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4 The Classification of Sleep Disorders
Conceptual Overview
The classification of sleep disorders has evolved over time as research has contributed to a better understanding of these disorders. As with other areas or disciplines related to clinical dentistry, a classification system for sleep disorders will facilitate a comprehension of the various disorders, especially with regard to supporting evidence, signs and symptoms, pathophysiology, etiology, and clinical management. However, for a greater appreciation of the full spectrum of sleep disorders, the practitioner is encouraged to at least be familiar with the more common sleep disorders. This chapter is intended as a review of the third edition of the International Classification of Sleep Disorders (ICSD‐3) [1] with the emphasis placed on the sleep disorders that are more likely to be encountered by the practicing dentist.
Classification Systems
A classification system assists with the development of a differential diagnosis of various health and medically related disorders. There are currently four classification systems for sleep disorders that should be considered:
1 Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) [2]
2 International Classification of Diseases (ICD‐10) [3]
3 Diagnostic and Statistical Manual of Mental Disorders (DSM) [4]
4 International Classification of Sleep Disorders, Third Edition (ICSD‐3) [1]
For the sake of clarity and simplicity, the ICSD‐3 will be the primary focus for the classification of sleep disorders that the dentist, especially when involved in the care and management of patients with a sleep‐related breathing disorder (SRBD), will most commonly encounter and utilize. It must be kept in mind that the recognition of a sleep disorder does not mean that the dentist is making the diagnosis. The intent here is that by recognizing that a sleep disorder may be present the dentist is establishing the risk for such a disorder and by doing so can then make the appropriate referral for a more definitive diagnosis and subsequent treatment as is deemed necessary.
Diagnostic Classification of Sleep and Arousal Disorders (DCSAD)
The DCSAD was the first classification system for defining sleep disorders. It was first published in 1979. The DCSAD was subsequently used as the foundation for the formation of the other future classification systems, in particular the ICSD that was first published in 1990 [2]. The DCSAD was structured such that it organized the sleep disorders into symptomatic categories and thus became the basis of the more current classification system used today. This classification system was first published by the Association of Sleep Disorders Centers, founded in 1975, then became known as the American Sleep Disorders Association (ASDA), and today it is known as the American Academy of Sleep Medicine (AASM).
International Classification of Disease (ICD‐10)
In 1948, the World Health Organization (WHO), which is part of the United Nations System, was formed and it published the sixth edition of the ICD [5] for the purposes of diagnostic coding as well as collating mortality statistics regarding all medical conditions. The initial development of the ICD‐10 started in 1983 and was approved by the WHO in 1990. The World Health Organization is the organization that publishes the ICD; however, member countries, like the United States, are authorized to make appropriate modifications for clinical purposes as well as for heath management. The ICD has since undergone multiple revisions that include clinical modifications (CM) resulting in the ICD‐10‐CM [3]. In the Introduction to the ICSD‐3 under the coding section, it is reported that the codes that defined the various classifications in the ICSD were not always found to be in agreement with the ICD codes.
At this time the majority of the sleep disorders are the G47 codes and these are in the chapter Diseases of the Nervous System. This group of codes applies to many of the more commonly encountered sleep disorders and will be reviewed more specifically, especially those that are of importance to the dentist, as each of the sleep disorders is reviewed in this chapter. The codes that begin with R06 are related to abnormal breathing, such as snoring and even mouth breathing. These are respiratory codes that are associated with abnormal clinical and laboratory findings as well as signs and symptoms that are not otherwise classified. The F50 codes are in the broad category of behavioral disorders. In this specific group, these are sleep disorders (F51) that are not related to a substance or to any known physiological condition.
In January of 2022 the ICD‐11 will go into effect. Information regarding this can be found on the website for
