literature demonstrates that myofunctional therapy decreases AHI by approximately 50% in adults and 62% in children. Lowest oxygen saturations, snoring, and sleepiness outcomes improve in adults. Myofunctional therapy could serve as an adjunct to other OSA treatments.

    View details for PubMedID 25348130

  • The Psychiatric Dimensions of Narcolepsy Psychiatric Times Ruoff, C. M., Black, J. 2014; 31 (1): 17 - 21
  • Orthodontics and sleep-disordered breathing SLEEP AND BREATHING Ruoff, C. M., Guilleminault, C. 2012; 16 (2): 271-273

    View details for DOI 10.1007/s11325-011-0534-9

    View details for Web of Science ID 000301737400002

    View details for PubMedID 21559930

  • Hypocretin receptor antagonists for insomnia: rationale and clinical data Clinical Investigation Chad Ruoff, Christian Guilleminault 2012; 2 (6): 623 - 637
  • Oral Appliances and Sleep-Disordered Breathing CHEST Ruoff, C. M., Guilleminault, C. 2011; 140 (5): 1110-1111

    View details for DOI 10.1378/chest.11-1375

    View details for Web of Science ID 000296928500003

    View details for PubMedID 22045873

  • Hypocretin Antagonists in Insomnia Treatment and Beyond CURRENT PHARMACEUTICAL DESIGN Ruoff, C., Cao, M., Guilleminault, C. 2011; 17 (15): 1476-1482

    Abstract

    Hypocretin neuropeptides have been shown to regulate transitions between wakefulness and sleep through stabilization of sleep promoting GABAergic and wake promoting cholinergic/monoaminergic neural pathways. Hypocretin also influences other physiologic processes such as metabolism, appetite, learning and memory, reward and addiction, and ventilatory drive. The discovery of hypocretin and its effect upon the sleep-wake cycle has led to the development of a new class of pharmacologic agents that antagonize the physiologic effects of hypocretin (i.e. hypocretin antagonists). Further investigation of these agents may lead to novel therapies for insomnia without the side-effect profile of currently available hypnotics (e.g. impaired cognition, confusional arousals, and motor balance difficulties). However, antagonizing a system that regulates the sleep-wake cycle while also influencing non-sleep physiologic processes may create an entirely different but equally concerning side-effect profile such as transient loss of muscle tone (i.e. cataplexy) and a dampened respiratory drive. In this review, we will discuss the discovery of hypocretin and its receptors, hypocretin and the sleep-wake cycle, hypocretin antagonists in the treatment of insomnia, and other implicated functions of the hypocretin system.

    View details for Web of Science ID 000295455800009

    View details for PubMedID 21476951

Books and Book Chapters


  • Central Nervous System Hypersomnias Atlas of Clinical Sleep Medicine Ruoff, C., Mignot, E. Elsevier Inc. 2014; 2nd: 159-173
  • Neurologic basis of sleep: an overview Handbook of Nutrition, Diet and Sleep Ruoff, C., Guilleminault, C. Wageningen Academic Publishers. 2013; 1: 13 - 26

Stanford Medicine Resources: