Clinical Focus

  • Sleep Wake Disorders
  • Pediatrics
  • Sleep Medicine

Professional Education

  • Board Certification: American Board of Pediatrics, Sleep Medicine (2009)
  • Board Certification: American Board of Pediatrics, Pediatric Pulmonology (2008)
  • Fellowship: Stanford University - Fellowship (2008) CA
  • Fellowship: University of California at San Francisco School of Medicine (2007) CA
  • Board Certification: American Board of Pediatrics, Pediatrics (2004)
  • Residency: University of California San Francisco (2004) CA
  • Medical Education: University of Michigan School of Medicine (2001) MI
  • Fellowship, Stanford University, Sleep Disorders (2008)

Clinical Trials

  • Study of the Usability and Efficacy of a New Pediatric CPAP Mask Not Recruiting

    This study will evaluate a newly developed pediatric mask (known as Pixi) on children aged 2-7 using continuous positive airway pressure (CPAP), or Non-invasive ventilation (NIV) treatment. The participants will undergo a monitored sleep study, followed by a 7 night trial of the Pixi mask in the home environment. During the study usability will be measured through questionnaires filled in by the parent and clinician. The study hypothesis is that the usability of the mask will be superior to the patient's usual mask.

    Stanford is currently not accepting patients for this trial. For more information, please contact Chia-Yu Cardell, (650) 721 - 7576.

    View full details

All Publications

  • Permanent standard time is the optimal choice for health and safety: an American Academy of Sleep Medicine position statement. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Rishi, M. A., Cheng, J. Y., Strang, A. R., Sexton-Radek, K., Ganguly, G., Licis, A., Berneking, M. W., Bhui, R., Creamer, J., Kundel, V., Spector, A. R., Olaoye, O., Hashmi, S. D., Abbasi-Feinberg, F., Abreu, A. R., Gurubhagavatula, I., Kapur, V. K., Kuhlmann, D., Martin, J., Olson, E., Patil, S., Rowley, J., Shelgikar, A., Trotti, L. M., Wickwire, E. M., Sullivan, S. 2023

    View details for DOI 10.5664/jcsm.10898

    View details for PubMedID 37904574

  • Sleep medicine advocacy matters for public health and safety. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Sullivan, S. S., Rishi, M. A. 2023

    View details for DOI 10.5664/jcsm.10692

    View details for PubMedID 37340983

  • Health advisory: melatonin use in children. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Rishi, M. A., Khosla, S., Sullivan, S. S. 2022

    View details for DOI 10.5664/jcsm.10332

    View details for PubMedID 36239049

  • The COVID-19 pandemic and sleep medicine: a look back and a look ahead. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Khosla, S., Beam, E., Berneking, M., Cheung, J., Epstein, L. J., Meyer, B. J., Ramar, K., So, J. Y., Sullivan, S. S., Wolfe, L. F., Gurubhagavatula, I. 2022


    The COVID-19 pandemic is a reminder that global infectious disease outbreaks are not new, and they have the potential to cause catastrophic morbidity and mortality, disrupt health care delivery, demand critical decision-making in the absence of scientific certainty, interrupt trainee education, inflict economic damage, and cause a spike in demand for health care services that exceeds societal capacity. In this document, we look back at how the sleep medicine community adapted to challenges imposed by the COVID-19 pandemic. To mitigate viral transmission, perhaps the single most effective and efficient adaptation was the rapid adoption of telemedicine. Many additional strategies were taken up virtually overnight, including more home sleep apnea testing, reconsideration of potential risks of positive airway pressure therapy, a reduction or cessation of laboratory services, and deployment of workers to provide front-line care to infected patients. During some periods, critical shortages in essential personal protective equipment, respiratory assist devices, and even oxygen added to logistical challenges, which were exacerbated by persistent financial threats and insufficient staffing. Through ongoing innovation, resiliency and adaptability, breakthroughs were made in assigning staff responsibilities and designing workflows, the use of clinical spaces, legislative support, and in professional society collaboration and guidance so that the missions of health care, teaching and academic pursuit could continue. Here we summarize what we have learned through these critical months and highlight key adaptations that deserve to be embraced as we move forward.

