The complaints of insomnia and excessive daytime sleepiness are covered later in this section.
Medically reviewed byGerald Hurowitz, M.D.Updated 26 August 201113 min read
Key points
The pathophysiology and main symptoms of sleep disorders form the basis of the approach to these conditions in this section (Table 1.5).
ICSD-3 is published in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society.
The ICD-10 system sets aside two areas for sleep disorders: organic (ICD-10 code: G47) and nonorganic (ICD-10 code: F51), but it only includes a few actual sleep disorder diagnoses.
The International Classification of Sleep Disorders (ICSD) uses a multiaxial system for stating and coding diagnoses both in clinical reports or for data base purposes.
The pathophysiology and main symptoms of sleep disorders form the basis of the approach to these conditions in this section (Table 1.5).
The complaints of insomnia and excessive daytime sleepiness are covered later in this section. The circadian rhythm disorders are separately identified since they form a physiological entity. The links between the pathophysiology, clinical features and treatment of these sleep disorders are emphasized throughout these chapters.
This approach has many similarities to, but also some differences from, the widely used 1997 third revision of the International Classification of Sleep Disorders (ICSD) produced by the American Sleep Disorders Association (ASDA) in association with other national and international sleep societies.
Sleep disorders are frequent processes, both as a symptom associated with other diseases and as independent disorders. However, only in the last 4 decades has Sleep medicine gained its position among the medical specialties.
In fact, it was only in these years that significant advances were obtained in the study of the etiology and treatment of these disorders. Similarly, the different classifications have been evolving over the years.
First, they were based upon the clinical symptom; later on, more emphasis was given to the diseases. Finally, in 2005, the new classification was once again based on the symptoms. More than 90 disorders are listed in this latest classification, and an attempt is made to include the symptoms and the diseases of sleep, as well as those in which sleep disorders are fundamental.
It is essential to have a clear idea of this complete classification of sleep disorders in order to deal with these patients appropriately.
The International Classification of Sleep Disorders (ICSD) was produced primarily for diagnostic and epidemiologic purposes so that disorders could be indexed and morbidity and mortality information could be recorded and retrieved.
This classification is not intended to provide a differential diagnostic listing of sleep and arousal disorders. A differential diagnostic listing is presented on page 331 and is included to assist the clinician in diagnosing disease related to one of three major sleep symptoms: insomnia, excessive sleepiness, or an abnormal event during sleep.
The ICSD is consistent in style with International Classification of Diseases (ICD-9-CM) classifications for disorders affecting systems such as the cardiovascular or respiratory.
The ICSD consists of four categories. The first category comprises the dyssomnias (i.e.,the disorders of initiating and maintaining sleep and the disorders of excessive sleepiness).
There are currently three systems used to classify sleep disorders:
ICSD-3 is published in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. It distinguishes six subcategories of sleep disorders:
The Diagnostic and Statistical Manual for Mental Disorders, Fifth Edition
(commonly known as the DSM-V), published by the American Psychiatric Association, Washington, DC, 2013.;
This system lists 10 "sleep-wake disorders," conditions (or groups of conditions) that are manifested by disturbed sleep that cause both distressed and impaired functioning during the daytime:
Insomnia disorder
Hypersomnolence disorder
Narcolepsy
Breathing-related sleep disorders, including:
Obstructive sleep apnea hypopnea
Central sleep apnea
Sleep-related hypoventilation
Circadian rhythm sleep disorders, including:
Advanced sleep phase syndrome
Irregular sleep-wake type
Non-24-hour sleep-wake type
Non-REM (NREM) sleep arousal disorders
Nightmare disorder
REM sleep behavior disorder
Restless legs syndrome
Substance- or medication-induced sleep disorder.
The International Classification of Sleep Disorders, Third Edition (ICSD-3), published by the American Academy of Sleep Medicine, Chicago, 2014.
ICSD-3 is published in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. It distinguishes six subcategories of sleep disorders:
Insomnia
Sleep Related Breathing Disorders
Central Disorders of Hypersomnolence
Circadian Rhythm Sleep-Wake Disorders
Parasomnias
Sleep-Related Movement Disorders
The International Classification of Diseases, 10th edition (ICD-10), published by the World Health Organization, Geneva, Switzerland, 1994.
The ICD-10 system sets aside two areas for sleep disorders: organic (ICD-10 code: G47) and nonorganic (ICD-10 code: F51), but it only includes a few actual sleep disorder diagnoses.
