International Classification of Sleep Disorders

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International Classification of Sleep Disorder
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The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine".[1] The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979.[2][3] A second edition, called ICSD-2, was published in 2005.[4] The third edition, ICSD-3, was released in 2014.[5]

Milestones of Sleep Disorder Classifications

Year ICSD ICD DSM
1974 DSM-III
1975 ICD-9
1979 Nosology
1980 ICD-CM DSM-III
1987 DSM-III-R
1990 ICSD
1992 ICD-10
1994 DSM-IV
1997 ICSD-R
2000 DSM-IV-TR
2005 ICSD-2
2006 ICSD-2 Pocket Version
2010 ICD-10-CM
2014 ICSD-3 DSM-5
2015 ICD-11 Beta

Introduction

In 1979, the first Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) was developed by the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep. Disorders were divided into four main categories.[2][3]

  1. Disorders of initiating and maintaining sleep (DIMS) - Insomnias
  2. Disorders of Excessive somnolence (DOES) - Hypersomnias
  3. Disorders of the Sleep-Wake Schedule - Circadian Disorders
  4. Dysfunctions Associated with Sleep, Sleep Stages, or Partial Arousals - Parasomnias

In 1990, the first comprehensive classification of disorders of sleep and arousal, the International Classification of Sleep Disorders (ICSD-1990), was developed by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society[6]. 84 sleep disorders were inventoried, based on pathophysiological characteristics. It was later revised as the ICSD-R in 1997.

The International Classification of Sleep Disorders (ICSD) uses a multiaxial system for stating and coding diagnoses both in clinical reports or for database 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. Diagnoses and procedures are listed and coded on three main "axes." The axial system is arranged as follows:[7]

Axis A ICSD Classification of Sleep Disorders

Axis B ICD-9-CM Classification of Procedures

Axis C ICD-9-CM Classification of Diseases (nonsleep diagnoses).

ICSD - I (1990) and ICSD-Revised (1997)

  1. Dyssomnias
    1. Intrinsic Sleep Disorders
    2. Extrinsic Sleep Disorders
    3. Circadian Rhythm Sleep Disorders
  2. Parasomnias
    1. Arousal Disorders
    2. Sleep-Wake Transition Disorders
    3. Parasomnias Usually Associated with REM Sleep
    4. Other Parasomnias
  3. Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders
    1. Associated with Mental Disorders
    2. Associated with Neurologic Disorders
    3. Associated with Other Medical Disorders
  4. Proposed Sleep Disorders
    1. Shorter Sleeper
    2. Long Sleeper
    3. Menstrual-Associated Sleep Disorders

ICSD -2

In 2005, the International Classification of Sleep Disorders underwent minor updates and modifications resulting in version 2 (ICSD-2).[4]

