Chest
Volume 146, Issue 5, November 2014, Pages 1387-1394
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Contemporary Reviews in Sleep Medicine
International Classification of Sleep Disorders-Third Edition

https://doi.org/10.1378/chest.14-0970Get rights and content

The recently released third edition of the International Classification of Sleep Disorders (ICSD) is a fully revised version of the American Academy of Sleep Medicine's manual of sleep disorders nosology, published in cooperation with international sleep societies. It is the key reference work for the diagnosis of sleep disorders. The ICSD-3 is built on the same basic outline as the ICSD-2, identifying seven major categories that include insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. Significant modifications have been made to the nosology of insomnia, narcolepsy, and parasomnias. Major features and changes of the manual are reviewed in this article. The rationales for these changes are also discussed.

Section snippets

Insomnia

The classification of insomnia disorders in ICSD-3 represents a marked departure from that of prior systems. Historically, insomnia disorders have been dichotomized in several ways that relate to duration and presumed pathophysiology. The distinction of acute and chronic insomnia has existed in most diagnostic systems since the inception of sleep-wake disorders nosology. The ICD system has, at least through its 10th edition, clung to the now-archaic distinction of “organic” vs “nonorganic”

Sleep-Related Breathing Disorders

Sleep-related breathing disorders are divided into four sections: OSAs, central sleep apnea (CSA) syndromes, sleep-related hypoventilation disorders, and sleep-related hypoxemia disorder. The full listing of diagnoses can be found inTable 3.

Central Disorders of Hypersomnolence

These disorders are characterized by excessive daytime sleepiness (hypersomnolence) that is not attributable to another sleep disorder, specifically those that result in disturbed sleep (eg, sleep-related breathing disorders) or abnormalities of circadian rhythm. The central disorders of hypersomnolence are often caused by intrinsic CNS abnormalities in control of sleep-wake, although other medical conditions or substances may account for the hypersomnolence. Behaviorally induced insufficient

Circadian Rhythm Sleep-Wake Disorders

The nomenclature for these disorders has been changed to “sleep-wake” to underscore that the physiologic alterations associated with these conditions are evident throughout the 24-h cycle. The diagnoses included in this section are the same as those in ICSD-2 (Table 5). The criteria for these diagnoses are also much the same. Physicians are more strongly encouraged to consider the use of actigraphy and biomarkers such as dim-light melatonin onset in establishing a circadian rhythm sleep-wake

Parasomnias

The parasomnias are divided onto three clusters: non-rapid eye movement (NREM) related, rapid eye movement (REM) related, and other (Table 6).

Sleep-Related Movement Disorders

These conditions (Table 7) are characterized by simple, often stereotyped movements occurring during sleep. In the case of restless legs syndrome (RLS), a waking dysesthesia is the predominant symptom, although repetitive limb movement during sleep is often observed in association with RLS.

Summary

ICSD-3 includes seven major categories of sleep disorders: insomnia, sleep-related breathing disorders, central disorders of hypersomnolence, CRSWDs, sleep-related movement disorders, parasomnias, and other sleep disorders. Key changes from ICSD-2 include the consolidation of chronic insomnia into a single disorder, the division of narcolepsy into types 1 and 2, and the addition of a treatment-emergent CSA diagnosis. Diagnostic criteria have been revised for many disorders. It is essential for

Acknowledgments

Financial/nonfinancial disclosures:The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Other contributions:The author recognizes the contributions of the Task Force for the ICSD-3: Jack Edinger, PhD; Richard Berry, MD; Michael Silber, MBChB; Phyllis Zee, MD, PhD; Arthur Walters, MD; Michel Cramer Bornemann, MD; Richard Ferber, MD; Gerald Rosen, MD; and Karl Doghramji, MD.

References (22)

  • JD Edinger et al.

    Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses. Results of a multitrait-multimethod analysis

    Arch Gen Psychiatry

    (2011)
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