The United States still uses a precursor to the ICD-10, the ICD-9-CM (CM stands for "clinical modifications") - although the country will change over to the ICD-10 system in October 2015. ICD-9 recently incorporated most sleep disorder diagnoses listed in ICSD-2.
The second category, the parasomnias, comprises the disorders of arousal, partial arousal, or sleep stage transition, which do not cause a primary complaint of insomnia or excessive sleepiness. The third category, sleep disorders associated with mental, neurologic, or other medical disorders, comprises disorders with a prominent sleep complaint that is felt to be secondary to another condition. The fourth category, proposed sleep disorders, includes those disorders for which there is insufficient information available to confirm their acceptance as definitive sleep disorders.
Textual content is included for all the ICSD disorders that are listed in Axis A.
THE AXIAL SYSTEM
The International Classification of Sleep Disorders (ICSD) uses a multiaxial system for stating and coding diagnoses both in clinical reports or for data base purposes. The axial system uses International Classification of Diseases (ICD-9-CM) coding wherever possible. Additional codes are included for procedures and physical signs of particular interest to sleep disorders clinicians and researchers.
Modifying information,such as severity, duration, and symptoms, also can be specified and coded by a special ICSD sleep code. Diagnoses and procedures are listed and coded on three main "axes."
The axial system is arranged as follows:
Axis AICSD Classification of Sleep Disorders
Axis BICD-9-CM Classification of Procedures
Axis CICD-9-CM Classification of Diseases (nonsleep diagnoses)
In the revised International Classification of Sleep Disorders Diagnostic and Coding Manual (ICSD-DCM), the American Sleep Disorders Association (ASDA; 1990) broadly classifies three categories of disordered sleep: 1) dyssomnias, 2) parasomnias, and 3) sleep disorders associated with medical and psychiatric conditions.
A partial list of ICSD-DCM and DSM-IV dyssomnias that are commonly observed in children and adolescents is presented in Tables 17-1 and 17-2, respectively.
The ICSD-DCM and DSM-IV parasomnias that most commonly affect children and adolescents are listed in Tables 17-3 and 17-4, respectively. Again, concordance between the two systems is good.
The ICSD-DCM sleep disorders that co-occur most commonly with medical and psychiatric disorders of children and their DSM-IV equivalents are listed in Tables 17-5 and 17-6, respectively.
Hypersomnias of Central Origin Not Due to a Circadian Rhythm Sleep Disorder, Sleep Related Breathing Disorder, or Other Cause of Disturbed Nocturnal Sleep
Insomnia
Adjustment Insomnia (Acute Insomnia)
Psychophysiological Insomnia
Paradoxical Insomnia
Idiopathic Insomnia
Insomnia Due to Mental Disorder
Inadequate Sleep Hygiene
Behavioral Insomnia of Childhood
Insomnia Due to Drug or Substance
Insomnia Due to Medical Condition
Insomnia Not Due to Substance or Known Physiological Condition
Unspecified (Nonorganic Insomnia, NOS)
Physiological (Organic) Insomnia, Unspecified
Sleep Related Breathing Disorders
Central Sleep Apnea Syndromes
Primary Central Sleep Apnea
Central Sleep Apnea Due to Cheyne Stokes Breathing Pattern
Central Sleep Apnea Due to High-Altitude Periodic Breathing
Central Sleep Apnea Due to Medical Condition Not Cheyne Stokes
Central Sleep Apnea Due to Drug or Substance
Primary Sleep Apnea of Infancy (Formerly Primary Sleep Apnea of Newborn)
Obstructive Sleep Apnea Syndromes
Obstructive Sleep Apnea, Adult
Obstructive Sleep Apnoea, Pediatric
Sleep Related Hypoventilation/Hypoxemic Syndromes
Sleep Related Nonobstructive Alveolar Hypoventilation, Idiopathic
Congenital Central Alveolar Hypoventilation Syndrome
Sleep Related Hypoventilation/Hypoxemia Due to Medical Condition
Sleep Related Hypoventilation/Hypoxemia Due to Pulmonary Parenchymal or Vascular Pathology
Sleep Related Hypoventilation/Hypoxemia Due to Lower Airways Obstruction
Sleep Related Hypoventilation/Hypoxemia Due to Neuromuscular and Chest Wall Disorders
Other Sleep Related Breathing Disorder
Sleep Apnea/Sleep Related Breathing Disorder, Unspecified