ICSD-2 ICD-9-CM ICD-10-CM
Insomnia: Insomnia is defined as the subjective perception of difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity for sleep, and that results in some form of daytime impairment.[4]
Adjustment sleep disorder (acute insomnia) 307.41 F 51.02
Psychophysiological insomnia 307.42 F 51.04
Paradoxical insomnia (formerly sleep state misperception) 307.42 F 51.03
Idiopathic insomnia 307.42 F 51.01
Insomnia due to mental disorder 307.42 F 51.05
Inadequate sleep hygiene V69.4 Z72.821
Behavioral insomnia of childhood 307.42
- Sleep-onset association type z73.810
- Limit-setting sleep type z73.811
- Combined type Z73.812
Insomnia due to drug or substance 292.85 G47.02
Insomnia due to medical condition (code also the associated medical condition) 327.01 G47.01
Insomnia not due to a substance or known physiological condition, unspecified 780.52 F51.09
Physiological (organic) insomnia, unspecified; (organic insomnia, NOS) 327.00 G47.09
Sleep-Related Breathing Disorders:
Central sleep apnea syndromes
Primary central sleep apnea 327.21 G47.31
Central sleep apnea due to Cheyne-Stokes breathing pattern 768.04 R06.3
Central sleep apnea due to high altitude periodic breathing 327.22 G47.32
Central sleep apnea due to a medical condition, not Cheyne-Stokes 327.27 G47.31
Central sleep apnea due to a drug or substance 327.29 F10-19
Primary sleep apnea of infancy 770.81 P28.3
Obstructive sleep apnea syndromes
Obstructive sleep apnea, adult 327.23 G47.33
Obstructive sleep apnea, pediatric 327.23 G47.33
Sleep-related hypoventilation/hypoxemic syndromes
Sleep-related non-obstructive alveolar hypoventilation, bidiopathic 327.24 G47.34
Congenital central alveolar hypoventilation syndrome 327.25 G47.35
Sleep-related hypoventilation/hypoxemia due to a medical condition
Sleep-related hypoventilation/hypoxemia due to pulmonary parenchymal or vascular pathology 327.26 G47.36
Sleep-related hypoventilation/hypoxemia due to lower airways obstruction 327.26 G47.36
Sleep-related hypoventilation/hypoxemia due to neuromuscular or chest wall disorders 327.26 G47.36
Other sleep-related breathing disorder
Sleep apnea/sleep related breathing disorder, unspecified 320.20 G47.30
Hypersomnias of Central Origin:
Narcolepsy with cataplexy 347.01 G47.411
Narcolepsy without cataplexy 347.00 G47.419
Narcolepsy due to medical condition 347.10 G47.421
Narcolepsy, unspecified 347.00 G47.43
Recurrent hypersomnia 780.54 G47.13
- Kleine-Levin Syndrome 327.13 G47.13
- Menstrual-related hypersomnia 327.13 G47.13
Idiopathic hypersomnia with long sleep time 327.11 G47.11
Idiopathic hypersomnia without long sleep time 327.12 G47.12
Behaviorally induced insufficient sleep syndrome 307.44 F51.12
Hypersomnia due to medical condition 327.14 G47.14
Hypersomnia due to drug or substance 292.85 G47.14
Hypersomnia not due to a substance or known physiological condition 327.15 F51.1
Physiological (organic) hypersomnia, unspecified (organic hypersomnia, NOS) 327.10 G47.10
Circadian Rhythm Sleep Disorders:
Circadian rhythm sleep disorder, delayed sleep phase type 327.31 G47.21
Circadian rhythm sleep disorder, advanced sleep phase type 327.32 G47.22
Circadian rhythm sleep disorder, irregular sleep-wake type 327.33 G47.23
Circadian rhythm sleep disorder, free-running (non-entrained) type 327.34 G47.24
Circadian rhythm sleep disorder, jet lag type 327.35 G47.25
Circadian rhythm sleep disorder, shift work type 327.36 G47.26
Circadian rhythm sleep disorders due to medical condition 327.37 G47.27
Other circadian rhythm sleep disorder 327.39 G47.29
Other circadian rhythm sleep disorder due to drug or substance 292.85 G47.27
Parasomnias:
Disorders of arousal (from non-REM sleep)
- Confusional arousals 327.41 G47.51
- Sleepwalking 307.46 F51.3
- Sleep terrors 307.46 F51.4
Parasomnias usually associated with REM sleep
- REM sleep behavior disorder (including parasomnia overlap disorder and status dissociatus) 327.42 G47.52
- Recurrent isolated sleep paralysis 327.43 G47.53
- Nightmare disorder 307.47 F51.5
Other Parasomnias
Sleep-related dissociative disorders 300.15 F44.9
Sleep enuresis 788.36 N39.44
Sleep-related groaning (catathrenia) 327.49 G47.59
Exploding head syndrome 327.49 G47.59
Sleep-related hallucinations 368.16 R29.81
Sleep-related eating disorder 327.49 G47.59
Parasomnia, unspecified 227.40 G47.50
Parasomnia due to a drug or substance 292.85 G47.54
Parasomnia due to a medical condition 327.44 G47.54
Sleep-Related Movement Disorders:
Restless legs syndrome (including sleep-related growing pains) 333.49 G25.81
Periodic limb movement sleep disorder 327.51 G47.61
Sleep-related leg cramps 327.52 G47.62
Sleep-related bruxism 327.53 G47.63
Sleep-related rhythmic movement disorder 327.59 G47.69
Sleep-related movement disorder, unspecified 327.59 G47.90
Sleep-related movement disorder due to drug or substance 327.59 G47.67
Sleep-related movement disorder due to medical condition 327.59 G47.67
Isolated Symptoms, Apparently Normal Variants, and Unresolved Issues
Long sleeper 307.49 R29.81
Short sleeper 307.49 R29.81
Snoring 786.09 R06.83
Sleep talking 307.49 R29.81
Sleep starts, hypnic jerks 307.47 R25.8
Benign sleep myoclonus of infancy 781.01 R25.8
Hypnagogic foot tremor and alternating leg muscle activation during sleep 781.01 R25.8
Propriospinal myoclonus at sleep onset 781.01 R25.8
Excessive fragmentary myoclonus 781.01 R25.8
Other Sleep Disorders
Other physiological (organic) sleep disorder 327.8 G47.8
Other sleep disorder not due to a known substance or physiological condition 327.8 G47.9
Environmental sleep disorder 307.48 F51.8
Sleep disorders associated with conditions classifiable elsewhere
Fatal familial insomnia 046.8 A81.8
Fibromyalgia 729.1 M79.7
Sleep-related epilepsy 345 G40.5
Sleep-related headaches 784.0 R51
Sleep-related gastroesophageal reflux disease 530.1 K21.9
Sleep-related coronary artery ischemia 411.8 I25.6
Sleep-related abnormal swallowing, choking, and laryngospasm 787.2 R13.1
Other psychiatric/behavioral disorders frequently encountered in the differential diagnosis of sleep disorders
Mood disorders
Anxiety disorders
Somatoform disorders
Schizophrenia and other psychotic disorders
Disorders usually first diagnosed in infancy, childhood, or adolescence
Personality disorders

