Sleep Medicine Fellowships for Otolaryngologists: Are They Worth It?
Sleep medicine fellowships offer unique advantages for otolaryngologists, including the ability to care for patients from the time of diagnosis.
Abhay Sharma, MD, and Allison Ikeda, MD, on behalf of the International Sleep Surgical Society
Sleep is trending in the news, on social media, and among your friends, groups, and colleagues. There is no better time to get involved in the subspecialty of sleep medicine than now, especially as an otolaryngologist-head and neck surgeon. A health-focused population has set its sights on improved sleep as one key factor to a healthier lifestyle. One only has to look at the $13 billion wearable sleep tracker industry to understand why this is the case.1
Watch or listen to the companion Voices of Otolaryngology podcast to learn more about the evolving landscape of sleep medicine for otolaryngologists. Join Ryan J. Soose, MD, and Thomas M. Kaffenberger, MD, with host Rahul K. Shah, MD, MBA, as they discuss training pathways, practice opportunities, and innovations in sleep medicine.
Obstructive sleep apnea (OSA) remains one of the most common disorders in the world. Despite the increased sleep apnea awareness, most patients with OSA can be undertreated or carry significant burdens (i.e., symptoms, function, reduced quality of life). Patients with OSA often try using continuous positive airway pressure (CPAP) as first-line therapy but less than 50% of patients can tolerate it and are adherent (defined as >4 hours per night and 70% of nights per week). The good news is there are other therapies available, and patients demand alternatives. Other noninvasive therapies besides CPAP include mandibular advancement devices/oral appliances, medications (GLP-1), and upper airway exercises (myofunctional therapy). In cases where sleep apnea burden is significant or inadequately managed with noninvasive therapies, patients with OSA may consider invasive options, like sleep surgery.
Otolaryngologists with specific training in sleep medicine and surgery are at a unique advantage when managing patients with complex OSA. They can offer care to patients with OSA from the time of diagnosis. This includes trialing first-line therapies, navigating different combinations of therapies, and, ultimately, sleep surgery. This long-term relationship with patients who are invested in their overall health can be very rewarding.
Although this may convince many that sleep medicine is worthwhile for an otolaryngologist to pursue, what necessitates a sleep fellowship, specifically one that has such a large focus on medicine? There are several common questions to consider when deciding on a sleep fellowship. Will my surgical skills suffer if I’m doing fewer surgeries than I was in residency? Am I really gaining any new skills if I have already performed most of the surgeries I will be doing in fellowship? Do I really want to treat a chronic disease with surgeries that are seen as significantly inferior to the noninvasive option (i.e., CPAP) and only partially effective?
Sleep medicine fellowships offer unique advantages for otolaryngologists and are receiving increasing interest from otolaryngology residents. Typically, otolaryngology applicants will consider ACGME-accredited sleep medicine hybrid programs (through the formal match process) or non-ACGME-accredited sleep surgery programs. These fellowships provide extended time with established sleep surgeons, focusing on surgical skills in complex functional nasal surgery (both closed and open approaches), the nuances of pharyngeal surgery, and in some situations, collaborative experiences in skeletal surgery.
Additionally, certain sleep medicine fellowship programs offer unique pediatric sleep surgery components, which can meet the needs of some applicants who have an interest in specialized pediatric otolaryngology. Another advantage of ACGME-accredited sleep medicine fellowships is the ability to learn from sleep study research to improve one’s surgical outcomes.
Sleep surgery techniques integrate novel devices like hypoglossal nerve stimulators. Otolaryngology residents learn how to perform the device implantation procedure without a fellowship. However, any sleep-trained otolaryngologist knows patient counseling and selection are incredibly important for the best possible outcome. Understanding the nuances of treatment is what fellowship is for. This includes both finding novel approaches to managing complex cases of OSA with a repertoire of interventions, as well as understanding the limitations of sleep surgery and when other interventions should be pursued. One of the biggest advantages of a fellowship-trained sleep surgeon is the ability to provide patients with OSA options other than trying CPAP again.
After a sleep medicine fellowship, no longer are you “just a surgeon” to your sleep medicine colleagues. You have the same training in sleep medicine as other specialists and can make sleep treatment recommendations with as much confidence as any other physician. For example, a patient with mild OSA may seek out sleep surgery because they have been told they are at risk of dying from OSA without CPAP; yet they derived little benefit from CPAP thus far. As a sleep medicine-trained otolaryngologist, you are in a unique position to counsel the patient and restructure their expectations and outcomes.
Fellowships also provide robust exposure to other sleep disorders that may also impact the effectiveness of OSA therapies, such as insomnia, excessive daytime sleepiness, restless leg syndrome, and circadian rhythm disorders, to name a few.
A sleep medicine trained otolaryngologist can provide comprehensive care to patients and implement nuanced surgical techniques to improve upper airways. A survey revealed that 90% of recent sleep fellows joined academic practice;2 however, private practice settings are ideal for sleep management expertise given how common OSA is and how poorly CPAP is tolerated.
There are many reasons to consider a sleep medicine fellowship, and there is a huge need for more sleep-trained otolaryngologists. To learn more about the subspecialty, visit theInternational Surgical Sleep Society (ISSS) website and consider attending the upcoming ISSS 2025 Annual Meeting on October 9–11 in Indianapolis, Indiana, immediately before the AAO-HNSF Annual Meeting & OTO EXPO on October 11–14.
Kaffenberger TM, Huntley C, Boon M, Soose RJ, Whelan RL, Postol A, Strollo PJ Jr, Atwood CW Jr, El Ali M, Stone B, Rodin J. Analysis of Recent Sleep Surgery Fellowship Training. Laryngoscope. 2025 Feb;135(2):952-957. doi: 10.1002/lary.31749. Epub 2024 Sep 3. PMID: 39225153; PMCID: PMC11725702
LISTEN | Voices of Otolaryngology Podcast “Otolaryngology at the Center of Sleep Care”
In a recent episode of Voices of Otolaryngology, Rahul K. Shah, MD, MBA, AAO-HNS/F Executive Vice President and CEO, talks with two leaders in the field of sleep medicine: Ryan J. Soose, MD, Director of the Sleep Division and Associate Professor, and Thomas M. Kaffenberger, MD, Assistant Professor, both from the Department of Otolaryngology-Head & Neck Surgery University of Pittsburgh School of Medicine. The three discuss the importance and scope of sleep fellowships, the pathways to training and fellowship using the resources of the International Surgical Sleep Society (ISSS), the vast possibilities and rewarding nature of sleep medicine, the practical aspects of sleep medicine in both academic and private practice, and more! This episode is sponsored by Inspire Medical Systems. We thank them for their support.
