Classification of sleep disorders | |
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Specialty | Sleep medicine |
Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.
Three systems of classification are in use worldwide: the International Classification of Diseases (ICD), the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Sleep Disorders (ICSD). The ICD and DSM lump different disorders together, while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three systems of classification. [1] The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of sleep medicine.
Systems for the classification of sleep disorders are used to classify medical disorders related to human sleep patterns. Three systems of classification are in use worldwide: [2]
The ICD and DSM lump different disorders together, while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three major classification systems. [1]
The first book on sleep[ citation needed ] was published in 1830 by Robert MacNish; it described sleeplessness, nightmares, sleepwalking and sleep-talking. Narcolepsy, hypnogogic hallucination, wakefulness and somnolence were mentioned by other authors of the nineteenth century. Westphal, in 1877, described first case of narcolepsy, the name coined later by Gelineu in 1880 in association with cataplexy. Lehermitte called it paroxysmal hypersomnia in 1930 to differentiate it from prolonged hypersomnia. Roger in 1932 coined the term parasomnia and classified hypersomnia, insomnia and parasomnia. [3] Kleitman in 1939 recognized types of parasomnias as nightmares, night terrors, somniloquy (sleep-talking), somnambulism (sleepwalking), grinding of teeth, jactatians, enuresis, delirium, nonepileptic convulsions and personality dissociation. [4] Broughton in 1968 developed classification of the arousal disorders as confusional arousals: night terrors and sleep walking. [5] Insomnias were classified as primary and secondary until 1970 when they were recognized as symptoms of other disorders. Sir William Osler in 1906 correlated snoring, obesity and somnolence (sleepiness) to Dicken's description of Joe. Charles Burwell in 1956 recognized obstructive sleep apnea as Pickwickian syndrome. [6] Circadian rhythm sleep disorders were discovered in 1981 by Weitzman as delayed sleep phase syndrome in contrast to advanced sleep phase syndrome in 1979. [7]
Classification of sleep disorders, as developed in the 19th century, used primarily three categories: insomnia, hypersomnia and nightmare. In the 20th century, increasingly in the last half of it, technological discoveries led to rapid advances in the understanding of sleep and recognition of sleep disorders. Major sleep disorders were defined following the development of electroencephalography (EEG) in 1924 by Hans Berger.
Year | ICSD | ICD | DSM | Development |
---|---|---|---|---|
1955 | ICD-7R [8] | Disturbance of sleep was seen as a symptom of other diseases | ||
1965 | ICD-8 [9] | Recognized as both a disease and a symptom of other diseases | ||
1968 | DSM-II | Disorder of Sleep as an independent category | ||
1975 | ICD-9 [10] | Organic sleep disorder, nonorganic sleep disorder and as symptom of other diseases | ||
1979 | Nosology | Clinical classification into four major groups: Disorder of initiating and maintaining sleep (DIMS) - Insomnias, Disorder of Excessive sleep (DOES) - Hypersomnias, Disorder of sleep-wake schedule (Circadian rhythm disorders) and Parasomnias | ||
1980 | ICD-CM | DSM-III | Manifestation of other disorders with physical manifestation, as Sleep walking and Sleep terror | |
1987 | DSM-III-R | Sleep Disorders were classified into dysomnias and parasomnias. | ||
1990 | ICSD | Expanded previous system into Dysomnias, Parasomnias, Symptomatic and Proposed disorder of sleep | ||
1990 | ICD-10 [11] | Organic sleep disorders included under nervous system disorder, nonorganic under psychiatric disorders and a third category as manifestation of other diseases | ||
1994 | DSM-IV | Dyssomnias, Parasomnias, Manifestation of mental disorders and Other | ||
1997 | ICSD-R | First detailed classification of various sleep disorders
| ||
2000 | DSM-IV-TR |
| ||
2005 | ICSD-2 | Most extensive classification of sleep disorders | ||
2010 | ICD-10-CM [12] | Three major categories, F51 as nonorganic sleep disorders, G47 organic sleep disorders and R- as symptoms of sleep disorders | ||
