Brian B. Koo, MD
Associate ProfessorCards
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Director, Sleep Medicine Laboratory at Connecticut Veterans Affairs Healthcare System, Medicine
Director, Yale Center for Restless Legs Syndrome
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View this doctor's clinical profile on the Yale Medicine website for information about the services we offer and making an appointment.
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Director, Sleep Medicine Laboratory at Connecticut Veterans Affairs Healthcare System, Medicine
Director, Yale Center for Restless Legs Syndrome
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View this doctor's clinical profile on the Yale Medicine website for information about the services we offer and making an appointment.
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Director, Sleep Medicine Laboratory at Connecticut Veterans Affairs Healthcare System, Medicine
Director, Yale Center for Restless Legs Syndrome
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Titles
Associate Professor
Director, Sleep Medicine Laboratory at Connecticut Veterans Affairs Healthcare System, Medicine; Director, Yale Center for Restless Legs Syndrome
Biography
Dr. Brian Koo is director of the Yale Center for Restless Legs Syndrome (RLS) and of the Connecticut Veterans Affairs sleep laboratory. Dr. Koo is a physician-scientist, boarded in both neurology and sleep medicine, and his clinical and research interest lies at the intersection between these two disciplines. Following his clinical training, Dr. Koo completed a 2-year Sleep Disorders Epidemiology & Neurobiology research fellowship at Case Western Reserve University in 2008 and shortly after was recruited to Yale to join the Sleep Disorders division and Department of Neurology. Dr. Koo is an international expert in the sleep-related movement disorders and in particular, RLS, periodic limb movements during sleep and REM behavior disorder. Dr. Koo is a clinical leader in the field, having served on the 2024 American Academy of Sleep Medicine task force to revise the guidelines for the treatment of RLS. He also serves on the medical advisory board of the RLS Foundation.
Dr. Koo’s research laboratory studies the neurobiological underpinnings of RLS, the neurophysiologic significance of periodic limb movements during sleep (PLMS) and the role of gut inflammation in REM behavior disorder (RBD). Dr. Koo has shown that patients with RLS compared to those without RLS have lower levels of cerebrospinal fluid beta-endorphin and higher levels of melanocyte stimulating hormone, the latter sensitizing to pain and spurring movement. The Koo lab has also shown that PLMS are associated with fluctuations in ventilation and are a significant contributor to obstructive sleep apnea. Dr. Koo was the first to describe that RBD has increased prevalence among those with inflammatory bowel disease and is actively studying the role of gut inflammation and the gut microbiome in the progression of RBD to overt synucleinopathy.
Dr. Koo’s ultimate goal is to leverage the clinical insights gained through patient care to enhance treatment strategies, and at the same time apply these insights to advance understanding of the mechanisms underlying sleep-related neurological disease.
Appointments
Neurology
Associate Professor on TermPrimary
Other Departments & Organizations
Education & Training
- Fellowship
- Case Western Reserve University (2008)
- Fellowship
- Cleveland Clinic (2006)
- Residency
- Long Island Jewish Hospital (2005)
- MD
- Tufts University School of Medicine (2001)
- BA
- University of Pennsylvania, Biological Basis of Behavior (1995)
Research
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Overview
Medical Research Interests
ORCID
0000-0003-0166-5074
Research at a Glance
Yale Co-Authors
Publications Timeline
Research Interests
Jason Jonathon Sico, MD, MHS, FAHA, FAAN (Neurology), FANA, FACP, FAHS
Andrey Zinchuk, MD, MHS
Sangchoon Jeon, PhD
Nancy Schmieder Redeker, RN, MSN, PhD, FAHA, FAAN
Christine Won, MD, MSc, BA
Henry Yaggi, MD, MPH
Restless Legs Syndrome
Stroke
Sleep
Sleep Apnea, Obstructive
Veterans
Publications
2025
Quality Improvement Intervention to Increase Sleep Apnea Diagnostic Testing After Stroke and Transient Ischemic Attack