    View details for DOI 10.5664/jcsm.10102

    View details for PubMedID 35621129

  • Youth, mental health and sleep. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Yuen, K. M., Strang, A., Sullivan, S. 2022

    View details for DOI 10.5664/jcsm.10104

    View details for PubMedID 35632984

  • Re: Sørengaard TA, Saksvik-Lehouillier I. Associations between burnout symptoms and sleep among workers during the COVID-19 pandemic. Sleep Med. 2022 Feb;90:199-203. Sleep medicine Sullivan, S. S., Gurubhagavatula, I. 2022

    View details for DOI 10.1016/j.sleep.2022.03.027

    View details for PubMedID 35490151

  • ATS Core Curriculum 2021. Adult Sleep Medicine: Sleep Apnea. ATS scholar Jamil, S. M., Shafazand, S., Dudley, K. A., Lipford, M. C., Gu, C., Jun, J. C., Budnick, I., Davis, E. M., Kent, D., Stanley, J. J., Quaney, R., Stewart, N. H., Young, K., Sullivan, S., McSparron, J. I., Wang, T., Guzman, E., Coruh, B., Hayes, M. M. 2021; 2 (3): 484-496


    The American Thoracic Society Sleep Core Curriculum updates clinicians on important sleep topics, presented during the annual meeting, and appearing in summary here. This year's sleep core theme is sleep-disordered breathing and its management. Topics range from pathophysiological mechanisms for the association of obstructive sleep apnea (OSA) and metabolic syndrome, surgical modalities of OSA treatment, comorbid insomnia and OSA, central sleep apnea, and sleep practices during a pandemic. OSA has been associated with metabolic syndrome, independent of the role of obesity, and the pathophysiology suggests a role for sleep fragmentation and intermittent hypoxia in observed metabolic outcomes. In specific patient populations, surgical treatment modalities for OSA have demonstrated large reductions in objective disease severity compared with no treatment and may facilitate adherence to positive airway pressure treatment. Patient-centered approaches to comorbid insomnia and sleep apnea include evaluating for both OSA and insomnia simultaneously and using shared-decision making to determine the order and timing of positive airway pressure therapy and cognitive behavioral therapy for insomnia. The pathophysiology of central sleep apnea is complex and may be due to the loss of drive to breathe or instability in the regulatory pathways that control ventilation. Pandemic-era sleep practices have evolved rapidly to balance safety and sustainability of care for patients with sleep-disordered breathing.

    View details for DOI 10.34197/ats-scholar.2021-0027RE

    View details for PubMedID 34667995

  • Sleep Medicine Health-Care Worker Concerns About COVID-19: An Early Pandemic Survey. Respiratory care Johnson, K. G., Sullivan, S. S., Rastegar, V., Gurubhagavatula, I. 2021


    BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has produced numerous safety concerns for sleep medicine patients and health-care workers, especially related to the use of aerosol-generating positive airway pressure devices. Differences between physician and sleep technologist concerns with regard to viral exposure and mitigation strategies may inform protocols to ensure safety and promote patient and health-care worker resilience and retention.METHODS: An anonymous online survey aimed at sleep medicine practitioners was active from April 29, 2020 to May 8, 2020.RESULTS: We obtained 379 responses, including from 75 physicians and 283 technologists. The proportion of all the respondents who were extremely/very concerned about the following: exposing patients (70.8%), exposing technologists (81.7%), and droplet (82.7%) and airborne (81.6%) transmission from CPAP. The proportion of respondents who felt that aerosol precautions were extremely/very important varied by scenario: always needed (45.6%); only with CPAP (25.9%); and needed, despite negative viral testing (67.0%). More technologists versus physicians rated the following as extremely/very important: testing parents for COVID-19 (71.2 vs 47.5%; P = .01), high-efficiency particulate air filters (75.1 vs 61.8%; P = .02), and extremely/very concerned about shared-ventilation systems (65.9 vs 51.5%; shared ventilation P = .041). The respondents in northeastern and western United States were more concerned about the availability of COVID-19 testing than were those in other regions of the United States. Among the total number of respondents, 68.0% expected a ≥ 50% drop in patients willing to have in-laboratory testing, with greatest drops anticipated in northeastern United States.CONCLUSIONS: Sleep health-care workers reported high levels of concern about exposure to COVID-19. Physicians and technologists generally showed high concordance with regard to the need for mitigation strategies, but the respondents differed widely with regard to which strategies were necessary.

