International Classification of Sleep Disorders

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 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.^[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

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 three main categories.^[2][3]

1. Disorder of initiating and maintain sleep (DIMS) - Insomnias
2. Disorder of Excessive sleep (DOES) - Hypersomnias
3. Parasomnias

The first comprehensive classification of disorders of sleep and arousal 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 in 1990 and later revised as 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:^[6]

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 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. 4. Proposed 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-3

ICSD-3 includes 60 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.^[7] Furthermore, pediatric diagnoses are not distinguished from adult diagnoses except for sleep-related breathing disorders.^[8]

Insomnia

1. short-term insomnia,
2. chronic insomnia, and
3. other insomnia (when the patient has insomnia symptoms but does not meet criteria for the other two types of insomnia)

Sleep-related breathing disorders

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

Obstructive sleep apnea (OSA) syndromes

1. OSA, adult
2. OSA, pediatric

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
7. Sleep-related hypoxemia disorder

Isolated symptoms and normal variants

1. Snoring
2. Catathrenia

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

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

Parasomnias

NREM-related parasomnias

1. Disorder of arousal from NREM sleep
2. Confusional arousals
3. Sleepwalking
4. Sleep terrors
5. 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

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

Other sleep disorders

1. Isolated symptoms and normal variants — Other sleep-related symptoms or events do not meet the standard definition of a sleep disorder
   1. Some occur during normal sleep. As an example, sleep talking occurs at some time in most normal sleepers.
   2. 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.

See also

References