Boris Chernobilsky

1. How did you get engaged in sleep surgery? What inspired you to focus on surgical approaches for OSA, and how has your perspective evolved over time?  

My first job was in a small town in rural Kentucky.  The obesity epidemic was starting mainly in the south and mid-West at the time in the USA and I was seeing a lot of undiagnosed obstructive sleep apnea.  We had a good sleep lab and an excellent technician at the local hospital but the pulmonologist only came up from Vanderbilt University in Nashville, Tennessee once a month.  I ended up becoming the largest referrer to the lab and decided to take courses to be able to read my own studies and eventually became board certified in Sleep Medicine.  I found that many of the patients did not tolerate PAP therapy or oral appliances and then started taking courses on surgical approaches for OSA.  I have become much less surgically aggressive over time in my approach to the tongue base and hypopharynx.  I do not think that ablative procedures are very effective in what is primarily a muscle tone issue.

2. How is surgery for sleep-disordered breathing currently positioned in the U.S.? Is it recognized as a well-established field, or do you see gaps in diagnosis, treatment accessibility, or public awareness?  

I think that surgery for obstructive sleep apnea is established at the academic level, but there are major gaps in getting those providers. The journey through awareness at the patient or primary care level is very low.  Once recognized, there are hurdles to getting a proper diagnosis and then a robust treatment discussion.  It can take years before a patient is offered surgery for their obstructive sleep apnea. 

3. Are all therapeutic options for OSA covered by private and public insurance in the U.S.? Do insurance policies fully reimburse surgical and non-surgical treatments, or are there significant barriers to access?  

No.  The reimbursements for procedures can vary wildly between private and public insurance making it prohibitive to provide certain treatment options at the hospital level.  This is particularly evident with newer technologies like hypoglossal nerve stimulation or GLP-1 agonists.

4. How do you see the collaboration between surgical and non-surgical practices evolving in the future? 

I am hopeful that there will be more acceptance and understanding of the value of surgical airway evaluation and treatment by the medical community.  Sleep surgeons can evaluate the anatomy and physiology of the upper airway that can provide insight into the best and worst treatment options for a given patient resulting in individually tailored care. 

5. What impact do you foresee from new technologies like wearables and AI in sleep medicine? Could advancements in remote monitoring, AI-driven diagnostics, or personalized treatment approaches change the way we manage OSA?  

I think wearables will certainly raise awareness but the problem will be figuring out what to do with all this data and will likely lead to a significant amount of over diagnosis and treatment similar to the incredible amount of thyroidectomies we started doing once we had ultrasounds and found thyroid nodules in about a 1/3 of our patients. We had no idea who to operate on and had to develop strict criteria. Similarly, AI will need to be trained appopriately.  I think that AI can certainly personalize treatment in very narrow and techinically specific areas such as CBT-I or oral appliances.