    View details for DOI 10.4187/respcare.09106

    View details for PubMedID 34433676

  • Child and teen sleep and pandemic-era school. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Yuen, K., Strang, A. R., Flynn-Evans, E. E., Barrantes Perez, J. H., Berneking, M., Bhui, R., Cheng, J. Y., Dombrowsky, J., Ganguly, G., Rishi, M. A., Rosen, C., Upender, R., Sullivan, S. S. 2021

    View details for DOI 10.5664/jcsm.9122

    View details for PubMedID 33432917

  • The impact of the COVID-19 pandemic on sleep medicine practices. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Johnson, K. G., Sullivan, S. S., Nti, A. n., Rastegar, V. n., Gurubhagavatula, I. n. 2021; 17 (1): 79–87


    The COVID-19 pandemic required sleep centers to consider and implement infection control strategies to mitigate viral transmission to patients and staff. Our aim was to assess measures taken by sleep centers due to the COVID-19 pandemic and plans surrounding reinstatement of sleep services.We distributed an anonymous online survey to health care providers in sleep medicine on April 29, 2020. From responders, we identified a subset of unique centers by region and demographic variables.We obtained 379 individual responses, which represented 297 unique centers. A total of 93.6% of unique centers reported stopping all or nearly all sleep testing of at least one type, without significant differences between adult and pediatric labs, geographic region, or surrounding population density. By contrast, a greater proportion of respondents continued home sleep apnea testing services. A total of 60.3% reduced home sleep apnea testing volume by at least 90%, compared to 90.4% that reduced in-laboratory testing by at least 90%. Respondents acknowledged that they implemented a wide variety of mitigation strategies. While no respondents reported virtual visits to be ≥ 25% of clinical visits prior to the pandemic, more than half (51.9%) anticipated maintaining ≥ 25% virtual visits after the pandemic.Among surveyed sleep centers, the vast majority reported near-cessation of in-laboratory sleep studies, while a smaller proportion reported reductions in home sleep apnea tests. A large increase in the use of telemedicine was reported, with the majority of respondents expecting the use of telehealth to endure in the future.

    View details for DOI 10.5664/jcsm.8830

    View details for PubMedID 32964828

  • Opportunities and unknowns in adapting pediatric sleep practices to a pandemic world. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Sullivan, S., Anastasi, M., Beam, E., Berneking, M., Cheung, J., Epstein, L. J., Khosla, S., Meyer, B., Wolfe, L., Gurubhagavatula, I. 2020

    View details for DOI 10.5664/jcsm.9068

    View details for PubMedID 33295279

  • Daylight saving time: an American Academy of Sleep Medicine position statement. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Rishi, M. A., Ahmed, O., Barrantes Perez, J. H., Berneking, M., Dombrowsky, J., Flynn-Evans, E. E., Santiago, V., Sullivan, S. S., Upender, R., Yuen, K., Abbasi-Feinberg, F., Aurora, R. N., Carden, K. A., Kirsch, D. B., Kristo, D. A., Malhotra, R. K., Martin, J. L., Olson, E. J., Ramar, K., Rosen, C. L., Rowley, J. A., Shelgikar, A. V., Gurubhagavatula, I. 2020


    None: The last several years have seen intense debate about the issue of transitioning between standard and daylight saving time. In the United States, the annual advance to daylight saving time in spring, and fall back to standard time in autumn, is required by law (although some exceptions are allowed under the statute). An abundance of accumulated evidence indicates that the acute transition from standard time to daylight saving time incurs significant public health and safety risks, including increased risk of adverse cardiovascular events, mood disorders, and motor vehicle crashes. Although chronic effects of remaining in daylight saving time year-round have not been well studied, daylight saving time is less aligned with human circadian biology - which, due to the impacts of the delayed natural light/dark cycle on human activity, could result in circadian misalignment, which has been associated in some studies with increased cardiovascular disease risk, metabolic syndrome and other health risks. It is, therefore, the position of the American Academy of Sleep Medicine that these seasonal time changes should be abolished in favor of a fixed, national, year-round standard time.