Bravata D, Perkins A, Myers L, Daggy J, Sexson A, Taylor S, Burrone L, Koo B, Miech E, Rattray N, Story K, Waddell K, Ding Q, Sico J, Daley J, Fields B, Hermann L, Kunisaki K, Palacio S. Quality Improvement Intervention to Increase Sleep Apnea Diagnostic Testing After Stroke and Transient Ischemic Attack. JAMA Network Open 2025, 8: e2543385. PMID: 41236739, PMCID: PMC12619104, DOI: 10.1001/jamanetworkopen.2025.43385.Peer-Reviewed Original ResearchAltmetricMeSH Keywords and ConceptsConceptsObstructive sleep apneaTransient ischemic attackRandomized trial of patientsTrial of patientsDiagnostic testing ratesVascular event ratesIschemic strokeUsual care sitesCerebrovascular eventsObstructive sleep apnea testingPositive airway pressure treatmentIschemic attackTesting ratesAssociated with poor outcomesDiagnostic testsEvent ratesQuality improvement interventionsCare sitesGuideline-concordant careAcute cerebrovascular eventsSleep medicine servicesAcute ischemic strokeDelivery of guideline-concordant careCluster randomized trialIntervention sitesAddressing sleep apnea post-stroke and transient ischemic attack (ASAP) clinical trial design features: Inclusion of usual care control sites and electronic health record data validation
Bravata D, Myers L, Perkins A, Sexson A, Daggy J, Taylor S, Burrone L, Koo B, Miech E, Rattray N, Story K, Waddell K, Ding Q, Sico J. Addressing sleep apnea post-stroke and transient ischemic attack (ASAP) clinical trial design features: Inclusion of usual care control sites and electronic health record data validation. Contemporary Clinical Trials 2025, 159: 108135. PMID: 41173184, DOI: 10.1016/j.cct.2025.108135.Peer-Reviewed Original ResearchMeSH Keywords and ConceptsConceptsElectronic health recordsElectronic health record dataCerebrovascular diagnosisCluster randomized clinical trialStudy eligibilityTransient ischemic attackQuality improvementQuality improvement interventionsStepped-wedge trialPatient characteristicsIschemic strokeIntervention sitesHealth recordsImprovement interventionsImplementation sitesIntervention evaluationPost-strokeSite patientsIschemic attackTrial design featuresTRIAL REGISTRATIONStroke/TIA patientsInterventionChart reviewTemporal trendsAssessing prevalence and risk factors for REM sleep behavior disorder among patients with inflammatory bowel disease
Reddy V, Chen Z, Dewain S, Joo M, Bellomo M, Renkl E, Patel S, Rivera E, Weisbein L, Ali A, Kappelman M, Koo B. Assessing prevalence and risk factors for REM sleep behavior disorder among patients with inflammatory bowel disease. Npj Parkinson's Disease 2025, 11: 282. PMID: 41034267, PMCID: PMC12488973, DOI: 10.1038/s41531-025-01051-7.Peer-Reviewed Original ResearchCitationsAltmetricConceptsREM sleep behavior disorderInflammatory bowel diseaseSleep behavior disorderBowel diseaseSevere inflammatory bowel diseaseInflammatory bowel disease patientsRBD screening questionnaireChi-square testBehavioral disordersAntidepressant usageRisk factorsHistory questionnaireAssociated with Parkinson's diseaseHospitalization ratesLogistic regressionPrevalenceCross-sectional designPatientsDiseaseParkinson's diseaseREMCorrelates of Loneliness in Parkinson Disease During the COVID-19 Pandemic: A Longitudinal Study
de Figueiredo J, Kohn R, Patel A, Parsons E, Louis E, Koo B. Correlates of Loneliness in Parkinson Disease During the COVID-19 Pandemic: A Longitudinal Study. Behavioral Sciences 2025, 15: 1233. PMID: 41009263, PMCID: PMC12466522, DOI: 10.3390/bs15091233.Peer-Reviewed Original ResearchConceptsCorrelates of lonelinessEmotional supportHealth-related quality of lifeCOVID-19 pandemicLongitudinal studyAssociated with lonelinessParkinson's diseaseQuality of lifeEffects of lonelinessConsecutive PD outpatientsPublic health emergencyLinear regression analysisPD outpatientsPsychological variablesSocial isolationCOVID-19LonelinessHealth emergencyPD patientsRegression analysisTreatment planningDemoralizationAssociation Between Sleep-Related Leg Movements and Diabetes Prevalence: A Cohort Study From the United States
