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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  • 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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  • A Study of Safety and Efficacy of BTD-001 in Treatment of Patients With Idiopathic Hypersomnia (IH) or Narcolepsy Type 2 Recruiting

    This is a randomized, placebo-controlled, double-blind, multiple cohort, fixed-dose multiple crossover, dose-finding study of oral BTD-001 in adult patients with IH or Narcolepsy without cataplexy (Type 2).

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  • "A Long-Term Safety Study of JZP-110 in the Treatment of Excessive Sleepiness in Subjects With Narcolepsy or OSA" Recruiting

    This is a Phase 3 study to assess the long-term safety and maintenance of efficacy of JZP-110 in subjects who have completed Study 14-002, 14-003, 14-004, 15-004, 15-005, ADX-N05 201, or ADX-N05 202.

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  • "Twelve-week Study of the Safety and Efficacy of JZP-110 in the Treatment of Excessive Sleepiness in Narcolepsy" Recruiting

    This trial is a 12-week, randomized, double-blind, placebo controlled, multicenter, 4-treatment parallel group study of the safety and efficacy of JZP-110 in the treatment of excessive sleepiness in adult subjects 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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Graduate and Fellowship Programs

  • Sleep Medicine (Fellowship Program)


All Publications

  • A Case of Rapid Eye Movement Sleep Behavior Disorder in Parkinson Disease Treated With Sodium Oxybate. JAMA neurology Liebenthal, J., Valerio, J., Ruoff, C., Mahowald, M. 2016; 73 (1): 126-127

    View details for DOI 10.1001/jamaneurol.2015.2904

    View details for PubMedID 26595534

  • The ICSD-3 and DSM-5 Guidelines for Diagnosing Narcolepsy: Clinical Relevance and Practicality Current Medical Research and Opinion Ruoff, C., Rye, D. 2016
  • Hypersomnia Case Studies Review of Sleep Medicine Ruoff, C., Jain, V., Swick, T. Elsevier. 2016; 4
  • Effect of Oral JZP-110 (ADX-N05) on Wakefulness and Sleepiness in Adults with Narcolepsy: A Phase 2b Study. Sleep Ruoff, C., Swick, T. J., Doekel, R., Emsellem, H. A., Feldman, N. T., Rosenberg, R., Bream, G., Khayrallah, M. A., Lu, Y., Black, J. 2016


    To evaluate the efficacy and safety of oral JZP-110, a second-generation wake-promoting agent with dopaminergic and noradrenergic activity, for treatment of impaired wakefulness and excessive sleepiness in adults with narcolepsy.This was a Phase 2b, randomized, double-blind, placebo-controlled, parallel group trial conducted at 28 centers in the United States. Patients were adults with narcolepsy who had baseline scores ?10 on the Epworth Sleepiness Scale (ESS) and baseline sleep latency ?10 min on the Maintenance of Wakefulness Test (MWT). Patients received a daily placebo (n = 49) or JZP-110 (n = 44) 150 mg/day weeks 1-4 and 300 mg/day weeks 5-12. Primary efficacy endpoints were change from baseline in average MWT sleep latency, and the Clinical Global Impression-Change (CGI-C); secondary endpoints were change from baseline in ESS score and Patient Global Impression-Change.Improvements were significantly greater with JZP-110 versus placebo on mean MWT sleep latency (4 w, 9.5 versus 1.4 min, P < 0.0001; 12 w, 12.8 versus 2.1 min, P < 0.0001), percentage of patients with CGI-C improvement (4 w, 80% versus 51%, P = 0.0066; 12 w, 86% versus 38%, P < 0.0001), and mean change in ESS (4 w, -5.6 versus -2.4, P = 0.0038; 12 w, -8.5 versus -2.5, P < 0.0001). Three JZP-110-treated patients (6.8%) discontinued due to adverse events (AEs). The most common AEs with JZP-110 versus placebo were insomnia (23% versus 8%), headache (16% versus 10%), nausea (14% versus 6%), diarrhea (11% versus 6%), decreased appetite (14% versus 0%), and anxiety (11% versus 0%).At doses of 150-300 mg/day, JZP-110 was well tolerated and significantly improved the ability to stay awake and subjective symptoms of excessive sleepiness in adults with narcolepsy. ( identifier NCT01681121).

    View details for PubMedID 27166238

  • CNS Hypersomnias Sleep and Neurologic Disease Cheung, J., Ruoff, C., Mignot, E. 2016
  • Five-Minute Awake Snoring Test for Determining CPAP Pressures (Five-Minute CPAP Test): A Pilot Study. Sleep disorders Camacho, M., Ruoff, C. M., Kawai, M., Modi, R., Arbee, J., Hekmat, A., Robertson, M., Zaghi, S., Certal, V., Capasso, R., Kushida, C. A. 2016; 2016: 7380874-?


