Interim Chief of the University of Arizona Division of Pulmonary, Allergy, Critical Care and Sleep Medicine Sairam Parthasarathy, MD, has been hired by the National Institutes of Health (NIH) as an expert advisor to complete the collaborative effort on a five-year, strategic plan to lay out research goals for sleep medicine and circadian sciences.
Dr. Parthasarathy, a professor of medicine, is also the director of the UA Health Sciences Center for Sleep and Circadian Sciences and medical director of the Center for Sleep Disorders at Banner – University Medical Center Tucson.
At right, pictures of a photo shoot for an upcoming article to appear in the January 2019 issue of Tucson Lifestyle magazine on sleep medicine with Dr. Sai Parthasarathy. Pediatric sleep researcher Dr. Daniel Combs is with him in the image on the upper right corner.
His division, which he has led since late 2016, is the largest of 14 divisions in the UA Department of Medicine, one of six original and the largest department at the UA College of Medicine – Tucson with over 250 faculty physicians, 18 fellowship programs (four in pulmonary) and three residency programs, including the UA Internal Medicine Residency Program – Tucson Campus that is the largest at the college.
Coalescing the Ideas of Researchers Nationwide
Dr. Parthasarathy served as part of the Sleep Disorders Research Advisory Board for the National Heart, Lung, and Blood Institute, a unit of the NIH, that led development of the 2011 NIH Sleep Disorders Research Plan, the last strategic plan completed in 2011 and released in January 2012. He later served as chair of that board, his term expiring in 2014.
Simple math tells you a new plan is about two years overdue. Much of that may be due to managing heightened interest in sleep medicine and a more crowded field of researchers that rose in the intervening years with the explosive growth of personal activity trackers and the 2017 Nobel Prize for Physiology or Medicine that went to three U.S. scientists for their work on body clocks and sleep health.
Regardless, Dr. Partharathy will be working with the advisory board, NHLBI Division of Lung Diseases, NHLBI National Center on Sleep Disorders Research, Trans-NIH Sleep Research Coordinating Committee and multiple research groups nationwide to coalesce the information that they’ve already been working on to come up with a final product a soon as possible.
Dr. Parthasarathy calls the Nobel Prize a game-changer for sleep medicine, which wasn’t necessarily taken seriously seven years ago.
“You’ve hit the nail on the head. There’s a markedly greater understanding of sleep in the public consciousness, an awareness to the point that even Apple and Google are interested in sleep today,” said Dr. Parthasarathy, referring to inclusion of sleep tracking in the Apple Watch and similar features for Google SleepBot, Google Fit and Google Home. “Now, even scientists are gung ho. There’s an alignment within the public and among scientists which doesn’t happen too often.”
That’s because, he noted, of 17 chronic medical conditions (listed by the U.S. Centers for Disease Control and Prevention) that drive over 60 percent of health-care-dollar spending, sleep is co-located with all of them. Comorbidities affected by sleep range from Alzheimer’s and arthritis to diabetes and obesity to lung and heart disease and cancer.
For more detail on his role, see the Q&A at the bottom of this article.
A Dream of a Career in Sleep Medicine
Dr. Parthasarathy joined the UA College of Medicine – Tucson faculty in 2011. Prior to that, he was affiliated with the Southern Arizona VA Health Care System’s Tucson VA Medical Center as chief of research, section chief for pulmonary and critical care medicine, and head of the sleep medicine lab. He came to Tucson from Chicago, where he was with Loyola University Medical Center and the Edward Hines Jr. VA Hospital. He completed his residency in internal medicine and fellowship in pulmonary and critical care medicine at Loyola, after which he joined the faculty and became director of its Center for Sleep Disorders.
Dr. Parthasarathy has served on multiple NIH boards and committees related to the American Academy of Sleep Medicine (AASM) and National Center on Sleep Disorders Research—including chairing the Sleep Disorders Research Advisory Board (2012-14), and serving on editorial boards for several respiratory, critical care and sleep medicine related national and international journals. He also has consistently been named to the Top Doctors and Best Doctors nationwide lists.