    View details for DOI 10.5664/jcsm.8780

    View details for PubMedID 32844740

  • Sleep medicine exposure offered by United States residency training programs. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Sullivan, S. S., Cao, M. T. 2020


    To understand the sleep medicine (SM) educational exposure among parent specialties of sleep medicine fellowships, we conducted an online survey among ACGME-approved training programs.Target respondents were program directors of family medicine, otolaryngology, psychiatry, neurology, pediatrics, and pulmonary and critical care (PCCM) training programs in the United States. The survey was based on the Sleep Education Survey (SES), a peer-reviewed, published survey created by the American Academy of Neurology Sleep Section. The modified 18-question survey was emailed via Survey Monkey per published methods totaling 3 requests approximately one week apart in January 2017.A total of 1,228 programs were contacted, and 479 responses were received for an overall response rate of 39%. Some programs in every specialty group offered a SM elective or a required rotation to trainees. PCCM and neurology reported the highest percentages of SM rotation as an option for housestaff (85.7% and 90.8%, respectively), and PCCM had the highest portion of programs indicating a rotation requirement (75.4%). Teaching format was a mixture of didactic lectures, sleep center/lab exposure, and case reports; with lectures being the most common format. Didactics averaged 4.75 hours per year. Few programs reported trainees subsequently pursuing SM fellowship (< 10% produced a fellow over five years), and even fewer reported having a trainee who pursued grant funding for sleep-related research over five years.There is wide variability and overall low exposure to sleep medicine education among United States "parent" ACGME training programs whose medical boards offer sleep medicine certification.

    View details for DOI 10.5664/jcsm.9062

    View details for PubMedID 33382031

  • Narcolepsy Symptoms are Highly Persistent over Time Despite Treatment Ohayon, M. M., Sullivan, S. S., Krystal, A. D., Black, J., Swick, T. J., Shapiro, C. M., Wells, C. C. WILEY. 2019: S122
  • Longitudinal Assessment of Psychotropic Treatments for Narcolepsy Ohayon, M. M., Sullivan, S. S., Black, J., Krystal, A. D., Shapiro, C. M., Swick, T. J., Wells, C. C. WILEY. 2019: S212
  • Longitudinal Relationships between Chronic Pain, Major Depressive Disorder, and Use of Antidepressants Ohayon, M. M., Sullivan, S. S. WILEY. 2019: S169–S170
  • Longitudinal Survey of Hypersomnolence and Its Treatment in the General Population Ohayon, M. M., Sullivan, S. S. WILEY. 2019: S121–S122
  • Industrial Regulation of Fatigue: Lessons Learned From Aviation. Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine Flynn-Evans, E. E., Ahmed, O., Berneking, M., Collen, J. F., Kancherla, B. S., Peters, B. R., Rishi, M. A., Sullivan, S. S., Upender, R., Gurubhagavatula, I., American Academy of Sleep Medicine Public Safety Committee 2019; 15 (4): 537–38

    View details for PubMedID 30952229

  • Sleep-Disordered Breathing, Orofacial Growth, and Prevention of Obstructive Sleep Apnea. Sleep medicine clinics Guilleminault, C., Sullivan, S. S., Huang, Y. 2019; 14 (1): 13–20


    Abnormal breathing during sleep is related to intrinsic and extrinsic factors that are present early in life. Investigation of fetal development and early-in-life orofacial growth allows recognition of risk factors that lead to change in upper airway patency, which leads to abnormal upper airway resistance, abnormal inspiratory efforts, and further increase in resistance and progressive narrowing of the collapsible upper airway. Such evolution can be recognized by appropriate clinical evaluation, specific polysomnographic patterns, and orofacial imaging. Recognition of the problems should lead to appropriate treatments and prevention of obstructive sleep apnea and its comorbidities.

    View details for PubMedID 30709527

  • Sleep-Disordered Breathing, Orofacial Growth, and Prevention of Obstructive Sleep Apnea SLEEP MEDICINE CLINICS Guilleminault, C., Sullivan, S. S., Huang, Y. 2019; 14 (1): 13-+
  • Pediatric sleep medicine: a key sub-specialty for the pediatrician. Sleep medicine Bruni, O., Sullivan, S., Guilleminault, C. 2019

    View details for PubMedID 30745076

  • Withdrawal of Advanced Notice of Proposed Rulemaking (ANPRM) on Obstructive Sleep Apnea (OSA) Does Not Mean Examiners and Employers Should Ignore Safety Risks JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL MEDICINE Sullivan, S. S., Gurubhagavatula, I. 2018; 60 (8): E431
  • Re: Withdrawal of Advanced Notice of Proposed Rulemaking (ANPRM) on Obstructive Sleep Apnea (OSA) Does Not Mean Examiners and Employers Should Ignore Safety Risks. Journal of occupational and environmental medicine Sullivan, S. S., Gurubhagavatula, I. 2018

