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Diagnostic classification of sleep disorders: implications for psychiatric practice
The Journal of Clinical Psychiatry
|August 1, 1981
Summary
The Association of Sleep Disorders Centers (ASDC) classification system identified more sleep-initiation/maintenance disorders than excessive sleepiness disorders in 174 patients. Psychiatric conditions were common in DIMS, while sleep apnea and narcolepsy were frequent in DOES.
Area of Science:
- Sleep Medicine
- Neurology
- Psychiatry
Background:
- The Association of Sleep Disorders Centers (ASDC) developed a diagnostic classification system for sleep and arousal disorders.
- Evaluating the utility of this nosology in a clinical patient population is essential for refining diagnostic practices.
Purpose of the Study:
- To assess the usefulness of the ASDC diagnostic classification system in a cohort of 174 patients.
- To analyze the distribution and associations of different sleep and arousal disorder categories within the study population.
Main Methods:
- Application of the ASDC diagnostic classification system to 174 patients.
- Categorization of patients into disorders of initiating and maintaining sleep (DIMS) and disorders of excessive sleepiness (DOES).
- Analysis of associated comorbidities, including psychiatric, medical, and substance abuse disorders.
Main Results:
- Disorders of initiating and maintaining sleep (DIMS) were more prevalent than disorders of excessive sleepiness (DOES), with a ratio exceeding 2:1.
- Psychiatric disorders, particularly affective disorders, accounted for 68.1% of DIMS diagnoses.
- Sleep apnea and narcolepsy-cataplexy were the most frequent diagnoses in DOES, representing 37.8% of cases.
- Drug/alcohol abuse showed a stronger association with DIMS, whereas medical disorders were more frequently linked to DOES.
- Only 58% of the sample received a single, adequate diagnosis, indicating potential limitations in current classification.
Conclusions:
- The ASDC nosology provides a framework for classifying sleep and arousal disorders but requires further evolution due to limitations in single-diagnosis classification.
- The findings highlight distinct etiological associations for DIMS (psychiatric, substance abuse) and DOES (sleep apnea, narcolepsy, medical disorders).
- Despite limitations, the ASDC system holds promise for improving data comparability and facilitating multi-center research in sleep medicine.