Sleep Medicine Education and Practice in Latin America: Current Challenges and Perspectives

Abstract

Introduction

Despite significant advancements in sleep medicine, its integration into formal medical education remains uneven. While structured programs exist in some regions, a standardized framework for postgraduate education is notably lacking in Latin America. This study assesses the availability of sleep medicine training programs, how specialists gain expertise, and the current clinical practice across the region.

Methods

A descriptive, cross-sectional survey was conducted among Latin American sleep medicine specialists via a WhatsApp group of 443 professionals. The questionnaire covered formal education programs, training locations, and public and private healthcare coverage for sleep disorder treatments. Descriptive statistical analysis was performed.

Results

Seventy-four physicians from 11 Latin American countries participated. Only four countries—Mexico, Brazil, Argentina, and Chile—had formal postgraduate programs, leading many specialists to seek training abroad. Mexico was the most cited destination for further education. Public healthcare coverage varied: five countries provided sleep surgeries, while others did not, and CPAP device access was inconsistent. Private insurance generally did not cover sleep disorder treatments, including DISE, which was only covered in Argentina and Colombia with mixed responses.

Discussion

Significant disparities exist in sleep medicine education and healthcare access in Latin America. The lack of structured training limits local expertise development and increases reliance on international education. Raising awareness is a crucial step toward improving education and ensuring broader access to standardized sleep disorder care. Continued research is necessary to bridge existing gaps and enhance opportunities for specialized sleep medicine care.

Keywords

sleep medicine - postgraduate training - latin america - sleep disorders - healthcare access - medical training programs

Introduction

Sleep medicine is a relatively recent discipline within modern Western medicine. Less than a century ago, sleep was not recognized by the medical community as a vital physiological function with distinct characteristics. Consequently, sleep disorders and conditions were not considered independent medical entities, even though they were not necessarily correlated with wakefulness. It was only in 1953 that Aserinsky and Kleitman described the two main sleep states: REM sleep and non-REM sleep. This groundbreaking discovery paved the way for further interest and research into sleep physiology and pathology.[1] [2]

Just over 70 years later, the practice and teaching of sleep medicine have become dynamic and increasingly relevant fields within modern medicine. An increasing number of healthcare professionals worldwide are showing interest in the diagnosis and management of sleep disorders. In the 1960s, researchers, primarily pulmonologists and upper airway surgeons in Europe, began identifying respiratory behaviors that only manifested during sleep. However, these findings were initially overlooked in other regions, such as the United States. Over time, obstructive sleep apnea has become one of the most extensively studied sleep disorders.[3] In 1981, two landmark publications significantly advanced the field. Fujita, at Stanford University, introduced uvulopalatopharyngoplasty, a surgical technique aimed at controlling snoring, while Sullivan, from the University of Sydney, published his research on the use of positive airway pressure devices for sleep apnea management. These studies emphasized the critical need for a better understanding and effective management of sleep-related breathing disorders.[4] [5]

In 1988, Kryger, Roth, and Dement published a seminal textbook on sleep medicine. The following year, the American Academy of Sleep Medicine (AASM) accredited the first fellowship programs for physicians interested in this specialty. In 1990, the first comprehensive guide for diagnosing sleep disorders, the International Classification of Sleep Disorders (ICSD-1), was released.[6]

Despite the high prevalence of sleep disorders, many healthcare professionals worldwide remain unaware of their significance. A considerable percentage of cases went unrecognized and undiagnosed. Studies estimated that fewer than 1 in 1,000 individuals with sleep disorders were formally diagnosed based on patient records. Additionally, targeted sleep questionnaires in tertiary care centers revealed that ∼47% of patients experienced insomnia or excessive daytime sleepiness, yet these symptoms were often missing from their medical records.[7] This finding led us to formulate the central research question of this article: How widespread and appropriate is sleep medicine education among healthcare professionals, particularly physicians?