    View details for PubMedID 29851731

  • Can we avoid development of a narrow upper airway and secondary abnormal breathing during sleep? LANCET RESPIRATORY MEDICINE Sullivan, S. S., Guilleminault, C. 2017; 5 (11): 843–44

    View details for PubMedID 28965819

  • Survey of Sleep Education Offered by US Pulmonary and Critical Care Fellowship Training Programs Sullivan, S., Cao, M. ELSEVIER SCIENCE BV. 2017: 554A
  • Sleep and Health: Medical Students' Perspectives and Lessons Learned ACADEMIC PSYCHIATRY Sullivan, S. S., Cao, M. T. 2017; 41 (5): 679–81

    View details for PubMedID 28929351

  • Management of Obstructive Sleep Apnea in Commercial Motor Vehicle Operators: Recommendations of the AASM Sleep and Transportation Safety Awareness Task Force JOURNAL OF CLINICAL SLEEP MEDICINE Gurubhagavatula, I., Sullivan, S., Meoli, A., Patil, S., Olson, R., Berneking, M., Watson, N. F. 2017; 13 (5): 745–58


    The American Academy of Sleep Medicine Sleep and Transportation Safety Awareness Task Force responded to the Federal Motor Carrier Safety Administration and Federal Railroad Administration Advance Notice of Proposed Rulemaking and request for public comments regarding the evaluation of safety-sensitive personnel for moderate-to-severe obstructive sleep apnea (OSA). The following document represents this response. The most salient points provided in our comments are that (1) moderate-to-severe OSA is common among commercial motor vehicle operators (CMVOs) and contributes to an increased risk of crashes; (2) objective screening methods are available and preferred for identifying at-risk drivers, with the most commonly used indicator being body mass index; (3) treatment in the form of continuous positive airway pressure (CPAP) is effective and reduces crashes; (4) CPAP is economically viable; (5) guidelines are available to assist medical examiners in determining whether CMVOs with moderate-to-severe OSA should continue to work without restrictions, with conditional certification, or be disqualified from operating commercial motor vehicles.

    View details for PubMedID 28356173

    View details for PubMedCentralID PMC5406951

  • Sleep Apnea Evaluation of Commercial Motor Vehicle Operators JOURNAL OF CLINICAL SLEEP MEDICINE Gurubhagavatula, I., Patil, S., Meoli, A., Olson, R., Sullivan, S., Berneking, M., Watson, N. F., Amer Acad Sleep Med 2016; 12 (3): 285–86

    View details for PubMedID 26857051

    View details for PubMedCentralID PMC4773613

  • Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing SLEEP AND BREATHING Lee, S., Guilleminault, C., Chiu, H., Sullivan, S. S. 2015; 19 (4): 1257-1264


    Adenotonsillectomy (T&A) may not completely eliminate sleep-disordered breathing (SDB), and residual SDB can result in progressive worsening of abnormal breathing during sleep. Persistence of mouth breathing post-T&As plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth.Retrospective study on non-overweight and non-syndromic prepubertal children with SDB treated by T&A with pre- and post-surgery clinical and polysomnographic (PSG) evaluations including systematic monitoring of mouth breathing (initial cohort). All children with mouth breathing were then referred for myofunctional treatment (MFT), with clinical follow-up 6 months later and PSG 1 year post-surgery. Only a limited subgroup followed the recommendations to undergo MFT with subsequent PSG (follow-up subgroup).Sixty-four prepubertal children meeting inclusion criteria for the initial cohort were investigated. There was significant symptomatic improvement in all children post-T&A, but 26 children had residual SDB with an AHI > 1.5 events/hour and 35 children (including the previous 26) had evidence of "mouth breathing" during sleep as defined [minimum of 44 % and a maximum of 100 % of total sleep time, mean 69 ± 11 % "mouth breather" subgroup and mean 4 ± 3.9 %, range 0 and 10.3 % "non-mouth breathers"]. Eighteen children (follow-up cohort), all in the "mouth breathing" group, were investigated at 1 year follow-up with only nine having undergone 6 months of MFT. The non- MFT subjects were significantly worse than the MFT-treated cohort. MFT led to normalization of clinical and PSG findings.Assessment of mouth breathing during sleep should be systematically performed post-T&A and the persistence of mouth breathing should be treated with MFT.