Ding Q, Xie Y, Koo B, Hass Z, Wojeck B, Sico J, Murray-Kolb L, Bravata D, Zinchuk A. Association Between Sleep-Related Leg Movements and Diabetes Prevalence: A Cohort Study From the United States. Cureus 2025, 17: e84701. PMID: 40557002, PMCID: PMC12185253, DOI: 10.7759/cureus.84701.Peer-Reviewed Original ResearchAltmetricConceptsNational Health and Nutrition Examination SurveyShort sleep durationSleep durationDiabetes prevalenceHealth and Nutrition Examination SurveyNational population-based cohort studyNon-Hispanic white individualsCohort studyPopulation-based cohort studyWeighted logistic regression modelsOdds of diabetesNutrition Examination SurveyUS adult populationPrevalence of diabetesRisk of diabetesLeg movementsDiabetes mellitusLogistic regression modelsDM prevalenceExamination SurveyCardiometabolic healthUnited StatesWhite individualsAdult populationPotential mediatorsSex differences in cerebrospinal fluid proteomics of patients with restless legs syndrome
Mogavero M, Peng G, Marchese G, Lanza G, Ferini-Strambi L, Ferri R, Koo B. Sex differences in cerebrospinal fluid proteomics of patients with restless legs syndrome. Sleep 2025, 48: zsaf112. PMID: 40289925, DOI: 10.1093/sleep/zsaf112.Peer-Reviewed Original ResearchCitationsConceptsRestless legs syndromeProteomic signatureCerebrospinal fluid proteomeUntreated RLS patientsObservational cross-sectional studyBody mass indexProteome of patientsCerebrospinal fluid samplesSex-specific mechanismsCross-sectional studyRLS patientsSex-specific analysesMass indexSex differencesTherapeutic strategiesImmune responseInflammatory pathwaysEffective treatmentCerebrospinal fluid proteome of patientsDisease pathophysiologyPatientsSyndromeProtein levelsFluid samplesProteomic alterations
2024
The Melanocortin and Endorphin Neuropeptides in Patients with Restless Legs Syndrome
Koo B, Abdelfattah A, Eysa A, Lu L. The Melanocortin and Endorphin Neuropeptides in Patients with Restless Legs Syndrome. Annals Of Neurology 2024, 95: 688-699. PMID: 38308537, DOI: 10.1002/ana.26876.Peer-Reviewed Original ResearchCitationsConceptsRestless legs syndromeRestless legs syndrome patientsRestless legs syndrome severityAdrenocorticotropin hormoneCerebrospinal fluidB-endorphinPro-opiomelanocortinA-MSHPlasma adrenocorticotropin hormoneRLS participantsInternational RLS Study Group Severity ScaleRLS patientsAssessed plasmaPain symptomsLumbar punctureA-melanocyte-stimulating hormoneMatched ControlsPatientsHormoneSeverity ScaleSensory discomfortPlasmaSeverityMelanocortin hormonesHyperalgesiaAssociation of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality
Zinchuk A, Srivali N, Qin L, Jeon S, Ibrahim A, Sands S, Koo B, Yaggi H. Association of Periodic Limb Movements and Obstructive Sleep Apnea With Risk of Cardiovascular Disease and Mortality. Journal Of The American Heart Association 2024, 13: e031630. PMID: 38240208, PMCID: PMC11056155, DOI: 10.1161/jaha.123.031630.Peer-Reviewed Original ResearchCitationsAltmetricMeSH Keywords and ConceptsConceptsPeriodic limb movement indexApnea-hypopnea indexObstructive sleep apneaPeriodic limb movementsSleep apneaIncident cardiovascular diseasePrimary outcomeCardiovascular diseaseAssociation of apnea-hypopnea indexIncreased risk of primary outcomeIncreased riskRisk factorsRisk of primary outcomeAssociated with primary outcomeMedian Follow-UpBaseline risk of mortalityCox proportional hazards regressionRisk of cardiovascular diseaseLimb movement indexCharlson Comorbidity IndexFramingham risk scoreProportional hazards regressionRisk of mortalityCardiovascular disease eventsFollow-upPatient Insights on Integrating Sleep Apnea Testing into Routine Stroke and TIA Care
Rattray N, Story K, Burrone L, Sexson A, Koo B, Bravata D, Perkins A, Myers L, Daggy J, Taylor S, Fields B, Kunisaki K, Daley J, Palacio S, Hermann L, Sico J. Patient Insights on Integrating Sleep Apnea Testing into Routine Stroke and TIA Care. Journal Of Patient Experience 2024, 11: 23743735241310263. PMID: 39742072, PMCID: PMC11686624, DOI: 10.1177/23743735241310263.Peer-Reviewed Original ResearchConceptsObstructive sleep apnea testingObstructive sleep apneaTransient ischemic attackSleep testPrevalence of obstructive sleep apneaPatients expressed higher levelsSleep apnea testingCerebrovascular diseaseGuideline-concordant screeningSleep apneaApnea testingIschemic attackPatientsImprove outcomesAHA/ASA guidelinesIschemic strokeStroke/TIAVeterans Affairs facilitiesAcute stroke/TIARoutine partExperience of careThematic analysis of semi-structured interviewsCerebrovascularAnalysis of semi-structured interviewsDisease
2023
Can tonic motor activation be the magical elixir for restless legs syndrome?