In 1978, a survey by the Association of Sleep Disorders Centers found that 46% of U.S. medical schools offered no education on sleep physiology or sleep disorders.[8] Similarly, a 1998 study by Stores and Crawford in the United Kingdom found that medical students received an average of only 30 minutes of preclinical instruction on sleep medicine and a median of 60 minutes of clinical teaching on courses covering sleep-related topics, with minimal focus on sleep-related breathing disorders.[9]

By the year 2000, the AASM Fellowship Training Committee supervised 18 sleep medicine training programs in the United States. Structured academic education in this field is essential for training professionals who can diagnose, manage, and conduct research on sleep disorders, while ensuring standardized knowledge and clinical practices. Most sleep medicine fellowship programs are designed as medical subspecialties and consist of one year of training. Currently, specialists from various fields, including internal medicine, family medicine, otorhinolaryngology, pulmonology, psychiatry, neurology, and pediatrics, can access these programs.[7] [10]

In 2008, the European guidelines for certifying professionals in sleep medicine were established by the European Sleep Research Society (ESRS).[11] These guidelines, developed through a consensus process, define educational and evaluation standards for healthcare professionals interested in sleep medicine. They also outline competency objectives and qualification procedures for medical specialists, non-medical professionals with a master's degree (such as psychologists and biologists), and nurses and technologists.

Recently, countries such as Saudi Arabia and China have documented their progress in both clinical sleep medicine and the development of academic fellowship programs.[12] [13] However, in Latin America, postgraduate education in sleep medicine has evolved at a slower pace. Despite a high prevalence of insomnia and sleep-related breathing disorders, no published studies describe the state of postgraduate education in sleep medicine in this region. Latin America has contributed significantly to clinical and basic research on sleep medicine, covering topics such as chronobiology, insomnia, sleep-related breathing disorders, and restless legs syndrome. However, the educational landscape remains unclear.[14] [15] [16]

In light of this context, we conducted a survey among Latin American physicians specializing in the diagnosis and treatment of sleep disorders. The survey aimed to assess how sleep medicine is taught in their respective countries. Additionally, for those without local fellowship programs, we inquired about where they had studied or where they would choose to study if given the opportunity. Finally, the survey included questions about clinical practice and the approach to sleep medicine in different Latin American countries.

Methods

A descriptive, observational, cross-sectional, and retrospective study was conducted.

A survey was conducted among physicians practicing sleep medicine via Google Forms. The invitation was shared in a WhatsApp group called “Sleep Apnea Friends,” which includes 443 members worldwide. Participants were explicitly instructed to respond only if they currently practice in Latin American countries.

The survey included the following items:

1. Country and population size.

2. Are there specialists in sleep medicine in your country?

3. What types of sleep disorders do they treat?

4. Where did they study sleep medicine?

5. Are there formal university programs in sleep medicine in your country?

6. If you were to study sleep medicine today, which country would you choose?

7. Do public health institutions in your country perform sleep surgery?

8. Do public health institutions in your country provide CPAP devices to those in need?

9. In private healthcare, does medical insurance cover sleep medicine?

10. In private healthcare, does medical insurance cover surgical treatment for sleep disorders?

11. In private healthcare, does medical insurance cover Drug-Induced Sleep Endoscopy (DISE)?

Responses were analyzed using descriptive statistical methods for each participating country.

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are in controlled access data storage at the Mexican Institute of Integral Sleep Medicine.

Results

Of the 443 participants in the WhatsApp group, 74 decided to answer the survey, representing 11 Latin American countries. The details of their distribution are presented in [Table 1].

Table 1 Country, population, number of participants and sleep medicine approach (C = comprehensive, R = )

COUNTRY	POPULATION	NUMBER OF PARTICIPANTS	ARE THERE SLEEP MEDICINE SPECIALISTS?	SLEEP MEDICINE APPROACH
Mexico	130 million	12	Yes	C: 5, R: 7
Colombia	52 million	10	Yes	C: 6, R:4
Panama	5 million	4	Yes	R: 3, C: 1
Costa Rica	5 million	4	Yes	C: 2, R: 2
Chile	12 million	12	Yes	C: 10, R: 2
Brazil	210 million	16	Yes	C: 16
Argentina	47 million	4	Yes	C: 2, R: 2
Peru	31 million	4	Yes	R: 3, C: 1
Ecuador	18 million	4	Yes	C: 2, R: 2
Paraguay	8 million	2	Yes	C: 2
Guatemala	18 million	2	No	–

The represented countries were Brazil (16), Mexico (12), Chile (12), Colombia (10), Argentina (4), Panama (4), Costa Rica (4), Ecuador (4), Peru (4), Paraguay (2), and Guatemala (2). All the participating physicians' countries had sleep medicine specialists, except for Guatemala.

