An Auckland clinic has defended its obligation to report a patient's sleep disorder diagnosis to their GP or the New Zealand Transport Agency (NZTA) after a customer claimed they were not properly informed.
The patient, who wishes to remain anonymous, said he visited a Sleep Well Clinic to see if a continuous positive airway pressure (CPAP) machine, a device that assists breathing, would help put an end to his noisy snoring - a frequent topic of complaint from his wife.
After undertaking a sleep study, the man was informed by the clinic via email that he likely had severe obstructive sleep apnoea (OSA) - a disorder in which breathing repeatedly stops and starts during sleep, characterised by loud snoring and fatigue.
However, he says the clinic failed to inform him of the possible implications of his diagnosis prior to the sleep study.
The man told Newshub he was "really pissed off" he wasn't informed beforehand that the NZTA could potentially be notified of his sleep disorder diagnosis if he refused to pursue treatment, or was unwilling for his GP to be informed of the diagnosis.
He argued the clinic should have made the possible implications explicitly clear.
"They never, at any point, tell you that once you are 'logged' as a person with sleep apnoea - [and] if you don't want to buy a CPAP machine - they register you with NZTA and can take your licence from you," he told Newshub.
"My issue is that they don't tell you this before you start the process - and when I asked why this doesn't happen, they say it would scare people off."
He said it was always his intention to opt for a CPAP machine if it would help with his noisy snoring, but felt forced into the purchase given the implications if he was unwilling to accept treatment.
"If I had known I would have imported a machine myself [and not had a sleep study] as I only wanted it for snoring. I never felt tired during the day."
In the email, the clinic advised him that under NZTA guidelines the man should "restrict or cease driving" until he had received effective treatment - such as CPAP therapy - for his OSA.
"In practice, this means that you should be careful that you don’t start driving if you feel sleepy. If you do drive, you should restrict your driving to no more than an hour at a time. After driving for an hour, you must take at least a ten-minute break, even if you don’t think you feel sleepy," said the email, supplied to Newshub.
In a second email, the clinic told him it was standard protocol that a patient's GP is informed of the diagnosis, as OSA is linked to many potentially dangerous medical conditions and can put sufferers at a heightened risk on the road.
The clinic added that if the man was unwilling to pursue treatment - or unwilling to have his GP informed of his diagnosis - they would be obligated to notify NZTA directly, potentially costing him his licence.
"If the patient is unwilling for us to pass [the sleep study results] over to their GP then we are required to notify NZTA directly. I hasten to add, I can't recall the last time we did that," said the email, provided to Newshub.
"We are required to notify EITHER your GP, or NZTA if you aren't accessing therapy."
According to NZTA, untreated OSA patients can pose a risk behind the wheel as they are prone to fatigue and drowsiness.
NZTA senior manager vehicle and driver licencing, Sue Hardiman, confirmed to Newshub that medical practitioners are required to inform the agency if they believe the "mental or physical condition of a licence holder" means that in the interest of public safety, they should not be allowed to drive.
"If a person refuses treatment and there are no other options available then we must consider road safety risk, and consider the patient's medical fitness to drive. Untreated OSA poses a high risk to road safety as the licence holder will be excessively tired and this can result in delayed reaction times or falling asleep at the wheel. If a person has untreated OSA, this would generally result in the patient’s licence being revoked," Hardiman said.
However, the patient maintains this was not clearly communicated to him prior to the sleep study.
In response to Newshub's query, a Sleep Well Clinic clinical support staffer said the NZTA guidelines are stated in the terms and conditions of a form sent to the patient before their sleep study.
As provided by the clinic, the form states: "If you also have a sleep test provided through Sleep Well Clinic as part of your overall sleep assessment and the sleep test shows severe obstructive sleep apnoea, we are required to include a sleep study report to your family doctor or GP because severe sleep apnoea can affect driving and also many long-term medical conditions."
The man acknowledged the form did contain the information, but argued it could have been communicated verbally.
"Nobody reads that detail when they click submit… there was no mention in phone conversations at all around this," he told Newshub.
"I definitely feel this should be gone over in detail verbally before going forward."
A managing director and sleep physiologist for Sleep Well Clinic told Newshub that to his knowledge, the clinic has never directly notified NZTA of an OSA diagnosis. He says the clinic has chosen a "gentler" approach.
"We don't directly inform NZTA, but instead inform the patient's nominated family doctor," he reiterated.
"When talking on the phone there is a lot of information to take in, and people tend to miss things… So our policy is to put everything about what will happen, that we can, in writing and not as fine print. We don't want to trick people."
He says a consultation would be the "first opportunity" for a specialist to go over the NZTA guidelines and possible implications based on the individual case.
He added that people undergoing an eye exam don't expect to be pre-warned that if they fail, they may be advised not to drive until they get corrective lenses.
"You wouldn't expect the specialist at the outset before you did the test to warn you - either verbally or in writing - that if you failed the eye test there might be flow-on implications for your drivers licence."
The patient claims that prior to using a CPAP machine, OSA had never impacted his day-to-day life or ability to drive safely.
"I never felt tired during the day at all and feel the same now as I did before," he said.
"My wife appreciates it though as I no longer snore."
