AN OVERVIEW OF THE SPECIALTY

Sleep Medicine/Sleep Surgery fellowships remain the newest member at the otolaryngology fellowship table – with growing interest.

There are several reasons to consider this subspeciality: 1) patient gratitude, 2) intellectual challenge 3) interdisciplinary practice 4) surgical variety 5) research opportunities 6) limitless patient base and 7) lifestyle.  Allow me to expand on each of these points.

  • Patient gratitude. Imagine having resident-level sleep deprivation for years. Patients with sleep apnea can have significant sleep burden, including sleepiness/fatigue, poor work productivity, and negative impacts on quality of life – not to mention long-term health outcomes. Patients seek improved sleep and are extremely grateful for improvements in their tolerance of CPAP therap.

  • Intellectual challenge. Every patient's airway and resulting treatment selection is unique. Operating on the sleep airway entails a comprehensive understanding of the relevant anatomy - skeletal structure, soft tissue components – and the physiology of the neuromuscular-driven patterns of collapse during sleep. We operate on a state-dependent phenomenon which remains elusive in many ways. We attempt to simulate sleep through anesthetics in the operating room and tailor surgical recommendations to the level of obstruction(s), using sleep endoscopy.

  • Interdisciplinary practice. In the clinic setting, sleep surgeons work closely with pulmonologists, neurologists, cardiologists and pediatricians. In the surgical setting, sleep surgeons have unique interactions with anesthesiologists and perform team surgery with oral/maxillofacial surgeons.

  • Surgical variety. Sleep apnea commonly affect adults and kids. A complete surgical sleep apnea practice includes nasal surgery (functional septorhinoplasty, inferior turbinate reduction), pharyngeal surgery (modified expansion pharyngoplasty, midline glossectomy (robotic or coblation)), skeletal surgery (maxillo-mandibular advancement), and device implantation (hypoglossal nerve stimulator).  

  • Research opportunities. I firmly believe there are more questions than answers in our field today. It’s a collaborative field with a broad funding source. One who is interested in research can go in self-driven directions.

  • Limitless patient base. The obesity epidemic has increased the number of sleep apnea patients, and simple math demonstrates the magnitude of need. Of roughly 240 million adult Americans, 5% are affected by moderate-severe sleep apnea, 50% of whom do not use CPAP long-term. That amounts to about 2% of the U.S. population or 6 million people! That doesn't include the pediatric population in which OSA is the leading indication for tonsillectomy. If we continue to make great strides in our field, we will have, without question, the biggest impact of any ENT subspecialty.

  • Lifestyle. There are no emergency sleep surgery consults. All surgeries are elective. Post-operative hemorrhage, however, can be challenging and requires adept difficult airway management.

Fellowship options. Fellowships come in 3 flavors: 1) sleep surgery, 2) sleep medicine and 3) hybrid sleep medicine & surgery. Fellowships are often 1-year, though there are a handful that are 2-years. To learn more about available sleep surgery fellowships, the International Surgical Sleep Society (ISSS) offers a comprehensive directory. This is extremely helpful in learning more about training opportunities and to be able to compare programs.

After recently going through the fellowship application process and insights from a fellowship director, here are some key aspects to consider:

  • Accreditation. Similar to residency, there are ACGME-accredited fellowships (often the hybrid sleep medicine/sleep surgery programs and sleep medicine only), and there are non-ACMGE accredited fellowships (typically sleep surgery only). Sleep surgery only fellowships provide excellent exposure to advanced sleep surgery techniques – however, fellowship trainees are not eligible to sit for the sleep medicine board exam. Conversely, the hybrid sleep medicine/sleep surgery programs have designated sleep medicine training in reading sleep studies.  

  • Surgical case load. In the hybrid sleep medicine/sleep surgery programs, at least 30% of the trainee’s time will be spent with sleep surgery. There are different ways this time can be spent, including time in the operating room. Every sleep surgeon’s practice is different, and exposure to different surgical techniques is variable. Other influencing factors are the number of sleep surgeons, number of co-fellows, and surgical volume of the site.

  • Recent Fellows. If you want the “boots on the ground” perspective of a program, there is no better perspective than that of current (and past) fellows. Programs with a track record of fellows have a training framework; however, programs that have not had fellows recently, or are new, have their own appeal. An incoming fellow could customize their training with mentor support.

  • Sleep medicine exposure. If pursuing a hybrid sleep medicine/sleep surgery fellowship, you will spend time with sleep medicine. Before pursuing, it is important to determine to what extent you are interested in sleep medicine training.

Once you have decided to pursue Sleep Medicine Fellowship, the fellowship application cycle is late, in comparison to other subspeciality fellowships. It starts roughly one year before you plan to start fellowship. An guide for ACGME programs (Dates change year to year, check out: Medicine and Pediatric Specialties Match):

  • Early June: Start by registering for your application token. The registration fee is $165 for the July cycle. Get started by visiting ERAS Fellowship Documents.

  • Early July: Submit your application.

  • August – October: Interviews

  • Mid August: The match process opens. This is your chance to align with top programs in the field. Find more details at NRMP R3.

  • Mid November: Submit your rank list and finalize your preferences.

  • Early December: Celebrate Match Day and take the next step in your professional journey!

  • July 1st: Start Sleep Medicine Fellowship

Applicants for these fellowship spots also include those who have completed residency in Neurology, Internal Medicine, Pediatrics, Psychiatry, Anesthesiology, or Family Medicine.

Alternatively, if you have chosen to apply for non-ACGME fellowship programs, then we encourage you to reach out to individual program directors for more information. These applications are reviewed on a rolling basis and specific to each program. Sleep surgeon mentors congregate throughout the year at conferences, including the International Surgical Sleep Society Educational Updates that is immediately before the AAO-HNS Annual Meeting in September/October, the Combined Otolaryngology Spring Meeting (COSM), and biannual International Surgical Sleep Society Conference (2026, Mumbai India). If you are interested in meeting Sleep Medicine colleagues, then consider attending the American Academy of Sleep Medicine SLEEP Annual Meeting in June. These are valuable experiences to learn more about the field and to present research. More importantly, fellowship directors and current fellows often attend.

We hope you consider joining us in this exciting, dynamic, and quickly growing field.

Allison Ikeda, MD MS
University of Washington

Tom Kaffenberger MD
University of Pittsburgh

Raj C. Dedhia, MD MSCR
University of Pennsylvania
Contact Dr. Dedhia

Fellowship Program List
Below is list of hybrid sleep medicine & surgery fellowships as of August 2019. More fellowship details can be found on Otomatch and on the ENT Connect website, Sections for Residents and Fellows-in-Training, Discussion Board.

University of Cincinnati | Contact: Narong Simakajornboon, MD

Henry Ford/Wayne State University | Contact: Andrea Plawecki, MD

Medical College of Wisconsin | Contact: Tucker Woodson, MD

University of Pennsylvania | Contact: Raj C. Dedhia, MD MSCR

University of Colorado | Contact: Katherine Green, MD

University of California, Los Angeles (UCLA) Fellowship in Sleep Medicine | Contact: Eric Kezirian MD, MPH (ekezirian@mednet.ucla.edu)

Stanford University | Contact: Robson Capasso, MD

University of Washington | Contact: Ed Weaver MD, MPH

Texas Facial Plastic Surgery and ENT | Contact: Jose Barrera: San Antonio [SLEEP SURGERY ONLY]

Thomas Jefferson University | Contact: Colin Huntley, MD

Mount Sinai | Contact: Courtney Chou, MD

University of Pittsburgh | Contact: Thomas Kaffenberger, MD

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