Effects of COVID-19 on Sleep Services Use and Its Recovery

Abstract

Purpose

The COVID-19 pandemic affected the utilization of various healthcare services differentially. Sleep testing services utilization (STU), including Home Sleep Apnea Testing (HSAT) and Polysomnography (PSG), were uniquely affected. We assessed the effects of the pandemic on STU and its recovery using the Veterans Health Administration (VHA) data.

Patients and Methods

A retrospective cohort study from the VHA between 01/2019 and 10/2023 of veterans with age ≥ 50. We extracted STU data using Current Procedural Terminology codes for five periods based on STU and vaccination status: pre-pandemic (Pre-Pan), pandemic sleep test moratorium (Pan-Mor), and pandemic pre-vaccination (Pan-Pre-Vax), vaccination (Pan-Vax), and postvaccination (Pan-Post-Vax). We compared STU between intervals (Pre-Pan as the reference).

Results

Among 261,371 veterans (63.7±9.6 years, BMI 31.9±6.0 kg/m², 80% male), PSG utilization decreased significantly during Pan-Mor (−56%), Pan-Pre-Vax (−61%), Pan-Vax (−42%), and Pan-Post-Vax (−36%) periods all compared to Pre-Pan. HSAT utilization decreased significantly during the Pan-Mor (−59%) and Pan-Pre-Vax (−9%) phases compared to the Pre-Pan and subsequently increased during Pan-Vax (+6%) and Pan-Post-Vax (−1%) periods. Over 70% of STU transitioned to HSAT, and its usage surged five months after the vaccine Introduction.

Conclusion

Sleep testing services utilization recovered differentially during the pandemic (PSG vs HSAT), including a surge in HSAT utilization post-vaccination.

Keywords:

• home sleep apnea testing
• polysomnography
• COVID-19
• pandemic
• current procedural terminology

Acknowledgment

The abstract of this paper was published in journal: Sleep, Volume 47, Issue Supplement_1, May 2024, https://doi.org/10.1093/sleep/zsae067.01059.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

Supported by seed funding from Baylor College of Medicine, Houston, Texas, United States, the Center for Innovations in Quality, Effectiveness and Safety (CIN 13–413), Michael E. DeBakey VA Medical Center, Houston, TX, United States, and a national institute of health (NIH), National Heart, Lung, and Blood Institute (BHLBI) K25 funding (#:1K25HL152006-01) to Dr. Razjouyan.