Nature and Science of Sleep (Jun 2024)
Effects of COVID-19 on Sleep Services Use and Its Recovery
Abstract
Amin Ramezani,1– 4 Amir Sharafkhaneh,1,4 Ahmed S BaHammam,5,6 Samuel T Kuna,7 Javad Razjouyan1– 4 1VA’s Health Services Research and Development Service (HSR&D), Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA; 2Big Data Scientist Training Enhancement Program, VA Office of Research and Development, Washington, DC, 20420, USA; 3VA Quality Scholars Coordinating Center, Iquest, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA; 4Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA; 5Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia; 6The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia; 7Department of Medicine, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USACorrespondence: Amir Sharafkhaneh, VA’s Health Services Research and Development Service (HSR&D), Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, 77030, USA, Email [email protected]: 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