The ICSD-2 thus lists 81 sleep disorder diagnostic categories divided in 8 major categories. Each diagnostic is detailed in a description that presents the diagnostic criteria. The 81 diagnostics are divided into 8 main categories, namely insomnias, sleep-related breathing disorders, hypersomnias of central origin, circadian rhythm sleep disorders, parasomnias, sleep-related movement disorders, isolated symptoms apparently normal variants and unresolved issues, other sleep disorders. The two last categories (i.e. sleep disorders associated with disorders classified elsewhere and psychiatric disorders frequently encountered in the differential diagnosis of sleep disorders) are presented in the appendices and count 13 diagnostics[6].

In 2006, a pocket version of the ICSD-2 was released. In this version, a pediatric section was added listing the following diagnostic categories:

  1. Behavioural Insomnia in Childhood
    1. Onset Type
    2. Limit Setting Type
  2. Primary Sleep Apnea of Infancy
  3. Obstructive Sleep Apnea, Pediatric
  4. Congenital Central Alveolar Hypoventilation Syndrome
  5. Sleep Enuresis
  6. Restless Legs Syndrome
  7. Sleep-related Rhythmic Movement Disorder

However, this classification brought some confusion into the field, which led to the revision of the classification in 2011. The classification was much more discussed by experts of the field and led to the third edition of the ICSD.

ICSD-3 (2014)

The revision of the ICSD-2 was firstly made by the AASM and other International Societies. This revision ntergrates pediatric diagnosis into clinical adult diagnosis (expect for Obstructive Sleep Apnea) ane led to the third edition of the ICSD, which was released in 2014.

ICSD-3 includes specific diagnoses within the seven major categories, as well as an appendix for classification of sleep disorders associated with medical and neurologic disorders. The International Classification of Diseases (ICD-9-CM and ICD-10-CM) codes corresponding to each specific diagnosis can be found within the ICSD-3.[8] Furthermore, pediatric diagnoses are not distinguished from adult diagnoses except for sleep-related breathing disorders.[9]

In addition, significant changes have been made in the nosology of insomnia, narcolepsy and parasomnia. Primary vs. secondary (i.e. comorbid) insomnia have been reunited into a single disorder: chronic insomnia. Narcolepsy have been dived into narcolepsy Type 1 and narcolepsy Type 2. These two types are distinguished by the presence or absence of cataplexy and the cerebrospinal fluid hypocretin-1 level. Concerning parasomnia, the sections have been modified, grouping together common features. Finally, a section on treatment-emerging CSA has been added to the CSA syndromes section.[10]

It also discusses common isolated symptoms and normal variants. Some occur during normal sleep: as an example, sleep talking occurs at some time in most normal sleepers. Some lie on the continuum between normal and abnormal: as an example, snoring without associated airway compromise, sleep disturbance, or other consequences is essentially normal, whereas heavy snoring is often part of obstructive sleep apnea.

Furthermore, some features are no longer disorders and are reunited in the AASM [American Academy of Sleep Medicine] Manual for the Scoring of Sleep and Associated Events. Therefore, ICSD permanently refers to this manual. The latter allows, for instance, to find definitions of polysomnography or specific features.[10]

The ICSD-3 counts 383 pages for 83 disorders. It is divided into 7 main categories:

1. Insomnia

  1. Chronic insomnia disorder
  2. Short-term insomnia disorder
  3. Other insomnia (when the patient has insomnia symptoms but does not meet criteria for the other two types of insomnia)
Isolated symptoms and normal variants