Berkowski J, Koo B. Can tonic motor activation be the magical elixir for restless legs syndrome? Sleep 2023, 46: zsad230. PMID: 37671678, PMCID: PMC11240113, DOI: 10.1093/sleep/zsad230.Peer-Reviewed Original Research
Clinical Trials
Current Trials
Intestinal Immunity in Neurologic Disease
HIC ID2000033081RoleSub InvestigatorPrimary Completion Date12/31/2023Recruiting ParticipantsSchizophrenia Spectrum Biomarkers Consortium (SSBC)
HIC ID2000029485RoleSub InvestigatorPrimary Completion Date12/31/2030Recruiting Participants
Academic Achievements & Community Involvement
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Activities
activity Sleep & Breathing
06/01/2013 - PresentCommitteesMemberDetailsJournal Editorial Boardactivity Journal of Korean Sleep Research Society
06/01/2012 - PresentCommitteesMemberDetailsJournal Editorial Boardactivity Restless Legs Syndrome Foundation
06/01/2015 - PresentCommitteesMemberDetailsMedical advisory board RLS Foundationactivity Sleep-Related Movement Disorders Steering Committee Member, American Academy of Sleep Medicine
06/01/2012 - 06/01/2015CommitteesMemberDetailsSteering Committeeactivity American Academy of Sleep Medicine: Restless Legs Syndrome Quality Care Task Force
09/01/2013 - 09/01/2014CommitteesMemberDetailsRestless Legs Syndrome Quality Care Task Force
Honors
honor Sleep Research Network Junior Investigator Travel Award
10/01/2012National AwardSleep Research NetworkDetailsUnited Stateshonor American Academy of Sleep Medicine, Sleep-Related Movement Disorders Section Investigator Award
06/01/2012National AwardAmerican Academy of Sleep MedicineDetailsUnited Stateshonor American Academy of Sleep Medicine Young Investigator Forum
03/01/2012National AwardAmerican Academy of Sleep MedicineDetailsUnited States
Clinical Care
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Overview
Brian B. Koo, MD, is an award-winning physician who combines his training in neurology and sleep medicine to treat patients with a wide variety of sleep disorders.
An internationally recognized expert in his field, Dr. Koo is the director of the Sleep Medicine Program at the Connecticut Veterans Affairs Healthcare System, as well as director of the Yale Medicine Program for Restless Legs Syndrome (RLS). He works with patients who suffer from sleep disorders, including narcolepsy, RLS, sleep apnea and sleep issues caused by neurological conditions. “Sleep disorders are very treatable and we are almost always able to provide simple, effective treatments that can significantly and positively impact quality of life,” he says.
An assistant professor of neurology at Yale School of Medicine, Dr. Koo is also an active researcher and author specializing in RLS, and one of the world’s foremost experts on the epidemiologic research that links periodic limb movements during sleep and cardiovascular disease.
Clinical Specialties
Fact Sheets
Pediatric Movement Disorders
Learn More on Yale MedicineRestless Legs Syndrome (RLS)
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Yale Medicine News
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News
- November 19, 2025Source: Health Central
IBD-Related Sleep Problems Linked to Neurodegeneration
- March 04, 2025Source: Yale Medicine
Do You Have Restless Legs Syndrome (RLS)? Treatment Advice Has Changed
- July 27, 2023Source: Frontiers in Psychiatry
Differential Impact of Resilience on Demoralization and Depression in Parkinson Disease
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Are You a Patient? View this doctor's clinical profile on the Yale Medicine website for information about the services we offer and making an appointment.