Regarding their approach, namely the kind of sleep disorders they diagnose and treat, the answer was divided into two categories: integral or comprehensive sleep medicine (treating every kind of sleep disorder) or respiratory sleep medicine (approaching only snoring and sleep apnea). Forty-seven participants stated that the approach in their country is toward comprehensive sleep medicine, while 25 answered that they only managed respiratory disorders. Two participants (from Guatemala, where there are no sleep medicine specialists according to the survey) did not answer this question.

For the fourth question, “Where did they study sleep medicine?” the answers were: Mexico: 7, Brazil: 3, US: 4, Spain: 2, Argentina: 2, Israel: 1, Australia: 1, Uruguay: 1. The fifth question addressed the existence of formal university postgraduate programs in sleep medicine in their countries, and they responded that four countries did have them -Mexico, Brazil, Argentina, and Chile- while the other seven did not. When asked which country they would go to study sleep medicine, they answered, by country, the following: Mexico: 11, US: 4, Brazil: 3, Spain: 3, Germany: 1, Canada: 1, Chile: 1, Colombia: 1. ([Table 2])

Table 2 Country where they studied sleep medicine, the existence of formal university programs and country where they would study sleep medicine

COUNTRY	WHERE THEY STUDIED SLEEP MEDICINE	EXISTENCE OF FORMAL PROGRAMS	WHERE THEY WOULD STUDY SLEEP MEDICINE
Mexico	Canada, US, Mexico, Israel	Yes	Mexico, Germany, US
Colombia	Mexico, Brazil, US	No	Mexico, US, Spain, Brazil
Panama	Mexico, Spain	No	Mexico
Costa Rica	Mexico, Brazil, Australia	No	Mexico, Brazil
Chile	Mexico, Spain, US	Yes	Mexico, Chile
Brazil	Brazil	Yes	Brazil, US, Canada, Mexico
Argentina	Argentina	Yes	Mexico, Colombia, Brazil
Peru	Mexico, US	No	Mexico, US, Spain
Ecuador	Mexico, Argentina, Uruguay	No	Mexico, Spain
Paraguay	Argentina	No	Mexico
Guatemala	–	No	Mexico

Abbreviation: US, United States.

The last five questions were related to sleep medicine practice. In the question, “Do public health institutions in your country perform sleep surgery?” five countries answered yes, five answered no, and in Mexico, interestingly, half answered yes while the other half answered no. In the eighth question, “Do public health institutions provide CPAP devices to patients who need them?” four countries said yes, five said no, and Brazil and Chile had divided responses. ([Table 3])

Table 3 Situation of the public health institutions, regarding respiratory sleep disorders treatment

COUNTRY	DO PHI PERFORM DREAM SURGERY?	DO PHI PROVIDE CPAP?
Mexico	6 yes, 6 no	Yes
Colombia	Yes	Yes
Panama	Yes	No
Costa Rica	No	Yes
Chile	Yes	6 yes, 6 no
Brazil	Yes	12 yes, 4 no
Argentina	Yes	Yes
Peru	No	No
Ecuador	No	No
Paraguay	No	No
Guatemala	No	No

Abbreviation: PHI, Public Health Institutions.

Regarding private medical practice, when asked if medical insurance companies cover sleep medicine, six countries answered no and two answered yes, while Colombia, Argentina, and Peru had divided responses as well. Four countries answered that private insurance companies covered sleep surgical procedures, four answered no, and three answered that only some companies did. ([Table 4])

Table 4 Situation of private medicine and insurance companies regarding coverage of sleep medicine, sleep surgery and DISE

COUNTRY	SLEEP MEDICINE	SLEEP SURGERY	DISE
Mexico	No	No	No
Colombia	4 yes, 6 no	4 yes, 6 no	8 yes, 2 no
Panama	No	Yes	No
Costa Rica	No	No	No
Chile	Yes	Yes	No
Brazil	Yes	Yes	No
Argentina	2 yes, 2 no	Yes	2 yes, 2 no
Peru	2 yes, 2 no	Only few IC	No
Ecuador	No	No	No
Paraguay	No	Only few IC	No
Guatemala	No	No	No

Abbreviation: IC, Insurance companies.

In the last question, related to whether insurance companies cover DISE, nine countries said no, while Colombia and Argentina presented divided responses.

Discussion

Sleep medicine has seen exponential growth in recent decades worldwide. The high incidence and prevalence of sleep disorders, particularly sleep-related breathing disorders, have drawn increasing interest from healthcare professionals, especially in diagnosing snoring and sleep apnea. This includes a significant number of airway specialists, such as pulmonologists and otorhinolaryngologists.

