Alberta's unregulated sleep apnea clinics face new standards

Up to 200 sleep apnea clinics in Alberta — which have gone unregulated for years sparking concerns about the quality of patient care — now face new rules introduced Jan. 1 aimed at improving oversight, safety and consistency of care.

While standards have been in place for overnight sleep medicine clinics since the 1990s, until now labs offering take-home sleep apnea tests and treatment were not subject to similar rules.

"The quality of care issues [are] disastrous," said Dr. Charles Samuels, medical director of the Calgary-based Centre for Sleep and Human Performance and president of the Canadian Sleep Society, an organization that promotes sleep disorders medicine and education.

"We're seeing terrible problems and poor treatment that should never occur."

Samuels — whose overnight clinic has been been subject to accreditation standards for years — says many patients end up coming to him after being misdiagnosed or improperly treated at unregulated labs. 

For example, he said, sleep apnea clinics are not equipped to deal with other sleep disorders, of which there are dozens.

According to Samuels, improperly treated sleep problems can lead to fatigue, problems with weight control and cognitive impairment, as well as aggravating medical conditions such as heart disease and diabetes.

Lack of oversight

"The problem arises out of putting the care of patients with a medical disorder in the hands of non-physicians, which can work in many cases if there's oversight. But there was no oversight in this setting," said Samuels.

Sleep apnea facilities often employ respiratory therapists and, according to Samuels, the take-home tests can be interpreted by off-site doctors who don't examine the patients.

It is unclear how often tests are interpreted by non-physicians.

"There's been numerous problems in terms of gaps in care," said Samuels. 

New standards

The College of Physicians and Surgeons of Alberta (CPSA) is working to address the lack of oversight in what it calls a "rapidly evolving field."

"The thing that we're concerned with is: who's doing the work; how are they doing it; what kind of equipment are they doing it with; how well are they cleaning that equipment; what are their rules for lending it out?" said CPSA spokesperson Kelly Eby.

New CPSA accreditation standards, put in place Jan. 1, 2018, lay out numerous requirements including that sleep medicine facilities must have a medical director who is a physician with specific sleep medicine credentials and test results must be interpreted by an approved doctor.

While the college won't release a copy of its new standards, Eby says they are detailed and apply to all sleep medicine facilities in Alberta.

"We want to be sure people who are accessing these services in these facilities are getting safe care, quality care, consistent testing and good treatment. Because without any sort of oversight we don't know what's happening in them and neither do patients," said Eby. 

The college expects to start visiting and assessing clinics by mid-2018.

Facilities will need to be registered and meeting the standards by 2020, with full reviews occurring every four years.

The College and Association of Respiratory Therapists of Alberta says it worked in an advisory capacity as the regulations were being developed. 

"It is anticipated they will positively impact our members' professional practice by enhancing the quality and safety of patient care provided, particularly around home portable diagnostic testing," executive director Bryan Buell said in a statement e-mailed to CBC News. 

Buyer beware

While they won't be barred from operating, clinics that don't meet the new standards won't be accredited. 

It's a distinction that Albertans need to understand as they look for help with their sleep disorders, according to Samuels, who helped design the rules.

"[It's] creating quality of care so patients know these people are accredited, these people are not. And then it's buyer beware."