International Classification of Sleep Disorder | |
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Specialty | Sleep medicine |
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 by the AASM in 2005. [4] The third edition, ICSD-3, was released by the AASM in 2014. [5] A text revision of the third edition (ICSD-3-TR) was published in 2023 by the AASM. [6]
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 | ||
2023 | ICSD-3-TR |
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]
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. [7] 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: [8]
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).
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. [7]
In 2006, a pocket version of the ICSD-2 was released. In this version, a pediatric section was added listing the following diagnostic categories:
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.
The revision of the ICSD-2 was firstly made by the AASM and other International Societies. This revision integrates pediatric diagnosis into clinical adult diagnosis (except for obstructive sleep apnea) and 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. [9] Furthermore, pediatric diagnoses are not distinguished from adult diagnoses except for sleep-related breathing disorders. [10]
In addition, significant changes have been made in the nosology of insomnia, narcolepsy and parasomnia. Primary vs. secondary (i.e. comorbid) insomnia has been reunited into a single disorder: chronic insomnia. Narcolepsy has been divided 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. [11]
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 TheAASM [American Academy of Sleep Medicine] Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Therefore, ICSD permanently refers to this manual. The latter allows, for instance, to find definitions of polysomnography or specific features. [11]
The ICSD-3 counts 383 pages for 83 disorders. It is divided into 7 main categories:
Other sleep-related symptoms or events that do not meet the standard definition of a sleep disorder.
In 2023, the AASM revised the third edition with the International Classification of Sleep Disorders, third edition, text revision (ICSD-3-TR) (https://aasm.org/clinical-resources/international-classification-sleep-disorders/).
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. Sleep disorders are frequent and can have serious consequences on patients’ health and quality of life. 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.
Night terror, also called sleep terror, is a sleep disorder causing feelings of panic or dread and typically occurring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. It can last longer, especially in children. Sleep terror is classified in the category of NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories: REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experiences that occur during entry into sleep, during sleep, or during arousal from sleep.
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.
Upper airway resistance syndrome (UARS) is a sleep disorder characterized by the narrowing of the airway that can cause disruptions to sleep. The symptoms include unrefreshing sleep, fatigue, sleepiness, chronic insomnia, and difficulty concentrating. UARS can be diagnosed by polysomnograms capable of detecting Respiratory Effort-related Arousals. It can be treated with lifestyle changes, orthodontics, surgery, or CPAP therapy. UARS is considered a variant of sleep apnea, although some scientists and doctors believe it to be a distinct disorder.
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.
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.
The American Academy of Sleep Medicine (AASM) is a United States professional society for the medical subspecialty of sleep medicine which includes disorders of circadian rhythms. It was established in 1975.
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.
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. 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.
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 it, but the quality of sleep tends to be lessened.
Nocturnal sleep-related eating disorder (NSRED) is a combination of a parasomnia and an eating disorder. It is a non-rapid eye movement sleep (NREM) parasomnia. It is described as being in a specific category within somnambulism or a state of sleepwalking that includes behaviors connected to a person's conscious wishes or wants. Thus many times NSRED is a person's fulfilling of their conscious wants that they suppress; however, this disorder is difficult to distinguish from other similar types of disorders.
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).
A sleep-related breathing disorder is a sleep disorder in which abnormalities in breathing occur during sleep that may or may not be present while awake. According to the International Classification of Sleep Disorders, sleep-related breathing disorders are classified as follows:
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.
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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