The Otolaryngologist as Sleep Physician

B. Tucker Woodson, MD, is Professor and Chief of the Division of Sleep Medicine, Department of Otolaryngology and Communication Services at the Medical College of Wisconsin in Milwaukee.

Many non-otolaryngologists, and even some otolaryngologists, ask: Why would surgeons-especially busy ones-care about sleep medicine? Do they really want to read sleep studies? Is the link tying otolaryngology to sleep medicine broad enough to make it important to more than a handful of individuals? I argue that sleep medicine is not a novelty but rather an integral part of otolaryngology. The otolaryngologist should not be relegated to a consultant to be called on as needed; he or she must be an active member of the sleep medicine community, for several reasons.

The field of sleep medicine is inherently heterogeneous. No specialty corners the market on sleep. Sleep medicine specialists come from divergent backgrounds with great strengths in some areas of sleep and a total unfamiliarity with others. Our specialty has the greatest expertise in the disorder that has the greatest impact in the specialty (i.e., sleep-disordered breathing). Each primary specialty brings to sleep medicine unique expertise and patient populations. The sleep disorder patients of pediatricians are incomparable to those of the adult neurologist treating Parkinson’s disease patients. Despite the varying breadth of sleep medicine practices, training and examinations in sleep must be uniform.

Otolaryngologists are surgeons. The ability to perform surgery and other therapeutic interventions augments the diagnostic and medical therapeutics in sleep. Not only is being a surgeon a poor argument to not enter the sleep field, but it is an exciting opportunity for sleep medicine to attract some of the best and brightest trainees who come from our specialty. Surgeons who pursue added qualifications in this field will endow sleep medicine with a unique perspective. These renaissance sleep surgeons will enlighten both sleep medicine and otolaryngology.

Many otolaryngologists have a large percentage of sleep medicine in their practices, albeit highly focused on breathing disorders. A narrow focus of practice does not mean that a broader knowledge of sleep is not needed. Few individuals who present for surgery have only one sleep disorder. A broader emphasis on sleep and sleep disorders different from apnea can be added into current practices and are not beyond our level of expertise. Otolaryngologists already have practices that serve many divergent populations and disorders (i.e., medical, surgical, geriatric, adult, pediatric). We treat multiple medical disorders as complex as sleep disorders including medical otology, allergy, headaches, and reflux disease. Additional, knowledge in sleep will allow many to expand clinical practice and improve patient care.