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FOREWORD TO THE REVISED EDITION
Since its introduction in 1990,the
International Classification of Sleep Disorders (ICSD)
has gained wide acceptance as a tool for clinical practice andresearch in sleep disorders medicine. The years between 1990 and 1997 have wit-nessed wide-ranging changes in sleep disorders medicine from many perspec-tives:the growth of managed health care; public health care reform; efforts to bet-ter integrate sleep disorders medicine into the community of medical specialties;major efforts at improving public awareness of the serious toll of sleep disorders;and–perhaps most importantly–a rapid growth in our understanding of the patho-physiology and effective treatment of sleep disorders.Such changes present a fundamental challenge for any classification of dis-eases and disorders,including the
ICSD:
How often and how extensively shouldthe classification be updated to reflect developments in the field? On the one hand,research and clinical developments have clearly changed the way we view manysleep disorders,most notably sleep-related breathing disorders. Some disorders inthe
ICSD
may not be the distinct conditions conceptualized earlier (e.g.,noctur-nal paroxysmal dystonia),and other conditions
not
recognized in the
ICSD
(e.g.,upper airway resistance syndrome,sleep-related eating disorders) may deservetheir own listings. Such developments call for an in-depth revision of the classifi-cation system. On the other hand,frequent,major changes in a classification of disorders can be disruptive for both clinical and research practice. Maintaining astable definition of a syndrome over a period of time is necessary to further definethe reliability and validity of that disorder. Moreover,clinical and researchprogress has varied widely across disorders in the
ICSD.
Although we have great-ly improved our knowledge about some sleep disorders,the essential features of other disorders (not to mention their epidemiology,pathophysiology,and treat-ment) remain in the realm of expert opinion. Ideally,substantive revisions areguided by a comprehensive analysis of applied,clinical,and basic research on thedisorders themselves,as well as a clear understanding of which features of theclassification work (and which don’t work) in clinical and research practice.Expert opinion is always required,but should be secondary to empirical data.At this point,the sleep disorders field has not conducted the type of rigorousre-examination needed to support a substantive revision of its diagnostic classifi-cation. As a result,this revision to the
ICSD
falls on the side of minor rather thanmajor changes. Our intent in compiling this revision was to make the
ICSD
easi-er to use and more accurate,without altering the basic structure (or indeed,thevast majority of the text) of the classification. The revisions are summarized asfollows:1.The listing of disorders has been made accessible by printing it on theinside cover of the book. Diagnostic codes and page numbers are alsoincluded with this listing.2.Text for individual disorders has been revised to clarify textual errors,standardize format across disorders,and correct minor factual errors.3.Minor changes have been made to the text for a few of the disorders (e.g.,obstructive sleep apnea syndrome,apnea of infancy,narcolepsy,fibrositis
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Axis B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320Procedures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320Procedure Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320Axis C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 323Procedure Feature Codes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325Data Base. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329Differential Diagnosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337List of AbbreviationsGeneral Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352Appendix A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355ICSD Listing by Medical System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355ICD-9-CM Listings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358ICSD Alphabetical Listing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358ICSD Numerical Listing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360ICD-9-CM Sleep ListingsCurrent Procedural Terminology (CPT) Codes. . . . . . . . . . . . . . . . . . . . . 365Clinical Field Trials. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366Appendix B. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367Introduction to the DCSAD First Edition. . . . . . . . . . . . . . . . . . . . . . . . . 367DCSAD–Classification Outline. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378Alphabetical Listing of DCSAD and Comparison with ICSD. . . . . . . . . . 381Comparative Listing of DCSAD and ICSD. . . . . . . . . . . . . . . . . . . . . . . 384Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389
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