    View details for DOI 10.1007/s11325-015-1154-6

    View details for PubMedID 25877805

  • Emerging drugs for common conditions of sleepiness: obstructive sleep apnea and narcolepsy EXPERT OPINION ON EMERGING DRUGS Sullivan, S. S., Guilleminault, C. 2015; 20 (4): 571-582


    Obstructive sleep apnea (OSA) and narcolepsy are sleep disorders associated with high prevalence and high symptomatic burden including prominent sleepiness, daytime dysfunction and poor nocturnal sleep. Both have elevated risk of poor health outcomes. Current therapies are often underutilized, cumbersome, costly or associated with residual symptoms.This review covers current available therapies for OSA and narcolepsy as well as discusses areas for potential drug development, and agents in the therapeutic pipeline, including the cannabinoid dronabinol (OSA), the histamine inverse agonist/ antagonist pitolisant (narcolepsy), and stimulants with uncertain and/or multiple activities such as JZP-110 and JZP-386 (narcolepsy, possibly OSA). Finally it addresses new approaches and uses for therapies currently on the market such as the carbonic anhydrase inhibitor acetazolamide (OSA).Both OSA and narcolepsy are conditions of sleepiness for which lifelong treatments are likely to be required. In OSA, while continuous positive airway pressure will likely remain the gold standard therapy for the foreseeable future, there is plenty of room for integrating phenotypes and variants of OSA into therapeutic strategies to lead to better, more personalized disease modification. In narcolepsy, unlike OSA, drug therapy is the current mainstay of treatment. Advances using novel mechanisms to treat targeted symptoms such as sleepiness and/or novel agents that can treat more than one symptom of narcolepsy, hold promise. However, cost, convenience and side effects remain challenges.

    View details for DOI 10.1517/14728214.2015.1115480

    View details for PubMedID 26558298

  • Current Treatment of Selected Pediatric Sleep Disorders NEUROTHERAPEUTICS Sullivan, S. S. 2012; 9 (4): 791-800


    While pediatric sleep disorders are relatively common, treatments are often not straightforward. There is often a paucity of gold standard studies and data available to guide clinicians, treatments may yield arguably incomplete results, interventions may require chronic use, and/ or involve multiple modalities including behavioral interventions that require high parental and family commitment. This review points out diagnostic differences compared to adults and focuses on current therapy for selected common pediatric sleep disorders including sleep disordered breathing/ obstructive sleep apnea, narcolepsy, and restless legs syndrome. Other common pediatric sleep disorders, such as insomnia and parasomnias, are not covered.

    View details for DOI 10.1007/s13311-012-0149-2

    View details for Web of Science ID 000310325000010

    View details for PubMedID 23055049

    View details for PubMedCentralID PMC3480565

  • Update on emerging drugs for insomnia EXPERT OPINION ON EMERGING DRUGS Sullivan, S. 2012; 17 (3): 295-298


    In recent years, there has been no evidence that the problem of chronic insomnia has faded in the least in US adults; on the contrary, a recent estimate of annual lost productivity due to insomnia was $63.2 billion dollars. However, the proportion of insomniacs who are treated continues to be low, indicating the need for continued development and dissemination of effective therapies. Hypnotic drug development has arguably become more focused in recent years, particularly upon the highly anticipated novel target, the orexin (hypocretin) system. Merck's suvorexant (MK-4305) is the first compound of the so-called dual orexin receptor antagonist (DORA) class expected to be submitted for FDA approval, with a new drug application anticipated in 2012. While there has also been some new activity in the modulation of well-characterized targets with well-characterized agents, such as CNS histamine receptors with low-dose doxepin, a decades-old antidepressant and GABA(A) with sublingual zolpidem, experience with melatonin and serotonin modulators suggests that other targets also exist. Diversifying insomnia drug targets may expand possibilities for customizing hypnotic administration to individualized patient presentation and mechanistic underpinnings. In addition, it may offer improved avenues for combining medications with non-drug treatments such as cognitive behavioral therapy for insomnia (CBT-I).

    View details for DOI 10.1517/14728214.2012.693158

    View details for Web of Science ID 000307998500003

    View details for PubMedID 22920041

  • Hiding in plain sight Risk factors for REM sleep behavior disorder NEUROLOGY Sullivan, S. S., Schenck, C. H., Guilleminault, C. 2012; 79 (5): 402-403

    View details for DOI 10.1212/WNL.0b013e31825dd3c0

    View details for Web of Science ID 000307161100008

    View details for PubMedID 22744669

  • Narcolepsy in adolescents. Adolescent medicine: state of the art reviews Sullivan, S. S. 2010; 21 (3): 542-?


