Classification of sleep disorders


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 in 1924 by Hans Berger.
Three systems of classification are in use worldwide:
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.
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.

History

Milestones

The first book on sleep 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. Kleitman in 1939 recognized types of parasomnias as nightmares, night terrors, somniloquy, somnambulism, grinding of teeth, jactatians, enuresis, delirium, nonepileptic convulsions and personality dissociation. Broughton in 1968 developed classification of the arousal disorders as confusional arousals: night terrors and sleep walking. Insomnias were classified as primary and secondary till 1970 when they were recognized as symptoms of other disorders. Sir William Osler in 1906 correlated snoring, obesity and somnolence to Dicken's description of Joe. Charles Burwell in 1956 recognized obstructive sleep apnea as Pickwickian syndrome. Circadian rhythm sleep disorders were discovered in 1981 by Weitzman as delayed sleep phase syndrome in contrast to advanced sleep phase syndrome in 1979.

Evolution of classifications of sleep disorders

The International Classification of Sleep Disorders (ICSD)

The International Classification of Sleep Disorders was produced by the American Academy of Sleep Medicine 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 that was produced by both the Association of Sleep Disorders Centers and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979.
  1. Disorder of initiating and maintain sleep - Insomnias
  2. Disorder of Excessive sleep - Hypersomnias
  3. Disorder of sleep wake schedule
  4. Parasomnias
The International Classification of Sleep Disorders 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 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:
Axis A ICSD Classification of Sleep Disorders
Axis B ICD-9-CM Classification of Procedures
Axis C ICD-9-CM Classification of Diseases.

ICSD - I Revised 1997

Dyssomnias

  1. Intrinsic Sleep Disorders
  2. Extrinsic Sleep Disorders
  3. Circadian Rhythm Sleep Disorders

    Parasomnias

  4. Arousal Disorders
  5. Sleep-Wake Transition Disorders
  6. Parasomnias Usually Associated with REM Sleep
  7. Other Parasomnias

    Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders

  8. Associated with Mental Disorders
  9. Associated with Neurologic Disorders
  10. Associated with Other Medical Disorders

    Proposed Sleep Disorders

ICSD 2 is tabulated in the main article International Classification of Sleep Disorders

ICSD - 3

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:

1. [Insomnia]

  1. Chronic insomnia disorder
  2. Short-term insomnia disorder
  3. Other insomnia disorder

    2. [Sleep-related breathing disorders]

  4. Obstructive sleep apnea disorders
  5. # OSA, adult
  6. # OSA, pediatric
  7. Central sleep apnea syndromes
  8. # Central sleep apnea with Cheyne-Stokes breathing
  9. # Central sleep apnea due to a medical disorder without Cheyne-Stokes breathing
  10. # Central sleep apnea due to high altitude periodic breathing
  11. # Central sleep apnea due to a medication or substance
  12. # Primary central sleep apnea
  13. # Primary central sleep apnea of infancy
  14. # Primary central sleep apnea of prematurity
  15. # Treatment-emergent central sleep apnea
  16. Sleep-related hypoventilation disorders
  17. # Obesity hypoventilation syndrome
  18. # Congenital central alveolar hypoventilation syndrome
  19. # Late-onset central hypoventilation with hypothalamic dysfunction
  20. # Idiopathic central alveolar hypoventilation
  21. # Sleep-related hypoventilation due to a medication or substance
  22. # Sleep-related hypoventilation due to a medical disorder
  23. Sleep-related hypoxemia disorder
  24. Isolated symptoms and normal variants

    3. [Central disorders of hypersomnolence]

  25. Narcolepsy type 1
  26. Narcolepsy type 2
  27. Idiopathic hypersomnia
  28. Kleine-Levin syndrome
  29. Hypersomnia due to a medical disorder
  30. Hypersomnia due to a medication or substance
  31. Hypersomnia associated with a psychiatric disorder
  32. Insufficient sleep syndrome

    4. [Circadian rhythm sleep-wake disorders]

  33. Delayed sleep-wake phase disorder
  34. Advanced sleep-wake phase disorder
  35. Irregular sleep-wake rhythm disorder
  36. Non-24-h sleep-wake rhythm disorder
  37. Shift work disorder
  38. Jet lag disorder
  39. Circadian sleep-wake disorder not otherwise specified

    5. [Sleep-related movement disorders]