2013 | ICSD-3 | DSM-V | Lumping and splitting of sleep disorders and concordance of two systems | |
2015 | ICD-11 Beta [13] | Proposed beta version yet to be finalized in line with ICDS3 and DSM V |
Diagnoses of sleep disorders are based on self-assessment questionnaires, clinical interview, physical examination and laboratory procedures. The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of sleep medicine. Admittedly, the development of sleep disorder classification remains as much an art as it is a science. [1]
The International Classification of Sleep Disorders (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. [14] [15]
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. Diagnoses and procedures are listed and coded on three main "axes." The axial system is arranged as follows: [16]
ICSD 2 is tabulated in the main article International Classification of Sleep Disorders
The last edition of ICSD-3 is a unified classification of sleep disorders. It includes seven major categories: insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. Each of these categories has several subgroups: [17]
Applicable To
Approximate Synonyms
ICD-9 [21] | Sleep Disorders |
---|---|
Primary Sleep Disorders | |
Dyssomnias | |
307.42 | Primary Insomnia |
307.44 | Primary Hypersomnia Specify if Recurrent |
347.00 | Narcolepsy |
780.59 | Breathing-Related Sleep Disorder |
307.45 | Circadian Rhythm Sleep Disorder |
327.31 | Circadian Rhythm Sleep Disorder, Delayed Sleep Phase Type |
327.35 | Circadian Rhythm Sleep Disorder, Jet Lag Type |
327.36 | Circadian Rhythm Sleep Disorder, Shift Work Type |
327.30 | Circadian Rhythm Sleep Disorder, Unspecified Type |
307.47 | Dyssomnia NOS |
Parasomnias | |
307.47 | Nightmare Disorder |
307.46 | Sleep Terror Disorder |
307.46 | Sleepwalking Disorder |
307.47 | Parasomnia NOS |
Sleep disorders related to another mental disorder | |
307.42 | Insomnia Related to ... [Indicate the Axis I or Axis II Disorder] |
307.44 | Hypersomnia Related to ... [Indicate the Axis I or Axis II Disorder] |
Other Sleep disorders | |
327.14 | Sleep Disorder Due to ... [Indicate the General Medical Condition], Hypersomnia Type |
327.01 | Sleep Disorder Due to ... [Indicate the General Medical Condition], Insomnia Type |
327.8 | Sleep Disorder Due to ... [Indicate the General Medical Condition], Mixed Type |
327.44 | Sleep Disorder Due to ... [Indicate the General Medical Condition], Parasomnia Type |
291.82 | Alcohol-Induced Sleep Disorder |
292.85 | Amphetamine-Induced Sleep Disorder |
292.85 | Caffeine-Induced Sleep Disorder |
292.85 | Cocaine-Induced Sleep Disorder |
292.85 | Opioid-Induced Sleep Disorder |
292.85 | Other (or Unknown) Substance-Induced Sleep Disorder |
Sleep-wake disorders comprise 11 diagnostic groups: [22] [ failed verification ][ clarification needed ]
ICD9-CM | ICD10-CM | DSM 5 |
---|---|---|
Insomnia disorder | ||
780.52 | G47.00 | Insomnia disorder Specify if: With non-sleep disorder mental comorbidity. With other Medical comorbidity. With other sleep disorder |
780.52 | G47.09 | Other specified insomnia disorder |
780.52 | G47.00 | Unspecified insomnia disorder |
780.54 | G47.10 | Hypersomnolence disorderSpecify if: With mental disorder. With medical condition. With another sleep disorder |
780.54 | G47.19 | Other specified hypersomnolence disorder |
780.54 | G47.10 | Unspecified hypersomnolence disorder |
Narcolepsy | ||
347.00 | G47.419 | Autosomal dominant cerebellar ataxia, deafness, and narcolepsy |
347.00 | G47.419 | Autosomal dominant narcolepsy, obesity, and type 2 diabetes |
347.00 | G47.419 | Narcolepsy without cataplexy but with hypocretin deficiency |
347.01 | G47.411 | Narcolepsy with cataplexy but without hypocretin deficiency |
347.10 | G47.429 | Narcolepsy secondary to another medical condition |
Breathing-Related Sleep Disorders | ||
327.23 | G47.33 | Obstructive sleep apnea hypopnea |
Central sleep apnea | ||
780.57 | G47.37 | Central sleep apnea comorbid with opioid use |
327.21 | G47.31 | Idiopathic central sleep apnea: |
786.04 | R06.3 | Cheyne-Stokes breathing |
780.57 | G47.37 | Central sleep apnea comorbid with opioid use Note: First code opioid use disorder, if present. Specify current severity |
Sleep-related hypoventilation | ||
327.24 | G47.34 | Idiopathic hypoventilation |
327.25 | G47.35 | Congenital central alveolar hypoventilation |