    Narcolepsy is a disorder of children and adolescence, but until recently it was often not identified until adulthood, with a reported time from onset to diagnosis of about a decade. This disorder affects approximately 0.05% of the population and starts in childhood and adolescence about half of the time. With narcolepsy, the boundaries between wake, sleep, and dreams are blurred. The cardinal features of narcolepsy-cataplexy are daytime somnolence, cataplexy (sometimes occurring long after onset of sleepiness), sleep paralysis, and hypnagogic hallucinations. Weight gain, disturbed nocturnal sleep, and social/school functional changes are common; reactive substance use to maintain wakefulness during the day may also be seen. Males and females are equally affected. It is classically associated with HLA DQB1*0602, the most specific genetic marker for narcolepsy across all ethnic groups. CSF hypocretin has recently been found to be depleted in this disorder, and late-breaking data support that the disease is caused by autoimmune destruction of hypocretin-producing neurons in the hypothalamus. There is no known cure for narcolepsy. Therapies include behavioral/ scheduling modification, medications to combat daytime sleepiness and cataplexy, and treatment of concomitant disorders leading to daytime sleepiness. The differential diagnosis for this disorder should include other disorders of excessive daytime sleepiness with a proclivity toward onset in adolescence, such as delayed sleep phase syndrome, obstructive sleep apnea, and insufficient sleep time; substance use; and less commonly neurologic disorders such as Klein Levin syndrome, Prader-Willi syndrome, and others. Immunomodulator therapy and hypocretin replacement are proposed therapies that hold promise for the future.

    View details for PubMedID 21302860

  • Exploring the Electrocardiogram as a Potential Tool to Screen for Premotor Parkinson's Disease MOVEMENT DISORDERS Valappil, R. A., Black, J. E., Broderick, M. J., Carrillo, O., Frenette, E., Sullivan, S. S., Goldman, S. M., Tanner, C. M., Langston, J. W. 2010; 25 (14): 2296-2303


    The aim of this study was to test the hypothesis that patients with REM sleep behavior disorder, many of whom will develop Parkinson's disease (PD) or a related synucleinopathy, will demonstrate decreased heart rate variability (HRV) compared with a group of age-matched controls as measured by an electrocardiogram during wakefulness. We compared HRV in 11 untreated idiopathic REM sleep behavior disorder patients (9 men and 2 women; mean age, 63.3 years; SD, 7.5 years) and 11 control subjects with idiopathic insomnia without REM sleep behavior disorder (7 men and 4 women; mean age, 59.5 years; SD, 8.7 years). Subjects with other causes of reduced HRV were excluded. HRV was determined from 5-minute presleep segments of a single channel electrocardiogram recorded during polysomnographic evaluations, using R-R intervals during wakefulness. Time domain, geometric measures, and spectral analysis of the R-R intervals were significantly different between cases and controls. A discriminant function analysis correctly classified 95.5% of subjects (overall model fit, P = 0.016). Leave-one-out cross-validation correctly classified 77.3% of subjects. HRV during wakefulness is significantly decreased in patients with idiopathic REM sleep behavior disorder compared with control subjects, suggesting abnormalities of both sympathetic and parasympathetic function. Patients with RBD may later develop motor and cognitive features of a Lewy body disorder, such as PD. Cardiac autonomic dysfunction is also impaired in PD, suggesting that impaired HRV may be an early sign of PD. HRV measured by routine electrocardiograms could be used to screen for Lewy body disorders such as PD.

    View details for DOI 10.1002/mds.23348

    View details for Web of Science ID 000283483500006

    View details for PubMedID 20976736

  • Insomnia Pharmacology MEDICAL CLINICS OF NORTH AMERICA Sullivan, S. S. 2010; 94 (3): 563-?


    Insomnia is not only the most common sleep disorder in the population, it is a frequent complaint heard overall by primary care physicians and specialists alike. Given the high prevalence of this disorder, its tendency to persist, and the frequency with which patients complain of symptoms in practice, it is imperative to have an understanding of basic sleep-wake mechanisms and the evolving field of pharmacologic approaches to enhance sleep. Currently, pharmacologic approaches are among the most widely used therapies for insomnia. This article reviews sleep-wake mechanisms, the neuroanatomic targets for sleep and wake-promoting agents, and discusses currently used agents to promote sleep and investigational hypnotics.