  40. Restless legs syndrome
  41. Periodic limb movement disorder
  42. Sleep-related leg cramps
  43. Sleep-related bruxism
  44. Sleep-related rhythmic movement disorder
  45. Benign sleep myoclonus of infancy
  46. Propriospinal myoclonus at sleep onset
  47. Sleep-related movement disorder due to a medical disorder
  48. Sleep-related movement disorder due to a medication or substance
  49. Sleep-related movement disorder, unspecified
  50. Isolated symptoms and normal variants
  51. # Excessive fragmentary myoclonus
  52. # Hypnagogic foot tremor and alternating leg muscle activation
  53. # Sleep starts

    6. [Parasomnias]

  54. NREM-related parasomnias
  55. # Confusional arousals
  56. # Sleepwalking
  57. # Sleep terrors
  58. # Sleep-related eating disorder
  59. REM-related parasomnias
  60. # REM sleep behavior disorder
  61. # Recurrent isolated sleep paralysis
  62. # Nightmare disorder
  63. Other parasomnias
  64. # Exploding head syndrome
  65. # Sleep-related hallucinations
  66. # Sleep enuresis
  67. # Parasomnia due to a medical disorder
  68. # Parasomnia due to a medication or substance
  69. # Parasomnia, unspecified
  70. Isolated symptoms and normal variants
  71. # Sleep talking

    7. [Other sleep disorders]

International Classification of Disease (ICD)

http://www.wolfbane.com/icd/icd7h.htm ICD-7R 1955

780.7 Disturbance of sleep

http://www.wolfbane.com/icd/icd8h.htm ICD-8 1965

306.4 Specific disorder of sleep
780.6 Disturbance of sleep

http://www.wolfbane.com/icd/icd9h.htm ICD-9 1975

327 Organic sleep disorders

327.0 Organic disorders of initiating and maintaining sleep organic insomnia
307.4 Specific disorders of sleep of nonorganic origin

http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&codcol=15&codcch=2276# ICD-NA (1997)

G47 Sleep disorders

G47.1 Disorders of excessive somnolence hypersomnias
G47.2 Disorders of the sleep-wake schedule

F51 Nonorganic sleep disorders

F51.1 Nonorganic hypersomnia Excl.: hypersomnia (organic) (G47.1), narcolepsy (G47.4)
F51.2 Nonorganic disorder of the sleep-wake schedule
F51.4 Sleep terrors night terrors
F51.5 Nightmares, Dream anxiety disorder
F51.8 Other nonorganic sleep disorders
F51.9 Nonorganic sleep disorder, unspecified, Emotional sleep disorder NOS

P28.3 Primary sleep apnoea of newborn

G47 Sleep disorders

G47.0 Insomnia
G47.9 Sleep disorder, unspecified

F51 Sleep disorders not due to a substance or known physiological condition

F51.0 Insomnia not due to a substance or known physiological condition
F51.4 Sleep terrors night terrors
F51.5 Nightmare disorder
F51.8 Other sleep disorders not due to a substance or known physiological condition
F51.9 Sleep disorder not due to a substance or known physiological condition, unspecified

P28.3

Applicable To
Approximate Synonyms

Insomnia disorders

Disorders of arousal in non-REM sleep

Sleep Disorder

Dysomnias (disorders of amount, quality or time of sleep)

[Dyssomnia]s

Primary Insomnia">Insomnia">Primary Insomnia
Primary [Hypersomnia] Specify if Recurrent
[Narcolepsy]
Breathing-Related Sleep Disorder
Circadian Rhythm Sleep Disorder

[Parasomnias]

Sleep disorders related to another mental disorder

Other Sleep disorders

DSM-V Sleep Wake Disorders

Major changes from DSM IV

Sleep-wake disorders comprise 11 diagnostic groups:“
Specify if: With non-sleep disorder mental comorbidity. With other Medical comorbidity. With other sleep disorder

Hypersomnolence">Hypersomnia">Hypersomnolence disorder

Specify if: With mental disorder. With medical condition. With another sleep disorder

[Narcolepsy]

Breathing-Related Sleep Disorders

Obstructive sleep apnea hypopnea">Obstructive sleep apnea">Obstructive sleep apnea hypopnea
[Central sleep apnea]
Note: First code opioid use disorder, if present.
Specify current severity
Sleep-related hypoventilation
Primary Alveolar Hypoventilation

Circadian rhythm sleep-wake disorders

Non–rapid eye movement (NREM) sleep arousal disorders

Rapid eye movement (REM) sleep behavior disorder">REM Sleep Behavior Disorder Screening Questionnaire">Rapid eye movement (REM) sleep behavior disorder

Medication-induced sleep disorder

Disorder of Arousal

Other specified sleep-wake disorder

Unspecified sleep-wake disorder