Skip to main content

Advertisement

SpringerLink
Log in

Sleep medicine in otolaryngology units: an international survey

  • ENT • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

A Correction to this article was published on 14 September 2021

This article has been updated

Abstract

Purpose

No study to date has described the overall landscape of sleep disorders management and training in otolaryngology departments of different countries. The aim of our study was to investigate and compare settings, diagnostic and therapeutic approaches and training programmes.

Methods

An international online survey was developed with the collaboration of the YO-IFOS (Young Otolaryngologists-International Federation of Otorhinolaryngological Societies) to assess the current practice of otolaryngologists in the management of sleep disorders. The survey also included a session dedicated to training.

Results

A total of 126 otolaryngologists completed the survey. The larger part of responses was collected from Central/South America and Europe. The majority of responders from South/Central America (97%) declared to be certified as sleep specialist while 49% of Europeans stated the opposite. Of responders 83% perform a drug-induced sleep endoscopy (DISE) before planning a possible surgical intervention. Soft palate and base of tongue interventions were the most common procedure, respectively performed in 94% and 79% of the cases. Residents were allowed to perform soft palate surgery in 77% of the cases. Upper airway stimulation (26% vs 10%), trans-oral robotic surgery (36% vs 11%) and radiofrequency of the base of the tongue (58% vs 25%) were preferred more frequently by European responders. The highest caseloads of soft palate surgery and bi-maxillary advancement were registered in the academic institutions.

Conclusion

Significant concordance and few interesting divergences in diagnosis and treatment of sleep disorders were observed between nationalities and types of institution. Economic resources might have played a significant role in the therapeutic choice. Trainees’ lack of exposure to certain interventions and to a sufficient caseload appeared to be the main burden to overcome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Change history

References

  1. Marin JM, Carrizo SJ, Vicente E, Agusti AG (Mar. 2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365(9464):1046–1053. https://doi.org/10.1016/s0140-6736(05)71141-7

    Article  Google Scholar 

  2. Senaratna CV et al (2017) Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 34. W.B. Saunders Ltd:70–81. https://doi.org/10.1016/j.smrv.2016.07.002

    Article  PubMed  Google Scholar 

  3. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A (2013) Defining phenotypic causes of obstructive sleep apnea. Identification of novel therapeutic targets. Am J Respir Crit Care Med 188(8):996–1004. https://doi.org/10.1164/rccm.201303-0448OC

    Article  PubMed  PubMed Central  Google Scholar 

  4. Woodson BT, Naganuma H (1999) Comparison of methods of airway evaluation in obstructive sleep apnea syndrome. Otolaryngol Head Neck Surg 120(4):460–463

    CAS  PubMed  Google Scholar 

  5. Quan SF, Berry RB, Buysse D, Collop NA, Grigg-Damberger M, Harding SM, Iber C, McCall WV, Sateia MJ, Sheldon SH, Silber MH, Sorscher A, Ward SLD, Veasey S, Woodson BT, Hess B, Kangilaski R (2008) Development and results of the first ABMS subspecialty certification examination in sleep medicine. J Clin Sleep Med 4(5):505–508. https://doi.org/10.5664/jcsm.27287

    Article  PubMed  PubMed Central  Google Scholar 

  6. Kezirian EJ, Maselli J, Vittinghoff E, Goldberg AN, Auerbach AD (2010) Obstructive sleep apnea surgery practice patterns in the United States: 2000 to 2006. Otolaryngol Head Neck Surg 143(3):441–447. https://doi.org/10.1016/j.otohns.2010.05.009

    Article  PubMed  PubMed Central  Google Scholar 

  7. Shen T, Shimahara E, Cheng J, Capasso R (2011) Sleep medicine clinical and surgical training during otolaryngology residency: a national survey of otolaryngology residency programs. Otolaryngol Head Neck Surg 145(6):1043–1048. https://doi.org/10.1177/0194599811416765

    Article  PubMed  Google Scholar 

  8. Lam AS, Wise SK, Dedhia RC (2017) Practice patterns of sleep otolaryngologists at training institutions in the United States. Otolaryngol - Head Neck Surg (United States) 156(6):1025–1031. https://doi.org/10.1177/0194599816671699

    Article  Google Scholar 

  9. Gouveia CJ, Kern RC, Liu SY-C, Capasso R (2017) The state of academic sleep surgery: a survey of United States residency and fellowship programs. Laryngoscope 127(10):2423–2428. https://doi.org/10.1002/lary.26572

    Article  PubMed  Google Scholar 

  10. MacKay S, Holmes S, Jones A (2015) Australian training for contemporary airway management of obstructive sleep apnoea in ENT surgery: current status and future recommendations. J Laryngol Otol 129:S8–S15. https://doi.org/10.1017/S0022215114002801

