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

Figures & data

Table 1 Veterans’ Characteristics Who Used Sleep Testing Services (HSAT and PSG) During the Study Period

Labels	All	Pre-Pan	Pan-Mor	Pan-Pre-Vax	Pan-Vax	Pan-PostVax
n	261,369	100,105	8888	28,660	35,317	88,399
HSAT, N (%)	167,395(64.0)	55,266(55.2)	6392(71.9)	21,468(74.9)	25,063(71.0)	59,206(67.0)
PSG, N (%)	93,974(36.0)	44,839(44.8)	2496(28.1)	7192(25.1)	10,254(29.0)	29,193(33.0)
H/P Ratio	1.8	1.2	2.6	3.0	2.4	2.0
Age, M(SD)	63.7(9.7)	63.1(9.7)	62.8(9.6)	62.8(9.6)	63.9(9.6)	64.8(9.5)
Age ≥ 65, N (%)	107,087(41)	42,462(42.5)	3500(35)	11,295(39.4)	14,237(40.3)	35,593(40.3)
Sex, Male, N (%)	212,061(81.1)	87,559.0(87.5)	7602.0(85.5)	24,009.0(83.8)	27,919.0(79.1)	64,972.0(73.5)
Race
White, N (%)	157,325(60)	63,918.0(63)	5640.0(63)	17,990.0(62)	20,917.0(60)	48,860.0(55)
Black, N (%)	55,048(21)	23,145.0(23)	1916.0(22)	6126.0(21)	7257.0(20)	16,604.0(19)
Others, N (%)	48,996(19)	13,042(14)	1332(15)	4544(17)	7143(20)	22,935(26)
Ethnicity, Hispanic, N(%)	17,306(6.6)	6878.0(6.9)	643.0(7.2)	1900.0(6.6)	2225.0(6.3)	5660.0(6.4)
BMI, M(SD)	32(6.0)	32.3(6.1)	32.1(6.0)	31.9(6.0)	31.7(6.0)	31.7(5.9)
BMI ≥ 30, N(%)	139,604(53.4)	58,720.0(58.7)	5056.0(56.9)	15,792.0(55.1)	18,017.0(51.0)	42,019.0(47.5)
Telehealth, n per month	249,659	150,741	352,143	348,274	315,174	249,003
Telehealth /person/month, n	1.0	1.5	39.6	12.2	8.9	2.8

Notes: Pre-Pan = pre-pandemic (01/2019 to 02/2021, 14 months), Pan-Mor = pandemic-moratorium (03/2020 to 06/2020, 4 months), Pan-Pre-Vax = pandemic-pre-vaccination opening (07/2020 to 12/2020, 6 months), Pan-Vax = pandemic vaccination (01/2021 to 06/2021, 06 months), and Pan-Post-Vax = pandemic post-vaccination (07/2021 to 09/2022, 15 months).

Abbrevation: M(SD) = Mean and standard deviation.

Figure 1 The time series of sleep testing service utilization (Home Sleep Apnea Test [HSAT] and Polysomnography [PSG]), the cumulative number of vaccinated veterans per 1000 cases, and the number of positive COVID-19 cases divided by 10. Five intervals defined: 1) PRE-Pandemic (01/2019 to 02/2021, 14 months), 2) Pandemic-Moratorium (03/2020 to 06/2020, 4 months), 3) Pandemic-Pre-Vaccination opening (07/2020 to 12/2020, 6 months), 4) Pandemic Vaccination (01/2021 to 06/2021, 06 months), and 5) Pandemic Post-Vaccination (07/2021 to 09/2022, 15 months).

Table 2 Comparing the HSAT and PSG Between Pre-Pandemic and Different Peri-Pandemic Intervals

	Pre-Pan	Pan-Mor	Pan-Pre-Vax	Pan-Vax	Pan-Post-Vax
HSAT, N per Month	4723	1944	4316	5020	4663
Difference, %	Reference	−59	−9	6.29	−1.25
p-value (cohen’s d)	Reference	<0.001 (3.84)	0.0191 (1.32)	0.1297 (0.69)	0.6195 (0.19)
PSG, N per Month	3841	1671	1491	2203	2469
Difference, %	Reference	−56	−61	−42.63	−35.72
p-value (cohen’s d)	Reference	<0.001 (5.69)	<0.001 (9.07)	<0.001 (5.06)	<0.001 (5.13)

Notes: Pre-Pan = pre-pandemic (01/2019 to 02/2021, 14 months), Pan-Mor = pandemic-moratorium (03/2020 to 06/2020, 4 months), Pan-Pre-Vax = pandemic-pre-vaccination opening (07/2020 to 12/2020, 6 months), Pan-Vax = pandemic vaccination (01/2021 to 06/2021, 06 months), and Pan-Post-Vax = pandemic post-vaccination (07/2021 to 09/2022, 15 months).

Figure 2 Comparing the sleep testing service utilizations, ie, Home Sleep Apnea Test (HSAT) and Polysomnography (PSG). (A) between pre-pandemic and peri-pandemic; (B) between five intervals defined: 1) PRE-Pandemic (01/2019 to 02/2021, 14 months), 2) Pandemic-Moratorium (03/2020 to 06/2020, 4 months), 3) Pandemic-Pre-Vaccination opening (07/2020 to 12/2020, 6 months), 4) Pandemic Vaccination (01/2021 to 06/2021, 06 months), and 5) Pandemic Post-Vaccination (07/2021 to 09/2022, 15 months).