Classification of sleep disorders

Impact of Neurological Diseases

Hypersomonlence: Impact of Neurological Diseases

The main aim of this thesis was to examine sleep in adolescents and young adults during the first 10 years after diagnosis and treatment for childhood cancer: what has been the impact of being critically ill, undergoing extensive treatment and the type of cancer on sleep and how do we measure, identify and intervene in sleep problems and disorders in this patient group. In chapter 2, we evaluated the psychometric properties of the Dutch versions of the Pediatric PROMIS item banks for sleep disturbance (SD), sleep-related impairment (SRI) and fatigue in Dutch children and adolescents from the general population, since they have not been validated yet in this translation. The SD item bank did not meet all assumptions for item response theory (IRT) modeling (not unidimensional). The SRI and fatigue item banks met the assumptions and measured reliably, in which computerized adaptive testing (CAT) outperformed the full and short forms. Overall, this study shows that the Dutch pediatric PROMIS item banks for SRI and Fatigue are efficient and reliable in measuring sleep-related impairment and fatigue in Dutch children and adolescents, but further research is needed for the SD item bank. In chapter 3, we systematically reviewed the literature on risk factors associated with steroid-induced adverse psychological reactions (APRs) and sleep problems in children diagnosed with Acute Lymphoblastic Leukemia (ALL). The findings reveal that there were few high-quality prospective studies and sample sizes were small, necessitating caution in interpreting the results. We therefore formulated recommendations regarding risk factors associated with steroid-induced APRs and sleep problems and in addition recommend to invest in more high-quality studies to draw more substantiated conclusions. We recommend using standardized prospective registration of steroid-induced APRs and sleep problems, alongside the identification of risk factors in forthcoming studies involving children with ALL. In chapter 4, we assessed the prevalence of six sleep disorders based on the International Classification of Sleep Disorders, second edition (ICSD-2) in 576 adolescent and young adult childhood cancer patients in follow-up after treatment (aged 12-26; at least six months post-treatment). We found insomnia (9.6%) to be most prevalent disorder followed by circadian rhythm sleep disorder (CRSD; 8.1%), restless legs syndrome (7.6%), parasomnia (3.5%), hypersomnia (3.5%), and sleep-related breathing disorders (1.8%). A considerable proportion of participants expressed a need for sleep treatment (ranging from 42% to 72% depending on the sleep disorder), but only a small percentage received such treatment (0% to 5.6%). These findings emphasize the treatment access gap for sleep treatment among childhood cancer patients during their follow-up care. In chapter 5, we assessed the prevalence of insomnia-only, daytime fatigue-only, the coexistence of insomnia and daytime fatigue symptoms, and associated risk factors among 565 childhood cancer patients (aged 12-26; at least six months post-treatment). In total, 61.8% of the patients reported no insomnia or daytime fatigue symptoms, while 38.2% experienced symptoms. Among those with symptoms, 48.1% reported both insomnia and daytime fatigue, 34.7% had insomnia only, and 17.1% experienced daytime fatigue only. Our results indicate that approximately 40% of patients suffer from either insomnia or fatigue, with half of them experiencing both simultaneously. In chapter 6, we describe the study protocol of our randomized-controlled trial evaluating the effectiveness of online cognitive behavioral therapy for insomnia (online CBT-i) i-Sleep youth on insomnia symptoms in adolescents and young adults who finished childhood cancer treatment. We hypothesize that the intervention will improve sleep efficiency (actigraphy) and insomnia severity (self-report) on the short-term compared to the control group, which is maintained on the long-term up to a year after the intervention. We also aim to study the acceptability of the online intervention in the adolescent target group.

