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The new international classification of sleep disorders (ICSD-2)

Turkish Thoracic Society 9 th Annual Congress. The new international classification of sleep disorders (ICSD-2). Patrick J. Strollo, Jr., M.D., FCCP, D,ABSM University of Pittsburgh Medical Center. Major Sleep Disorders. Evolution of the Field of Sleep Medicine

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The new international classification of sleep disorders (ICSD-2)

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  1. Turkish Thoracic Society 9th Annual Congress The new international classification of sleep disorders (ICSD-2) Patrick J. Strollo, Jr., M.D., FCCP, D,ABSM University of Pittsburgh Medical Center

  2. Major Sleep Disorders • Evolution of the Field of Sleep Medicine • Classification of Sleep Disorders • Emphasis on common disorders

  3. Evolution of the field of Sleep Medicine Societies Milestones Association for the Psychophysiological Study of Sleep (APSS) 1964 Stanford Narcolepsy Center 1968 Manual for Scoring Sleep 1970 Stanford Sleep Center Association of Sleep Disorders Centers (ASDC) 1975 5 Centers PSGs Reimbursed 1977 ASDC Center Accreditation 1978 Journal SLEEP Certification in Sleep Medicine Clinical Sleep Society (CSS) 1984 Association of Professional Sleep Societies (APSS) 1986 American Sleep Disorders Association (ASDA) 1987 Associated Professional Sleep Societies 1988 1989 ASDA Fellowship Training Programs American Board of Sleep Medicine (ABSM), 1991 International Classification of Sleep National Sleep Foundation (NSF)Disorders (ICSD-1) Sleep Medicine Education & Research Foundation 1998 American Academy of Sleep Medicine (AASM) 1999 American Sleep Medicine Foundation (ASMF) 2003 Behavioral Sleep Medicine Certification 2005 International Classification of Sleep Disorders (ICSD-2) J Clin Sleep Med 2005: 1:61-82

  4. International Classification of Sleep Disorders Version 2 (ISCD-2) • Insomnias • Sleep-Related Breathing Disorders • Hypersomnias Not Due to a Sleep-Related Breathing Disorder • Circadian Rhythm Sleep Disorders • Parasomnias • Sleep-Related Movement Disorders • Other Sleep Disorders AASM, Chicago

  5. ISCD-2: Insomnias • Adjustment sleep disorders (acute insomnia) • Psychophysiological Insomnia • Paradoxical Insomnia (formerly Sleep State Misperception) • Idiopathic Insomnia • Insomnia due to mental disorder • Behavioral Insomnia of Childhood • Insomnia due to a medical condition • Insomnia due to a a drug or substance (alcohol) • Insomnia not due to a substance or known physiological condition (Nonorganic Insomnia, NOS) • Physiological (organic) insomnia, unspecified, unspecified; (Organic Insomnia, NOS) AASM, Chicago

  6. Insomnia in the Population Insomnia symptoms-Overall prevalence 30-48%-Often or always: 16-21%-Moderate to extreme: 10-28% Insomnia symptoms + daytime consequences 9-15% Insomnia diagnosis 6% Direct economic costs of insomnia in the US are estimated ~ $14 billion Ohayon, Sleep Med Rev, 2002

  7. ICSD-2: Sleep-Related Breathing Disorders • Central Sleep Apnea Syndromes • Primary Central Sleep Apnea • Central Sleep Apnea Due to Cheyne Stokes Breathing Pattern • Central Sleep Apnea Due to High-Altitude Periodic Breathing • Central Sleep Apnea Due to Medical Condition Not Cheyne Stokes • Central Sleep Apnea Due to Drug or Substance • Obstructive Sleep Apnea Syndromes • Obstructive Sleep Apnea • Sleep-Related Hypoventilation / Hypoxemic Syndromes • Sleep-Related Non-Obstructive Alveolar Hypoventilation, Idiopathic • Congenital Central Alveolar Hypoventilation Syndrome • Sleep-Related Hypoventilation / Hypoxemia due to Lower Airways Obstruction • Sleep-Related Hypoventilation / Hypoxemia due to Neuromuscular and Chest Wall Disorders • Sleep-Related Hypoventilation / Hypoxemia due to Pulmonary Parenchymal or Vascular Pathology • Other Sleep-Related Breathing Disorder • Sleep Apnea / Sleep Related Breathing Disorder, unspecified AASM, Chicago

