OBJECTIVES: The healthcare landscape in Germany is undergoing rapid changes due to multiple factors, not only but at least partially accelerated by the SARS-CoV-2 pandemic. Factors relevant to in-patient sleep medicine providers are on the one hand increased demand for sleep diagnostics and technological developments; and on the other hand political pressure towards more outpatient care; shortages of staff; and increased economic pressure for hospitals. Aim of this research is to analyze changes of in-patient sleep procedures over the past fifteen years in light of these changes.

METHODS: Data on claims related to the sleep tests was obtained from the public databases at the Federal Statistics Bureau (Destatis) and the German Hospital Institute (InEK). Relevant cases were identified with OPS procedure codes, which must be used to receive reimbursement for services provided in hospitals.

RESULTS: Over the period 2008-2022, inpatient sleep diagnostic procedures decreased in total by 29.8%, with Polysomnography cases declining by 42.6%, and vigilance test by 41.8%. Polygraphy utilization grew by 15.5% overall, though this number declined too after peaking in 2014. The compound annual growth rate was -2.5% for all tests; -3.9% for Polysomnography; +1.4% for Polygraphy and -3.8% for vigilance tests respectively. The largest reduction in volume occurred in the year 2020 (-27.1%; -30.7%; -21.5%; and -32.3%). During the entire period, overall procedure volume grew only in the years 2014 and 2022 (5.3% and 7.7%).

CONCLUSIONS: Utilization of in-patient sleep diagnostic services declined substantially in Germany over the past fifteen years, after peaking in 2014. A decrease in procedures occurred already before the SARS-CoV-2 pandemic, but significantly accelerated during the years 2020-2021. Diagnostic tests increased moderately again in the year 2022 when hospitals largely re-started in-patient services. Reasons for the decline of in-patient sleep diagnostic services could not be established from this analysis and will be subject of further studies.