327.26 | G47.36 | Comorbid sleep-related hypoventilation |
Primary Alveolar Hypoventilation | ||
Circadian rhythm sleep-wake disorders | ||
307.45 | G47.22 | Circadian rhythm sleep-wake disorders, Advanced sleep phase type |
307.45 | G47.21 | Circadian rhythm sleep-wake disorders, Delayed sleep phase type |
307.45 | G47.23 | Circadian rhythm sleep-wake disorders, Irregular sleep-wake type |
307.45 | G47.24 | Circadian rhythm sleep-wake disorders, Non-24-hour sleep-wake type |
307.45 | G47.26 | Circadian rhythm sleep-wake disorders, Shift work type |
307.45 | G47.20 | Circadian rhythm sleep-wake disorders, Unspecified type |
Non–rapid eye movement (NREM) sleep arousal disorders | ||
307.46 | F51.4 | Non-rapid eye movement sleep arousal disorders, Sleep terror type |
307.46 | F51.3 | Non-rapid eye movement sleep arousal disorders, Sleepwalking type |
Nightmare disorder | ||
307.47 | F51.5 | Nightmare disorder |
327.42 | G47.52 | Rapid eye movement (REM) sleep behavior disorder |
333.94 | G25.81 | Restless legs syndrome |
Medication-induced sleep disorder | ||
291.82 | Alcohol-induced sleep disorder | |
292.85 | Amphetamine (or other stimulant)-induced sleep disorder | |
292.85 | Caffeine-induced sleep disorder | |
292.85 | Cannabis-induced sleep disorder | |
292.85 | Cocaine-induced sleep disorder | |
292.85 | Opioid-induced sleep disorder | |
292.85 | Other (or unknown) substance-induced sleep disorder | |
292.85 | Sedative-, hypnotic-, or anxiolytic-induced sleep disorder | |
292.85 | Tobacco-induced sleep disorder | |
780.54 | G47.19 | Other Specified Hypersomnolence Disorder |
780.54 | G47.10 | Unspecified Hypersomnolence Disorder |
Disorder of Arousal | ||
Confusional Arousals | ||
Sleepwalking | ||
Sleep terrors | ||
780.59 | G47.8 | Other specified sleep-wake disorder |
780.59 | G47.9 | Unspecified sleep-wake disorder |
A sleep disorder, or somnipathy, is a medical disorder of an individual's sleep patterns. Some sleep disorders are severe enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for diagnosing sleep disorders.
Dyssomnias are a broad classification of sleeping disorders involving difficulty getting to sleep, remaining asleep, or of excessive sleepiness.
Somnolence is a state of strong desire for sleep, or sleeping for unusually long periods. It has distinct meanings and causes. It can refer to the usual state preceding falling asleep, the condition of being in a drowsy state due to circadian rhythm disorders, or a symptom of other health problems. It can be accompanied by lethargy, weakness and lack of mental agility.
Hypersomnia is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.
Sexsomnia, also known as sleep sex, is a distinct form of parasomnia, or an abnormal activity that occurs while an individual is asleep. Sexsomnia is characterized by an individual engaging in sexual acts while in non-rapid eye movement (NREM) sleep. Sexual behaviors that result from sexsomnia are not to be mistaken with normal nocturnal sexual behaviors, which do not occur during NREM sleep. Sexual behaviors that are viewed as normal during sleep and are accompanied by extensive research and documentation include nocturnal emissions, nocturnal erections, and sleep orgasms.
Polysomnography (PSG), a type of sleep study, is a multi-parameter study of sleep and a diagnostic tool in sleep medicine. The test result is called a polysomnogram, also abbreviated PSG. The name is derived from Greek and Latin roots: the Greek πολύς, the Latin somnus ("sleep"), and the Greek γράφειν.
Periodic limb movement disorder (PLMD) is a sleep disorder where the patient moves limbs involuntarily and periodically during sleep, and has symptoms or problems related to the movement. PLMD should not be confused with restless legs syndrome (RLS), which is characterized by a voluntary response to an urge to move legs due to discomfort. PLMD on the other hand is involuntary, and the patient is often unaware of these movements altogether. Periodic limb movements (PLMs) occurring during daytime period can be found but are considered as a symptom of RLS; only PLMs during sleep can suggest a diagnosis of PLMD.
Somnology is the scientific study of sleep. It includes clinical study and treatment of sleep disorders and irregularities. Sleep medicine is a subset of somnology.
Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.