  8. ISCD-2: Hypersomnias not due to a breathing disorder • Narcolepsy • Narcolepsy with Cataplexy • Narcolepsy without Cataplexy • Narcolepsy due to a medical condition with Cataplexy • Narcolepsy due to a medical condition without Cataplexy • Narcolepsy, unspecified • Other Hypersomnias • Kleine-Levin Syndrome • Menstrual-Related Hypersomnia • Idiopathic Hypersomnia with long sleep time • Idiopathic Hypersomnia without long sleep time • Behaviorally Induced Insufficient Sleep Syndrome • Hypersomnia due to a medical condition • Hypersomnia due to a drug or substance (Alcohol) • Hypersomnia not due to a substance or known physiologic condition • Physiological Hypersomnia, Unspecified AASM, Chicago

  9. Change in average amount of sleep per night over the past century • 1910 = 9.0 hrs/night • 1975 = 7.5 hrs/night • Today = 6.9 hrs/night Bull Psychon Soc 1975 6:47-48 Neurophysiol Clin 1996 26:30-39

  10. Prevalence of Narcolepsy/Cataplexy (USA) 260 162 Prevalence per 100,000 113 40 4-6 ALS = amyotrophic lateral sclerosis. National Sleep Foundation.Mittler. An Introduction to Narcolepsy. National Sleep Foundation Slide Kit.

  11. Narcolepsy: Epidemiology • Prevalence ~1 in 2000 (US) • Comparable to multiple sclerosis, greater than cystic fibrosis • Men and women affected equally • Age at onset • Can present at any age • Majority 15-30 years of age • 6% prior to 10 years of age J Clin Neurophysiol 2001;18:78.

  12. Mean Hours of Sleep Reported 8 hrs recommended = adequate sleep National Sleep Foundation (NSF): 2002 “Sleep in America” Poll (N = 1,010 adults)

  13. ISCD-2: Circadian Rhythm Sleep Disorders • Circadian Rhythm Sleep Disorders • Delayed Phase type • Advanced Phase type • Irregular Sleep-Wake type • Nonentrained type (Free running) • Due to a medical condition • Jet Lag type • Shift Work type • Due to a Drug or Substance (Alcohol) • Other AASM, Chicago

  14. ISCD-2: Parasomnias • Disorder of Arousal (From Non-REM Sleep) • Confusional arousals • Sleepwalking • Sleep terrors • Parasomnias Usually Associated with REM Sleep • REM Sleep Behavior Disorder • Recurrent Isolated Sleep Paralysis • Nightmare Disorder • Other Parasomnias • Sleep-Related Dissociative Disorder • Sleep-Related Enuresis • Sleep-Related Groaning • Exploding Head Syndrome • Sleep-Related Hallucinations • Sleep-Related Eating Disorder • Parasomnia, unspecified • Parasomnia due to drug or substance (Alcohol) • Parasomnia due to a medical condition AASM, Chicago

  15. ISCD-2: Sleep-related Movement Disorders • Restless Legs Syndrome (included Sleep-Related Growing Pains) • Periodic Limb Movement Sleep Disorder • Sleep-Related Leg Cramps • Sleep-Related Bruxism • Sleep-Related Rhythmic Movement Disorder • Sleep-Related Movement Disorder, unspecified • Sleep-Related Movement Disorder due to a drug or substance • Sleep-Related Movement Disorder due to a medical condition AASM, Chicago

  16. Restless Legs Syndrome • Prevalence: Estimated 10% of population (US & Europe) • Symptoms: • A compelling urge to move the limbs. • Motor restlessness; for example, floor pacing, tossing and • turning, and rubbing the legs. • The symptoms may be worse or exclusively present at rest, • with variable and temporary relief by activity. • Symptoms are worse in the evening and at night. • Associated features commonly found in RLS include: • Sleep disturbances and daytime fatigue. • Normal neurological exam in primary RLS. • Involuntary, repetitive, periodic, jerking limb movements, • either in sleep or while awake and at rest. National Sleep Foundation

  17. ISCD-2:Other Sleep Disorders • Physiological Sleep Disorder, unspecified • Environmental Sleep Disorder • Fatal Familial Insomnia AASM, Chicago

  18. Teşekkürler

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