Under Dr. Parthasarathy’s leadership, the Banner – UMC Tucson Center for Sleep Disorders opened in January 2012. In 2014, the center was accredited by the AASM to perform out-of-center sleep testing and Dr. Parthasarathy’s research team was awarded $2 million by PCORI (the Patient-Centered Outcomes Research Institute) to study sleep apnea. The UAHS Center for Sleep and Circadian Sciences was established in 2016 about the same time Dr. Parthasarathy took over the pulmonary division when prior chief Ken Knox, MD, left to join the faculty at the UA College of Medicine – Phoenix as associate dean for Faculty Affairs and Development. The UAHS sleep center’s research team has made a number of findings, including a link between persistent insomnia, inflammation and mortality.
Q&A WITH DR. SAIRAM PARTHASARATHY:
Q: This strategic plan for the National Institutes of Health has to do with sleep apnea and how to approach it for future funding and research targets, correct?
Dr. Parthasarathy: Yes. Every institute and center of the NIH puts out a strategic research plan for that particular entity for a five-year period, essentially to direct the strategies they’re going to be seeking in that area over the next five years.
Q: In terms of research and funding?
Dr. Parthasarathy: Yes. It’s the research direction and where it’s headed in the future. On the last NIH sleep medicine plan, I was actually part of the advisory board to the NIH. I helped write that plan back in 2011 and it’s the 2011 research plan that will be updated.
Q: This one will cover what period?
Dr. Parthasarathy: That’s somewhat up to interpretation, but it will have to cover forward from the year it is published. It’s currently behind schedule. The hope is to get it out for 2019, so it covers the five years from there onwards.
Q: When you were on this before, were you on a committee or chair of a committee…
Dr. Parthasarathy: Yes, I was chair of the Sleep Disorders Research Advisory Board to the NIH.
Q: In 2011?
Dr. Parthasarathy: A little later.
Q: And your role in this now differs how?
Dr. Parthasarathy: The 2011 plan, by the way, by the time it was released, it was January 2012. In 2012, I was the chair. In 2011, I was a member of the advisory board, but my term ended two years after that in 2014.
Q: And today?
Q: …which is based in Bethesda, Maryland?
Dr. Parthasarathy: Yes. It’s essentially a part of the Division of Lung Diseases. So, all asthma and COPD research is funded by the Division of Lung Diseases within the NHLBI, which is one of more than a dozen institutes within the NIH. Sleep medicine is within the lung arena because of sleep apnea. The other divisions are blood and heart. So, I am under the lung division in the sleep center. The sleep center, because sleep affects many other organ systems, has a trans-NIH coordinating committee so that the reach of sleep is beyond a particular division and institute—but they have to put it somewhere.
Q: Because it affects lungs, heart, neurosciences and all sorts of systems of the body?
Dr. Parthasarathy: Yes, but predominantly because sleep apnea is a driving force for the field, they put it under the lung division within NHLBI.
Q: Tell me this, what are some of the bigger point items you’re going to be focusing on that illustrate how much study in this field may have changed since 2011-12?
Dr. Parthasarathy: It’s changed tremendously. Our thinking now is very different than what it was five years ago—or, as it were, seven years ago since that plan came out in 2011.
Q: Such as how?
Dr. Parthasarathy: Well, sleep medicine won the Nobel Prize in medicine last year. I mean that is game changing. Circadian rhythms are integrally tied with sleep and this gives a molecular basis for how sleep is orchestrated.
Q: That particular Nobel Prize was for sleep and cancer patients, correct?
Dr. Parthasarathy: There is a connection, but it centered on circadian rhythms and health. So, our thinking on sleep medicine is very different now than what it was in 2011. That plan was limited to what we knew at that point in time and so much has happened in sleep research since then.
Q: So, what was the thinking then versus now?
Dr. Parthasarathy: It’s very different.
Q: Then, we were concerned with what?
Dr. Parthasarathy: I would say that it was in various areas, you know, in translational research. Just so you know, I can’t talk about the content of the plan.
Q: No, what I’m asking is what are targets. I mean, we know generally speaking, with the 2011-12 plan, what were the targets that you came up with then?
Dr. Parthasarathy: Everything. I know that sounds lame, but it was.
Q: Yup, it’s putting me to sleep (laughter from both).
Dr. Parthasarathy: Well, if you look at the 2016 NHLBI strategic plan, you’ll find lots of things related to sleep. It’s very cross-cutting, but it’s nudging people in certain directions. And unless you read the document, you won’t do justice just glibly talking about it. And I certainly can’t do that because this plan is in the process of being developed. I’m going to help them develop it.