A key limitation of our study is the potential bias introduced by the composition of the whatsapp group, as most participants are otorhinolaryngologists (ENTs). The study design is indeed a limitation, as the whatsapp group provides a convenience sample and it may lead to a biased cross-sectional picture of the outcomes. Although the group includes psychiatrists, pulmonologists, and other specialists, the predominance of ENTs likely introduces a bias toward sleep-related breathing disorders. To account for this, we specifically asked participants whether they practiced comprehensive sleep medicine or focused solely on respiratory sleep medicine, recognizing the growing interest among ENTs in sleep-induced respiratory conditions and their active engagement, particularly in sleep surgery. Nevertheless, it is important to state that there are no articles in the English literature about the education and practice of sleep medicine in Latin America. The lack of information about how sleep medicine is taught in Latin America has been one of the factors slowing the growth of sleep medicine practice in this region of the world and limits the possibility of creating validated teaching programs tailored to our reality. This article can serve as a basis for further research on this topic.

Another limitation of this study is its design, as no definitive conclusions can be drawn due to the absence of comparison groups. However, given the scarcity of publications on this topic, conducting a survey serves as a valuable first step to raise awareness among Latin American sleep specialists and healthcare professionals interested in this field. This study provides insight into the current state of sleep medicine in the region and may serve as a foundation for future research.

As expected, the countries with the largest populations -Brazil, Mexico, and Colombia- had the highest number of participants. Interestingly, Argentina and Peru, despite having significant populations, had only four participants each, whereas Chile, a smaller country by population, had participation levels comparable to Mexico.

Of the eleven countries surveyed, ten reported having specialists in sleep medicine, with Guatemala being the only exception. As anticipated, most countries emphasized respiratory sleep medicine. Notably, in Brazil, all participants indicated that comprehensive sleep medicine is practiced, while in Colombia, although responses varied, the majority acknowledged a comprehensive approach.

Except for Brazil and Argentina, where participants predominantly studied sleep medicine domestically, most specialists pursued their education abroad, primarily in Mexico, Brazil, Spain, and the United States. Alarmingly, only four of the eleven countries -Mexico, Brazil, Argentina and Chile- have formal sleep medicine programs. This limitation significantly restricts access to specialized training, leaving healthcare professionals in other countries with the only option of seeking education abroad or through online programs. When asked where they would choose to study sleep medicine today, most respondents selected Mexico, followed by the United States, Brazil, and Spain.

A notable finding is that within Mexico, there is a significant lack of awareness among physicians specializing in sleep medicine regarding whether public health institutions cover surgical procedures for sleep disorders. Half of the respondents answered affirmatively, while the other half did not. In this regard, the public healthcare system in Mexico is fragmented into several independent institutions, each of which manages its medical specialties according to its own needs, capabilities, and available expertise. Physicians are generally aware only of the practices within their own institution and are often unaware of how similar cases are handled elsewhere, which helps explain the contradictory responses observed. A similar pattern was observed regarding the provision of CPAP devices, with divided responses from Chile and Brazil. Equally concerning is the fact that in half of the surveyed countries, public health institutions do not provide treatment for sleep disorders, whether surgical interventions or CPAP therapy.

In the private healthcare sector, most respondents indicated that medical insurance does not cover sleep medicine treatments, whether medical or surgical. DISE, a widely used diagnostic tool for evaluating upper airway collapse in sleep apnea patients, is only covered in Argentina and Colombia, and even in these countries, responses were divided. This highlights the financial burden on patients, as treatments for sleep disorders—particularly those related to breathing—are often expensive and not covered by insurance.

This article aims to offer a concise overview of the current state of sleep medicine education and practice in Latin America. We believe that raising awareness among healthcare professionals in this region is a crucial starting point for the future proper and precise treatment of sleep disorders. Further studies in this field are essential to address existing gaps and improve access to specialized care.

Conflict of Interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers' bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Authors declare that no financial or non-financial interests are directly or indirectly related to the work submitted for publication.

Compliance with Ethical Standards

Ethical and research committee number: IMMIS 24–0012.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee of the Mexican Institute of Integral Sleep Medicine, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The Ethics Committee granted a waiver of participants consent.

This article does not contain any studies with animals performed by any of the authors.

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Publication History

Received: 25 March 2025

Accepted: 24 August 2025

Article published online:
31 December 2025