    Article  PubMed  Google Scholar 

  11. Sim MW, Stanley JJ (2014) Trends in otolaryngology residency training in the surgical treatment of obstructive sleep apnea. Laryngoscope 124(2):579–582. https://doi.org/10.1002/lary.24325

    Article  PubMed  Google Scholar 

  12. Plößl S, Herzog B, Glien A, Plontke S, Herzog M (2016) Survey of otorhinolaryngologists on their clinical examinations performed in patients with suspected sleep-disordered breathing. Eur Arch Oto-Rhino-Laryngology 273(4):1045–1053. https://doi.org/10.1007/s00405-015-3748-9

    Article  Google Scholar 

  13. Rombaux P et al. (2002) Standard ENT clinical evaluation of the sleep-disordered breathing patient; a consensus report, in Acta Oto-Rhino-Laryngologica Belgica

  14. Fakhry N, Teissier N (2019) Young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies (YO-IFOS)(Figure presented.). Eur Ann Otorhinolaryngol Head Neck Dis 136(3) Elsevier Masson SAS:S1. https://doi.org/10.1016/j.anorl.2019.04.003

    Article  CAS  PubMed  Google Scholar 

  15. Ayad T et al (2018) Young Otolaryngologists of International Federation of Oto-rhino-laryngological Societies (YO-IFOS) committees. Eur Ann Otorhinolaryngol Head Neck Dis 135(5) Elsevier Masson SAS:S61–S65. https://doi.org/10.1016/j.anorl.2018.08.004

    Article  CAS  PubMed  Google Scholar 

  16. Liu SYC, Guilleminault C, Huon LK, Yoon A (2017) Distraction osteogenesis maxillary expansion (DOME) for adult obstructive sleep apnea patients with high arched palate. Otolaryngol - Head Neck Surg (United States) 157(2):345–348. https://doi.org/10.1177/0194599817707168

    Article  Google Scholar 

  17. De Vito A et al (2018) European position paper on drug-induced sleep endoscopy: 2017 update. Clin Otolaryngol 43(6):1541–1552. https://doi.org/10.1111/coa.13213

    Article  PubMed  Google Scholar 

  18. Gobbi R, Baiardi S, Mondini S, Cerritelli L, Piccin O, Scaramuzzino G, Milano F, Melotti MR, Mordini F, Pirodda A, Cirignotta F, Sorrenti G (2017) Technique and preliminary analysis of drug-induced sleep endoscopy with online polygraphic cardiorespiratory monitoring in patients with obstructive sleep apnea syndrome. JAMA Otolaryngol - Head Neck Surg 143(5):459–465. https://doi.org/10.1001/jamaoto.2016.3964

    Article  PubMed  PubMed Central  Google Scholar 

  19. Padiyara TV, Bansal S, Jain D, Arora S, Gandhi K (2020) Dexmedetomidine versus propofol at different sedation depths during drug-induced sleep endoscopy: a randomized trial. Laryngoscope 130(1):257–262. https://doi.org/10.1002/lary.27903

    Article  CAS  PubMed  Google Scholar 

  20. Bergeron M, Lee DR, DeMarcantonio MA, Kandil A, Mahmoud MA, Fleck RJ, Ishman SL (2019) Safety and cost of drug-induced sleep endoscopy outside the operating room. Laryngoscope 130:2076–2080. https://doi.org/10.1002/lary.28397

    Article  PubMed  Google Scholar 

  21. Vicini C et al. (2019) Effectiveness of barbed repositioning pharyngoplasty for the treatment of obstructive sleep apnea (OSA): a prospective randomized trial, Sleep Breath, doi: https://doi.org/10.1007/s11325-019-01956-7

  22. Pang KP, Pang EB, Win MTM, Pang KA, Woodson BT (2016) Expansion sphincter pharyngoplasty for the treatment of OSA: a systemic review and meta-analysis. Eur Arch Otorhinolaryngol 273(9) Springer Verlag:2329–2333. https://doi.org/10.1007/s00405-015-3831-2

    Article  PubMed  Google Scholar 

  23. Cahali MB (Nov. 2003) Lateral Pharyngoplasty: a new treatment for obstructive sleep apnea hypopnea syndrome. Laryngoscope 113(11):1961–1968. https://doi.org/10.1097/00005537-200311000-00020

    Article  PubMed  Google Scholar 

  24. Friedman M, Hamilton C, Samuelson CG, Kelley K, Taylor D, Pearson-Chauhan K, Maley A, Taylor R, Venkatesan TK (2012) Transoral robotic glossectomy for the treatment of obstructive sleep apnea-hypopnea syndrome. Otolaryngol Head Neck Surg 146(5):854–862

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Otolaryngology, Hospital Morgagni Pierantoni, Via Carlo Forlanini 2, 47100, Forlì, Italy