To determine clinicians' patterns of use of the International Classification of Sleep Disorders (ICSD) and their ratings of its utility and organization. A telephone survey was conducted in one clinician practicing at each of 206 sleep centers accredited by the American Academy of Sleep Medicine (AASM). Descriptive analyses were performed, and ratings for various sleep classifications were compared with ANOVA and post- hoc tests. Clinicians at 230/251 (92%) of contacted centers agreed to participate, and data from 206/251 (82%) were actually collected. The ICSD was used by 91.7% of clinicians for clinical decision making but by lower percentages for billing or medical record keeping. Features of the ICSD pertaining to clinical descriptions and differential diagnosis were rated as most useful. The Association of Sleep Disorders Centers (ASDC) classification was rated more highly than ICSD in organization and ease of use. The ICSD and ASDC systems were rated more highly than other sleep disorders classifications in terms of organization, "fit" to patients, and ease of use. The ICSD is used widely by clinicians, primarily for diagnostic purposes, and is preferred over more general sleep disorders classification systems. However, more favorable ratings for the ASDC compared to ICSD indicate the value clinicians place on easy-to-use, symptom-oriented classifications.

The classification of sleep disorders is necessary to discriminate between disorders and to facilitate an understanding of symptoms, etiology, and pathophysiology that allows for appropriate treatment. The earliest classification systems, largely organized according to major symptoms (insomnia, excessive sleepiness, and abnormal events that occur during sleep), were unable to be based on pathophysiology because the cause of most sleep disorders was unknown. These 3 symptom-based categories are easily understood by physicians and are therefore useful for developing a differential diagnosis. The International Classification of Sleep Disorders, version 2, published in 2005 and currently undergoing revision, combines a symptomatic presentation (e.g., insomnia) with 1 organized in part on pathophysiology (e.g., circadian rhythms) and in part on body systems (e.g., breathing disorders). This organization of sleep disorders is necessary because of the varied nature and because the pathophysiology for many of the disorders is still unknown. The International Classification of Sleep Disorders, version 2 provides relevant diagnostic and epidemiological information on sleep disorders to more easily differentiate between the disorders.

ABSTRACTTaking into consideration that shift work has a wide-ranging impact on circadian and sleep functioning, it seems likely that shift work increases the risk of a general sleep disturbance, spread out over a multitude of comorbid sleep disorders. The aim of the present study is to analyze and present the sleep disorder data of 250 shift workers and 971 permanent day workers, taken from a nationally representative sample. Additional data concerning duration, timing, and quality of sleep, daytime functioning and social/family variables were added to the analyses. The results showed that the shift workers experienced significantly more difficulties with the variability of their sleep times, reported more napping and considered themselves more as poor sleepers than the day workers. Most importantly, shift work, in comparison with day work, appeared associated with a significantly higher prevalence of the clinical, International Classification of Sleep Disorders’ defined symptoms of nearly all main sleep disorders (including shift work disorder). For shift workers, the prevalence of a general sleep disturbance was 39.0% (95%CI 33.2 – 45.2), significantly higher than for day workers (24.6%, 95%CI 22.0 – 27.4). Moreover, shift workers were characterized by high levels of sleep disorder comorbidity. In addition, exclusively for shift workers, the prevalence of disordered sleep systematically decreased across decades of life and was considerably higher for single versus partnered shift workers. This study adds to the insight into the interacting factors that determine shift work coping and may play a role in occupational health interventions aimed at reducing sleep problems and thus improving the resilience and tolerance of the shift worker.

Evolution of the Classification of Sleep Disorders

Etiologies of Sleep-Related Movement Disorders (SRMD)

Sleep disorders are very often underestimated and, consequently, not treated with due priority. Common sleep disorders 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. The ketogenic diet (KD) is rich in fat, low in carbohydrates (CHO), and adequate in protein. The KD has shown several applications in treating medical conditions, such as epilepsy, neurodegenerative disorders, obesity with its comorbidities, and sleep disorders, with encouraging results. Therefore, the purpose of this review is to address the primary sleep disorders and their respective standard therapeutic approaches, analyse the effect of ketone bodies (KBs) on sleep homeostasis, and the effects of KD on sleep disorders and in particular on obstructive sleep apnoea (OSA) syndrome. The goal is to summarise the evidence existing up to now on the subject, to provide a starting point for further investigations.