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". 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. A second edition, called ICSD-2, was published by the AASM in 2005. The third edition, ICSD-3, was released by the AASM in 2014. A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM.
When we sleep, our breathing changes due to normal biological processes that affect both our respiratory and muscular systems.
Sleep medicine is a medical specialty or subspecialty devoted to the diagnosis and therapy of sleep disturbances and disorders. From the middle of the 20th century, research has provided increasing knowledge of, and answered many questions about, sleep–wake functioning. The rapidly evolving field has become a recognized medical subspecialty in some countries. Dental sleep medicine also qualifies for board certification in some countries. Properly organized, minimum 12-month, postgraduate training programs are still being defined in the United States. In some countries, the sleep researchers and the physicians who treat patients may be the same people.
Catathrenia or nocturnal groaning is a sleep-related breathing disorder, consisting of end-inspiratory apnea and expiratory groaning during sleep. and it describes a rare condition characterized by monotonous, irregular groans while sleeping. Catathrenia begins with a deep inspiration. The person with catathrenia holds her or his breath against a closed glottis, similar to the Valsalva maneuver. Expiration can be slow and accompanied by sound caused by vibration of the vocal cords or a simple rapid exhalation. Despite a slower breathing rate, no oxygen desaturation usually occurs. The moaning sound is usually not noticed by the person producing the sound, but it can be extremely disturbing to sleep partners. It appears more often during expiration REM sleep than in NREM sleep.
A sleep study is a test that records the activity of the body during sleep. There are five main types of sleep studies that use different methods to test for different sleep characteristics and disorders. These include simple sleep studies, polysomnography, multiple sleep latency tests (MSLTs), maintenance of wakefulness tests (MWTs), and home sleep tests (HSTs). In medicine, sleep studies have been useful in identifying and ruling out various sleep disorders. Sleep studies have also been valuable to psychology, in which they have provided insight into brain activity and the other physiological factors of both sleep disorders and normal sleep. This has allowed further research to be done on the relationship between sleep and behavioral and psychological factors.
Narcolepsy is a chronic neurological disorder that involves a decreased ability to regulate sleep–wake cycles. Symptoms often include periods of excessive daytime sleepiness and brief involuntary sleep episodes. Narcolepsy paired with cataplexy is evidenced to be an autoimmune disorder. These experiences of cataplexy can be brought on by strong emotions. Less commonly, there may be vivid hallucinations or an inability to move while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without, but the quality of sleep tends to be lessened.
Idiopathic hypersomnia(IH) is a neurological disorder which is characterized primarily by excessive sleep and excessive daytime sleepiness (EDS). The condition typically becomes evident in early adulthood and most patients diagnosed with IH will have had the disorder for many years prior to their diagnosis. As of August 2021, an FDA-approved medication exists for IH called Xywav, which is oral solution of calcium, magnesium, potassium, and sodium oxybates; in addition to several off-label treatments (primarily FDA-approved narcolepsy medications).
Sleep disorder is a common repercussion of traumatic brain injury (TBI). It occurs in 30%-70% of patients with TBI. TBI can be distinguished into two categories, primary and secondary damage. Primary damage includes injuries of white matter, focal contusion, cerebral edema and hematomas, mostly occurring at the moment of the trauma. Secondary damage involves the damage of neurotransmitter release, inflammatory responses, mitochondrial dysfunctions and gene activation, occurring minutes to days following the trauma. Patients with sleeping disorders following TBI specifically develop insomnia, sleep apnea, narcolepsy, periodic limb movement disorder and hypersomnia. Furthermore, circadian sleep-wake disorders can occur after TBI.
Confusional arousals are classified as “partial awakenings in which the state of consciousness remains impaired for several minutes without any accompanying major behavioural disorders or severe autonomic responses”. Complete or partial amnesia of the episodes may be present.
Behavioral sleep medicine (BSM) is a field within sleep medicine that encompasses scientific inquiry and clinical treatment of sleep-related disorders, with a focus on the psychological, physiological, behavioral, cognitive, social, and cultural factors that affect sleep, as well as the impact of sleep on those factors. The clinical practice of BSM is an evidence-based behavioral health discipline that uses primarily non-pharmacological treatments. BSM interventions are typically problem-focused and oriented towards specific sleep complaints, but can be integrated with other medical or mental health treatments. The primary techniques used in BSM interventions involve education and systematic changes to the behaviors, thoughts, and environmental factors that initiate and maintain sleep-related difficulties.
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