    Giovanni Cammaroto, Giuseppe Meccariello, Giannicola Iannella, Riccardo Gobbi, Filippo Montevecchi & Claudio Vicini

  2. Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS), Paris, France

    Giovanni Cammaroto, Jerome R. Lechien, Christian Calvo-Henriquez, Carlos Chiesa-Estomba, Maria Rosaria Barillari, Badr Ibrahim, Tareck Ayad, Nicolas Fakhry & Claudio Vicini

  3. Unit of Otolaryngology, University of Ferrara, Ferrara, Italy

    Giulia Bianchi

  4. Unit of Otolaryngology, Head and Neck Surgery, Royal National Throat, Nose and Ear Hospital, London, UK

    Henry Zhang, Vik Veer & Bhik Kotecha

  5. ENT and Allergy Associates, New York, NY, USA

    Ofer Jacobowitz

  6. Department of Otorhinolaryngology, Dr. Peset University Hospital, Valencia, Spain

    Marina Carrasco Llatas & Paula Martínez Ruiz de Apodaca

  7. Department of Otorhinolaryngology, Grupo Medico San Pedro, Monterrey, Mexico

    Rodolfo Lugo

  8. Department of Otolaryngology, Singapore General Hospital, Singhealth Duke-NUS Sleep Centre, National University of Singapore, Yong Loo Lin School of Medicine & Duke-NUS Medical School, Singapore, Singapore

    Song Tar Toh

  9. Department of Otolaryngology, Shin Kong Wu Ho-Su memorial Hospital, Taipei, Taiwan

    Ying-Shuo Hsu

  10. Department of Otorhinolaryngology, Alexandria University, Alexandria, Egypt

    Ahmed Yassin Baghat

  11. Department of Human Anatomy and Experimental Oncology, Faculty of Medicine, UMONS Research Institute for Health Sciences and Technology, University of Mons (UMons), Mons, Belgium

    Jerome R. Lechien

  12. Service of Otolaryngology, Travesía de Choupana, Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain

    Christian Calvo-Henriquez

  13. Service of Otolaryngology, Donostia University Hospital, San Sebastian, Spain

    Carlos Chiesa-Estomba

  14. Department of Mental and Physical Health and Preventive Medicine, University of L. Vanvitelli, Naples, Italy

    Maria Rosaria Barillari

  15. Division of Otolaryngology-Head and Neck Surgery, Centre Hospitalier de l’Université de Montréal, Montreal, QC, Canada

    Badr Ibrahim & Tareck Ayad

  16. Department of Otorhinolaryngology-Head and Neck Surgery, La Conception University Hospital, APHM, Aix Marseille University, Marseille, France

    Nicolas Fakhry

  17. Department of Otolaryngology, Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA

    Paul Hoff

  18. Samaritano Hospital, São Paulo, Brazil

    Eric Rodrigues Thuler

  19. Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia

    Lyndon Chan

  20. Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium

    Chloe Kastoer

  21. Department of Otorhinolaryngology - Head and Neck Surgery, OLVG, Amsterdam, the Netherlands

    Madeline Ravesloot

  22. Head & Neck Department, Ear Nose Throat (ENT) Unit, Santa Maria delle Croci Hospital, Romagna Health Company, Ravenna, Italy

    Andrea De Vito

Authors
  1. Giovanni Cammaroto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giulia Bianchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Henry Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vik Veer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bhik Kotecha
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ofer Jacobowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Marina Carrasco Llatas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Paula Martínez Ruiz de Apodaca
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Rodolfo Lugo
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Giuseppe Meccariello
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Giannicola Iannella
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Riccardo Gobbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Song Tar Toh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Ying-Shuo Hsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ahmed Yassin Baghat
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Jerome R. Lechien
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Christian Calvo-Henriquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Carlos Chiesa-Estomba
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Maria Rosaria Barillari
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Badr Ibrahim
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Tareck Ayad
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Nicolas Fakhry
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Paul Hoff
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Eric Rodrigues Thuler
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Lyndon Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Chloe Kastoer
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Madeline Ravesloot
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Andrea De Vito
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Filippo Montevecchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Claudio Vicini
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giovanni Cammaroto.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Not needed.

Informed consent

Not needed.

Additional information

Comment

The field of sleep surgery is quite young and there is no uniformity in the way we train our residents and fellows. We should aim to better train them with a clear syllabus, aims and end results. This study can help us to build a more uniform teaching program.

Uri Alkan

Israel

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

ESM 1

(PDF 336 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Cammaroto, G., Bianchi, G., Zhang, H. et al. Sleep medicine in otolaryngology units: an international survey. Sleep Breath 25, 2141–2152 (2021). https://doi.org/10.1007/s11325-020-02243-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-020-02243-6

Keywords

Search

Navigation