- Michael Friedman, MD
- Ofer Jacobowitz, MD, PhD, FAASM
Sleep medicine is one of the youngest medical specialties recognized by the American Board of Medical Specialties (ABMS). Before 2007, when the ABMS offered the first qualifying board examinations, the American Board of Sleep Medicine recognized itself and granted certification to its own members and those who took additional training in this field. Since the 2013 ABMS examination, however, the only route to board eligibility is through an Accreditation Council for Graduate Medical Education-accredited sleep medicine fellowship training program. Most fellowship programs are typically 12 months, with a few requiring an additional research year. The prevalence of sleep disorders within the population, combined with scientific progress in our ability to diagnose and treat these disorders, has created a tremendous demand for knowledgeable physicians trained in the area of sleep medicine.
Due to the multidisciplinary nature of the practice, sleep medicine physicians can have diverse primary specialty training. In the United States of America, sleep specialists most commonly have a background in pulmonary medicine, neurology, and psychiatry. Less commonly, physicians trained in anesthesiology, family or internal medicine, and pediatrics are sleep medicine board-certified. Although a small percentage of otolaryngologists pursue the diplomate in sleep medicine, they have the unique potential to provide both surgical and nonsurgical treatment options for obstructive sleep apnea/hypopnea syndrome (OSAHS).
Neurologists have training and expertise in the interpretation of electroencephalograms. Pulmonologists are experienced and trained in the use of positive airway pressure (PAP) and disorders of the lower airway. Otolaryngologists are trained with special expertise in the upper airway. For many years, otolaryngologists were not involved in the primary care of obstructive sleep apnea and would most often deal with OSAHS patients if they were specifically referred for surgery. Otolaryngologists, however, have the expertise to obtain a proper history, perform a complete upper airway examination, and uniquely assess and treat dysfunction and disorders of the upper airway, including chronic rhinosinusitis and neoplasms of the upper airway. As the upper airway specialists, otolaryngologists should be screening all patients for signs and symptoms of OSAHS and, when appropriate, order and interpret sleep testing akin to otolaryngologists’ interpretation of imaging studies for chronic rhinosinusitis ( Table 1.1 ).