The Consensus Development Conference on sleep disorders convened by the National Institute of Mental Health in 1979 [14] subdivided insomnia into transient, short term, and long term or chronic conditions. The first type lasts one to several days, the second, from one to 4 weeks and chronic insomnia for more than 4 weeks. The first and second types will be dealt with in this chapter, i.e. insomnia which is systematically linked to a clearly determined, perfectly identifiable cause, occurring in persons with a history of normal sleep. The International Classification of Sleep Disorders (ICSD) [9] comprises four sections, dyssomnias, parasomnias, sleep disorders associated with medical or psychiatric disorders and “proposed” sleep disorders. The section on dyssomnias itself comprises three subgroups: intrinsic sleep disorders, extrinsic sleep disorders and circadian rhythm sleep disorders. Most transient and short term insomnias are classed in the subgroup of extrinsic disorders, i.e. those whose causes are external to the organism Four of the main ones will be dealt with here: insomnia due to inadequate sleep hygiene, environment-related insomnia, altitude insomnia and adjustment or short term insomnia, to which will be added insomnia due to transient physical stress, pain, coughing, pruritis, not explicitly mentioned in the ICSD, as well as rebound insomnia following the discontinuation of certain hypnotics.

The recognition and growth of sleep medicine as a clinical specialty is manifested by the inclusion of sleep disorders in disease classification systems from the 1970s. The task of developing a classification system for sleep disorders has been undertaken by three organizations, namely, the World Health Organization (WHO), the American Psychiatric Association (APA) and associations and societies involved in sleep medicine as a clinical discipline, most recently the American Academy of Sleep Medicine (AASM). Three different classification systems have evolved: first, with sleep disorders being added to a general coding system, the International Classification of Diseases (ICD)(World Health Organization 1977, 1994, 2011); second, designed for use by mental health professionals, the Diagnostic and Statistical Manual of Mental Disorders (DSM)(American Psychiatric Association 1994, 2013); and third, developed by and for specialists in sleep medicine, the International Classification of Sleep Disorders (ICSD)(Association of Sleep Disorders Centers 1979, 1990, 1997; American Academy of Sleep Medicine 2005, 2014). A summary of the development of these three nosologies from the 1970s to the present is summarized in Table 2.1. In examining their development, it is important to recognize how the classification systems should, and do, evolve in response to other classification systems, as well as advances in scientific knowledge and clinical experience.

Cerebral palsy is the most common motor disability of childhood. Children with cerebral palsy have a wide range of abnormalities that predispose them to develop sleep disorders, including anatomic and functional upper airway abnormalities, muscle spasms, musculoskeletal pain, contractures, and epilepsy. Among the more common sleep disorders described in children with cerebral palsy are sleep-related breathing disorders, disorders of initiation and maintenance of sleep, circadian rhythm disorders, hypersomnias, parasomnias, and sleep-related movement disorders. The development of sleep disorders in these children can have a significant impact on physical, emotional, and cognitive development with far-reaching consequences that also affect caregivers and families. Despite the substantial health consequences of sleep disorders in cerebral palsy, there is a lack of both awareness and applied clinical research in this field. As the multidisciplinary care and longevity of children with cerebral palsy improve, recognizing and addressing sleep disorders in these patients becomes an important component in improving and maintaining their quality of life. This book chapter aims to provide an overview to increase awareness of sleep disorders in cerebral palsy.

Normal circadian rhythms are synchronized to a regular 24 h environmental light-dark cycle, and the suprachiasmatic nucleus and the hormone melatonin have important roles in this process. Desynchronization of circadian rhythms, as occurs in chronobiological disorders, can produce severe disturbances in sleep patterns. According to the International Classification of Sleep Disorders, circadian rhythm sleep disorders (CRSDs) include delayed sleep phase syndrome, advanced sleep phase syndrome, non-24 h sleep-wake disorder, jet lag and shift-work sleep disorder. Disturbances in the circadian phase position of plasma melatonin levels have been documented in all of these disorders. There is compelling evidence to implicate endogenous melatonin as an important mediator in CRSD pathophysiology, although further research involving large numbers of patients will be required to clarify whether the disruption of melatonin secretion is a causal factor in CRSDs. In this Review, we focus on the use of exogenous melatonin and light therapy to treat the disturbed sleep-wake rhythms seen in CRSDs.

Pathophysiology, Associations, and Consequences of Circadian Rhythm Sleep Disorder

Narcolepsy with and without cataplexy, idiopathic hypersomnia with and without long sleep time: a cluster analysis