    Objective. To develop a quick, simple, bedside test for determining continuous positive airway pressures (CPAP) for obstructive sleep apnea (OSA) patients. Study Design. Prospective case series at a tertiary medical center. Methods. The Five-Minute Awake Snoring Test for Determining CPAP (Five-Minute CPAP Test) was developed and tested. Patients wear a soft-gel nasal triangle mask while holding a tongue depressor with the wide section (1.75?cm) between the teeth. Fixed pressure nasal CPAP is applied while the patient simulates snoring at 4 centimeters of water pressure. The pressure is incrementally titrated up and then down to determine the lowest pressure at which the patient cannot snore (Quiet Pressure). Results. Overall, thirty-eight patients participated. All could simulate snoring. Correlation coefficients were statistically significant between Quiet Pressures and body mass index (r s = 0.60 [strong positive relationship], p = 0.0088), apnea-hypopnea index (r s = 0.49 [moderate positive relationship], p = 0.039), lowest oxygen saturation (r s = -0.47 [moderate negative relationship], p = 0.048), and oxygen desaturation index (r s = 0.62 [strong positive relationship], p = 0.0057). Conclusion. This pilot study introduces a new concept, which is the final product of over one year of exploration, development, and testing. Five-Minute CPAP Test is a quick, inexpensive, and safe bedside test based on supine awake simulated snoring with nasal CPAP.

    View details for DOI 10.1155/2016/7380874

    View details for PubMedID 26881088

  • Smartphone apps for snoring JOURNAL OF LARYNGOLOGY AND OTOLOGY Camacho, M., Robertson, M., ABDULLATIF, J., Certal, V., Kram, Y. A., Ruoff, C. M., Brietzke, S. E., Capasso, R. 2015; 129 (10): 974-979


    To identify and systematically evaluate user-friendly smartphone snoring apps.The Apple iTunes app store was searched for snoring apps that allow recording and playback. Snoring apps were downloaded, evaluated and rated independently by four authors. Two patients underwent polysomnography, and the data were compared with simultaneous snoring app recordings, and one patient used the snoring app at home.Of 126 snoring apps, 13 met the inclusion and exclusion criteria. The most critical app feature was the ability to graphically display the snoring events. The Quit Snoring app received the highest overall rating. When this app's recordings were compared with in-laboratory polysomnography data, app snoring sensitivities ranged from 64 to 96 per cent, and snoring positive predictive values ranged from 93 to 96 per cent. A chronic snorer used the app nightly for one month and tracked medical interventions. Snoring decreased from 200 to 10 snores per hour, and bed partner snoring complaint scores decreased from 9 to 2 (on a 0-10 scale).Select smartphone apps are user-friendly for recording and playing back snoring sounds. Preliminary comparison of more than 1500 individual snores demonstrates the potential clinical utility of such apps; however, further validation testing is recommended.

    View details for DOI 10.1017/S0022215115001978

    View details for Web of Science ID 000363039000010

    View details for PubMedID 26333720

  • 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. 2015; 38 (5): 669-675


    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 DOI 10.5665/sleep.4652

    View details for PubMedID 25348130

  • 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): 279-286


    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 PubMedID 25325439

  • Periorbital edema secondary to positive airway pressure therapy. Case reports in ophthalmological medicine Dandekar, F., Camacho, M., Valerio, J., Ruoff, C. 2015; 2015: 126501-?


    Two patients developed bilateral, periorbital edema after initiating positive airway pressure (PAP) therapy with a full face mask. The periorbital edema was more pronounced in the morning and would dissipate throughout the day. This phenomenon seemed to be correlated with the direct pressure of the full face mask, which may have impaired lymphatic and venous drainage. To test this hypothesis, each patient was changed to a nasal pillow interface with subsequent improvement in the periorbital edema.

    View details for DOI 10.1155/2015/126501

    View details for PubMedID 25767727

  • High rates of medical comorbidity in narcolepsy: findings from the burden of narcolepsy disease (BOND) study of 9312 patients in the United States JOURNAL OF SLEEP RESEARCH Black, J., Reaven, N., Funk, S., MCGAUGHEY, K., Ohayon, M., Guilleminault, C., Ruoff, C. 2014; 23: 152-152
  • 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


    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 ? 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 ? < 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


    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

    View details for PubMedID 24768358

  • The Psychiatric Dimensions of Narcolepsy Psychiatric Times Ruoff, C. M., Black, J. 2014; 31 (1): 17 - 21
  • 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
  • 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
  • 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


    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

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