2. Sleep-related breathing disorders

Obstructive sleep apnea (OSA) syndromes

  1. OSA, adult
  2. OSA, pediatric

Central sleep apnea syndromes

  1. Central sleep apnea with Cheyne-Stokes breathing
  2. Central sleep apnea due a medical disorder without Cheyne-Stokes breathing
  3. Central sleep apnea due to high altitude periodic breathing
  4. Central sleep apnea due to a medication or substance
  5. Primary central sleep apnea
  6. Primary central sleep apnea of infancy
  7. Primary central sleep apnea of prematurity
  8. Treatment-emergent central sleep apnea

Sleep-related hypoventilation disorders

  1. Obesity hypoventilation syndrome
  2. Congenital central alveolar hypoventilation syndrome
  3. Late-onset central hypoventilation with hypothalamic dysfunction
  4. Idiopathic central alveolar hypoventilation
  5. Sleep-related hypoventilation due to a medication or substance
  6. Sleep-related hypoventilation due to a medical disorder

Sleep-related hypoxemia disorder

Isolated symptoms and normal variants
  1. Snoring
  2. Catathrenia

3. Central disorders of hypersomnolence

  1. Narcolepsy type 1
  2. Narcolepsy type 2
  3. Idiopathic hypersomnia
  4. Kleine-Levin syndrome
  5. Hypersomnia due to a medical disorder
  6. Hypersomnia due to a medication or substance
  7. Hypersomnia associated with a psychiatric disorder
  8. Insufficient sleep syndrome

4. Circadian rhythm sleep-wake disorders

  1. Delayed sleep-wake phase disorder
  2. Advanced sleep-wake phase disorder
  3. Irregular sleep-wake rhythm disorder
  4. Non-24-hour sleep-wake rhythm disorder
  5. Shift work disorder
  6. Jet lag disorder
  7. Circadian sleep-wake disorder not otherwise specified

5. Parasomnias

NREM-related parasomnias
  1. Confusional arousals
  2. Sleepwalking
  3. Sleep terrors
  4. Sleep-related eating disorder
REM-related parasomnias
  1. REM sleep behavior disorder
  2. Recurrent isolated sleep paralysis
  3. Nightmare disorder
Other parasomnias
  1. Exploding head syndrome
  2. Sleep-related hallucinations
  3. Sleep enuresis
  4. Parasomnia due to a medical disorder
  5. Parasomnia due to a medication or substance
  6. Parasomnia, unspecified
Isolated symptoms and normal variants
  1. Sleep talking

6. Sleep-related movement disorders

  1. Restless legs syndrome
  2. Periodic limb movement disorder
  3. Sleep-related leg cramps
  4. Sleep-related bruxism
  5. Sleep-related rhythmic movement disorder
  6. Benign sleep myoclonus of infancy
  7. Propriospinal myoclonus at sleep onset
  8. Sleep-related movement disorder due to a medical disorder
  9. Sleep-related movement disorder due to a medication or substance
  10. Sleep-related movement disorder, unspecified
Isolated symptoms and normal variants
  1. Excessive fragmentary myoclonus
  2. Hypnagogic foot tremor and alternating leg muscle activation
  3. Sleep starts (hypnic jerks)

7. Other sleep disorders

Other sleep-related symptoms or events that do not meet the standard definition of a sleep disorder

See also

References

  1. 2.0 2.1 Howard P. Roffwarg (1979). "Diagnostic classification of sleep and arousal disorders. 1979 first edition. Association of Sleep Disorders Centers and the Association for the Psychophysiological Study of Sleep". Sleep. 2: 1–154. doi:10.1093/sleep/2.1.1. PMID 531417.
  2. 3.0 3.1 Thorpy, M. J. (1990-01-01). "Classification of sleep disorders". Journal of Clinical Neurophysiology. 7 (1): 67–81. doi:10.1097/00004691-199001000-00006. ISSN 0736-0258. PMC 3480567. PMID 2406285.
  3. 4.0 4.1 4.2
  4. 6.0 6.1 Thorpy, Michael J (2012). "Classification of Sleep Disorders". Neurotherapeutics. 9 (4): 687-701. doi:10.1007/s13311-012-0145-6. PMC 3480567.
  5. Sateia, Michael J. (2014-11-01). "International classification of sleep disorders-third edition: highlights and modifications". Chest. 146 (5): 1387–1394. doi:10.1378/chest.14-0970. ISSN 1931-3543. PMID 25367475.
  6. 10.0 10.1 Sateia, Michael J. (2014). "International Classification of Sleep Disorders - Third Edition: Highlights and Modifications". Chest. 146 (5). doi:10.1378/chest.14-0970.
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