Germany's remarkable 18-match winning streak in World Cup qualifiers came to a halt after Eljif Elmas scored a late winner for North Macedonia.
Genoa and former Inter Milan forward Goran Pandev, 37, opened the scoring just before half-time on Wednesday night.
Ilkay Gundogan equalised from the penalty spot in the 64th minute after Sane had been fouled by Alioski.
But Elmas won it late on for the visitors.
Line-ups
Germany XI: Gundogan, Ter Stegen, Emre Can, Rudiger, Goretzka, Gnabry, Ginter, Kimmich, Sane, Gosens, Havertz
Subs: Trapp, Leno, Younes, Werner, P.Max, Tah, Klostermann, Neuhaus, J. Musiala, F. Wirtz
North Macedonia XI: Pandev, A. Ademi, S. Ristovski, A. Trajkovski, V. Musliu, S. Dimitrievski, D. Velkovski, E. Alioski, B. Nikolov, Bardhi, Elmas
Subs: A. Ibraimi, S. Spirovski, M. Bogatinov, K. Velkoski, K. Ristevski, S. Aškovski, F. Hasani, D. Shishkovski, E. Bejtulai, M. Radeski, V. Stojanovski