Hypersomnias of Central Origin Not Due to a Circadian Rhythm Sleep Disorder, Sleep Related Breathing Disorder, or Other Cause of Disturbed Nocturnal Sleep
Narcolepsy With Cataplexy
Narcolepsy Without Cataplexy
Narcolepsy Due to Medical Condition
Narcolepsy, Unspecified
Recurrent Hypersomnia
Kleine-Levin Syndrome
Menstrual-Related Hypersomnia
Idiopathic Hypersomnia With Long Sleep Time
Idiopathic Hypersomnia Without Long Sleep Time
Behaviorally Induced Insufficient Sleep Syndrome
Hypersomnia Due to Medical Condition
Hypersomnia Due to Drug or Substance
Hypersomnia Not Due to Substance or Known Physiological Condition (Nonorganic Hypersomnia, NOS)
Circadian Rhythm Sleep Disorder, Irregular Sleep-Wake Type (Irregular Sleep-Wake Rhythm)
Circadian Rhythm Sleep Disorder, Free-Running Type (Nonentrained Type)
Circadian Rhythm Sleep Disorder, Jet Lag Type (Jet Lag Disorder)
Circadian Rhythm Sleep Disorder, Shift Work Type (Shift Work Disorder)
Circadian Rhythm Sleep Disorder Due to Medical Condition
Other Circadian Rhythm Sleep Disorder (Circadian Rhythm Disorder, NOS)
Other Circadian Rhythm Sleep Disorder Due to Drug or Substance
Parasomnias
Disorders of Arousal (From NREM Sleep)
Confusional Arousals
Sleepwalking
Sleep Terrors
Parasomnias Usually Associated With REM Sleep
REM Sleep behavior Disorder (Including Overlap Disorder and Status Dissociatus)
Recurrent Isolated Sleep Paralysis
Nightmare Disorder
Other Parasomnias
Sleep Related Dissociative Disorders
Sleep Enuresis
Sleep Related Groaning (Catathrenia)
Exploding Head Syndrome
Sleep Related Hallucinations
Sleep Related Eating Disorders
Parasomnia, Unspecified
Parasomnia Due to Drug or Substance
Parasomnia Due to Medical Condition
Sleep Related Movement Disorders
Restless Legs Syndrome
Periodic Limb Movement Disorder
Sleep Related Leg Cramps
Sleep Related Bruxism
Sleep Related Rhythmic Movement Disorder
Sleep Related Movement Disorder, Unspecified
Sleep Related Movement Disorder Due to Drug or Substance
Sleep Related Movement Disorder Due to Medical Condition
Isolated Symptoms, Apparently Normal Variants and Unresolved Issues
Long Sleeper
Short Sleeper
Snoring
Sleep Talking
Sleep Starts (Hypnic Jerks)
Benign Sleep Myoclonus of Infancy
Hypnagogic Foot Tremor and Alternating Leg Muscle Activation During Sleep
Propriospinal Myoclonus at Sleep Onset
Excessive Fragmentary Myoclonus
Other Sleep Disorders
Other Physiological (Organic) Sleep Disorder
Other Sleep Disorder Not Due to Substance or Known
Physiological Condition
Environmental Sleep Disorder
Disorders Association (ASDA) in association with other national and international sleep societies [25] (Table 1.6). This groups insomnia and excessive daytime sleepiness as dyssomnias and distinguishes them from disorders occurring during sleep (parasomnias).
It also has two other categories which are less satisfactory. First, a group of medical and psychiatric disorders which includes epilepsy and mood disorders, all of which interact with the sleep mechanisms in a similar fashion to the disorders in the dyssomnia and parasomnia categories. The second group of 'proposed sleep disorders' is heterogeneous and emphasizes the descriptive aspects and includes partly developed concepts such as the 'sleep choking syndrome'.
The 2005 version recognises eight categories of sleep disorder [26] (Table 1.7) with insomnia and hypersomnias separated, but motor disorders during sleep included in the parasomnia, sleep related movement disorders and isolated symptoms sections. The term 'parasomnia' has not been used in this book because of the wide range and heterogeneous nature of sleep conditions that it has come to represent, but the important influence of drugs is recognised by a separate chapter devoted to their effects. The AASM 2005 classification includes drug related sleep disorders in several different categories, but excludes disorders such as sleep related epilepsy and several medical and psychiatric disorders causing sleep related symptoms.
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Adapted from Shneerson JM, Ohayon MM, Carskadon MA
Written and revised by
Gerald Hurowitz, M.D.
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