Q: What I’m asking from you now, though, is for something that’s illustrative of the level at which people addressed sleep in medicine in 2011-12 versus today. You don’t have to highlight studies you’ve been involved in, studies that Dr. Michael Grandner has been involved in, or the research behind last year’s Nobel Prize, but give me something that illustrates that difference. For instance, back then, how seriously did people take the concepts of sleep and medicine versus now?
Dr. Parthasarathy: I think you’ve hit the nail on the head. There’s a markedly greater understanding of sleep in the public consciousness, an awareness to the point that even Apple and Google are interested in sleep today.
Q: How so? Why are they interested?
Dr. Parthasarathy: For Apple, for instance, they incorporated it into the Apple watch because they know that people want to know about their sleep. People want to monitor their sleep. People want to improve their productivity by enhancing their sleep. People are more conscious and aware of the importance of their health and sleep.
Q: Fitbit and all of these activity trackers didn’t exist in 2011-12.
Dr. Parthasarathy: Exactly. I mean, they did but didn’t have the reach they have today.
Q: Their use wasn’t as widespread.
Dr. Parthasarathy: Yes. I know this is sounding like a politician, but I can’t get into too many details. You can talk about an increase in awareness about the importance of sleep as an element in health. And you can talk about the fact the Nobel Prize in circadian rhythms has brought the issue up into the consciousness of scientists. In some ways, scientists were ignoring sleep in 2011—scientists outside of the sleep field. But the Nobel Prize gave it a legitimacy and importance and novelty. Now, even scientists are gung ho. See, there’s an alignment within the public and among scientists which doesn’t happen too often. We stand at a very important juncture in time where an area of study is as much in the public consciousness as of scientists due to the Nobel Prize and pervasiveness of activity trackers today.
Q: And I’m assuming that if we look at the way current or recent funding has been going, the examination into comorbidity issues related to cancer patients and their ability to sleep or diabetes patients and sleep, obesity issues and sleep and how these things all come together, it underscores the importance of sleep in the context of these other illnesses as well.
Dr. Parthasarathy: Yes. There are 17 chronic medical conditions. You don’t have to call out any specific one, but there are 17 chronic medical conditions that drive over 60 percent of health care dollar spending in this country. And sleep is co-located with all of those chronic conditions, starting with Alzheimer’s and arthritis to… diabetes and obesity. I can give you a list. All of these conditions can be aggravated by sleep problems. There are various sleep disorders, affecting quality and duration of sleep, that are constants of sleep health. What I’m trying to do is keep it to broad brushstrokes in this conversation. I don’t want to get too specific because then people may think I’m outing things which I’m not supposed to do. I hope that makes sense. With NIH, as they call it, that’s to defend their advisory board relationship. Here, they’re essentially commissioning me to help them with this strategic plan. I’m not the one writing it. I’m helping them to write it. In essence, it’s kind of like herding cats. All these cats are running in different directions.
Q: Are you overseeing a group of people or a process?
Dr. Parthasarathy: I’m working with a group of people, which is the current members of the Sleep Disorders Research Advisory Board and working groups. So, to explain, the NCSDR, which is the National Center on Sleep Disorders Research, and the Sleep Disorders Research Advisory Board members who are advisory to the NIH and various working groups of numerous sleep research organizations across the country—I’ll be working with all of them to help write the next five-year strategic plan.
Q: Okay, what’s the timeframe?
Dr. Parthasarathy: Yesterday. I’m just kidding.
Q: So, you’re going to be working to coalesce the information that they’ve already been working on to come up with a final product a soon as possible, hopefully within a year.
Dr. Parthasarathy: Yes, and I’ll be working with all these other elements. This includes the NCSDR, the Lung Diseases Division of the NHLBI, the Sleep Disorders Research Advisory Board to the NIH and working groups of various sleep and circadian rhythms researchers across the country. I’ll be working with these people to help write the next five-year strategic plan for sleep research for the NIH. Oh, this also includes the Trans-NIH Coordinating Committee, which has a member of each of the 13 institutes and two centers that make up the NIH. This includes the NHLBI, NCI, NICHD, NIAID, NIA and so forth… Each one of them has a senior program officer who is part of that committee, which is commissioned as such by the U.S. Congress. They are also part of this as ad hoc members of the Sleep Disease Research Advisory Board, even though it may not be immediately apparent. So, that is to say that this five-year plan will inform sleep and circadian rhythm research across all of these entities and beyond in the broader scientific community. ■
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