    View details for DOI 10.1016/j.mcna.2010.02.012

    View details for Web of Science ID 000278853600010

    View details for PubMedID 20451033

  • Emerging drugs for insomnia: new frontiers for old and novel targets EXPERT OPINION ON EMERGING DRUGS Sullivan, S. S., Guilleminault, C. 2009; 14 (3): 411-422


    Insomnia is the most prevalent sleep disorder, with up to 50% of the US adult population reporting symptoms of insomnia on a weekly basis and approximately 12% with insomnia disorder. Comorbid conditions such as depression and anxiety are frequent. Insomnia is more common with older age, female gender and socioeconomic status. Traditionally, therapy has focused on GABA(A) receptor agonists, and off-label antidepressant and antihistamine use.With increased understanding of complex neural networks involved in sleep and wake, hypnotics are being developed to target a broader variety of receptors with increasing selectivity. This review summarizes promising compounds in Phase II and III trials with evidence supporting efficacy for treatment of insomnia.5-HT(2A) and 5-HT(2C) antagonists, melatonergic (MT1/MT2) agonists, orexin receptor (OX1/OX2) antagonists, as well as GABA(A) receptor agonists are reviewed and summarized. Data are collected from PubMed and Pharmaprojects database searches, company websites, recent scientific meeting presentations and abstracts.A variety of drugs targeting several pathways, including GABA(A) agonism, MT1/MT2 agonism, 5-HT(2A) antagonism, OX1/OX2 antagonism and others, are in Phase II and III trials. More work should be done to understand the impact of these drugs in certain populations and in the context of comorbid conditions.

    View details for DOI 10.1517/14728210903171948

    View details for PubMedID 19708818

  • Multiple Sleep Latency Test and Maintenance of Wakefulness Test CHEST Sullivan, S. S., Kushida, C. A. 2008; 134 (4): 854-861


    Excessive daytime sleepiness and fatigue are common complaints in the sleep clinic. The objective evaluation and quantification of these symptoms is important for both the diagnosis of underlying health problems and for gauging treatment response. The multiple sleep latency test measures physiologic sleepiness, whereas the maintenance of wakefulness test (MWT) aims to measure manifest sleepiness. Neither test correlates well with subjective measures of sleep such as the Epworth sleepiness scale and the Stanford sleepiness scale. Although in the past methodological testing differences existed, in 2005 updated practice parameters were published, promoting the standardization of testing procedures. In recent years, there has been an effort to document daytime sleepiness when associated with occupational risk. However, these laboratory-based tests may not reflect or predict real-life experience. Normative data for both tests, particularly the MWT, are limited, and are inadequate for the evaluation of pediatric patients, shift workers, and others.

    View details for DOI 10.1378/chest.08-0822

    View details for Web of Science ID 000260097600032

    View details for PubMedID 18842919

  • Weighing the duty to inform a patient of possible future illness. The virtual mentor : VM Sullivan, S. 2008; 10 (9): 553–55

    View details for PubMedID 23211105

  • Nasal obstruction in children with sleep-disordered breathing ANNALS ACADEMY OF MEDICINE SINGAPORE Sullivan, S., Li, K., Guilleminault, C. 2008; 37 (8): 645-648


    Nasal obstruction secondary to pathological enlargement of inferior nasal turbinates contributes to sleep-disordered breathing (SBD) in prepubertal children, but treatments designed to address turbinate enlargement are often not performed. The aims of these studies are: (1) to appreciate the contribution to SDB of untreated enlarged nasal turbinates in prepubertal children; and (2) to report our experience with treatment of enlarged nasal turbinates in young children with SDB.Children with enlarged nasal turbinates who underwent adenotonsillectomy (T&A) had significantly less improvement in postoperative apnoea-hypopnoea index (AHI) compared to those treated with concomitant turbinate reduction. Children in the untreated turbinate hypertrophy group subsequently underwent radiofrequency ablation of the inferior nasal turbinates; following this procedure, AHI was no different than AHI of those without hypertrophy.In an analysis of safety and effectiveness of radiofrequency treatment of the nasal turbinates, we found the procedure to be a well-tolerated component of SDB treatment.We conclude that radiofrequency (RF) treatment of inferior nasal turbinates is a safe and effective treatment in young prepubertal children with SDB. When indicated, it should be included in the treatment plan for prepubertal children with SDB. However, the duration of effectiveness is variable and therapy may need to be repeated if turbinate hypertrophy recurs.

    View details for PubMedID 18797556