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1、睡眠疾病的国际分类北京协和医院呼吸睡眠中心 肖毅睡眠疾病的分类对于疾病之间的区分是有必要的，并且有利于理解症状、病因、病理生理和治疗。因为许多疾病的病理生理还不清楚，早期的疾病主要是根据主要的症状（失眠、嗜睡、以及在睡眠中出现的事件）分类。这样的分类很容易被临床医师所理解，而且对于鉴别诊断亦很有用。由于现代睡眠研究的发展，某些睡眠疾病可以根据病理生理分类。睡眠疾病国际分类第二版（The International Classification of Sleep Disorders，ICSD-2）于2004年出版，它结合症状学（如失眠），病理生理（如昼夜节律）以及部位（如呼吸疾病）进行分类。由于
2、睡眠疾病的不同特性，以及许多睡眠疾病的病理生理仍不明，因此是非常有必要的。ICSD-2不只是睡眠疾病的列表，而是一个手册，有很多的参考文献涉及疾病诊断的特点和流行病学，以帮助读者更容易进行鉴别诊断。自从睡眠疾病开始认识以来，临床医师就对睡眠疾病的分类产生了兴趣。第一次疾病分类（the Diagnostic Classification of Sleep and Arousal Disorders），颁布于1977年。这样一个分类是目前分类的基础。1990年，美国睡眠疾病协会（the American Sleep Disorders Association ， ASDA）在经过五年的工作之后，制
3、定了the International Classification of Sleep Disorders (ICSD)。有三个当时主要的国际睡眠组织共同参加，欧洲睡眠研究会，日本睡眠研究会和拉丁美洲睡眠研究会，出版了the International Classification of Sleep Disorders: Diagnostic and Coding Manual。该分类主要是根据诊断、流行病学和研究目的，对临床医师进行睡眠研究和国际交流起了重要的作用。2003年，美国睡眠医学会（the American Academy of Sleep Medicine）,前身是ASDA，对I
4、CSD进行了完全的修订和更新，在2005年发表了第二版的the International Classification of Sleep Disorders, ICSD-2。ICSD-2 列举了85种睡眠疾病，对每一种疾病都进行了详细的描述，包括诊断标准。它共有八个分类。1. 失眠 2. 睡眠呼吸疾病3. 不是由于呼吸疾病引起的嗜睡4. 昼夜节律睡眠障碍5. 异态睡眠 6. 睡眠相关运动失调. 7. 独立症状 8. 其他睡眠疾病ICSD-2 Sleep Disorder Categories and Individual Sleep DisordersInsomniasICD-9ICD-10
5、Adjustment Sleep Disorder (Acute Insomnia)307.41F 51.01Psychophysiological Insomnia307.42F 51.03Paradoxical Insomnia (formerly Sleep State Misperception)307.42F 51.02Idiopathic Insomnia780.52F 51.04Insomnia due to mental disorder (Code also the associated mental disorder)307.42F 51.05Inadequate Slee
6、p Hygiene (Code also any associated insomnia F51.0-, G47.0-)307.41Z72.821Behavioral Insomnia of Childhood307.42Z73.81Sleep-onset Association Type-Z73.810Limit-setting Sleep Type-Z73.811Combined Type-Z73.812Unspecified Type-Z73.819Insomnia due to a medical condition (Code also the associated medical
7、condition)780.52G 47.03Insomnia due to a drug or substance (Code first T36-T65 with 6th character 1-4 to identify drug or substance, and use additional code T36-T50 with 6th character 5 to identify adverse effect of drug). Use F10-F19 codes when there is associated drug abuse or dependence.291.89G 4
8、7.02Insomnia not due to a substance or known physiological condition, unspecified (Nonorganic Insomnia, NOS)307.42F 51.00Physiological (organic) insomnia, unspecified; (Organic Insomnia, NOS)780.52G 47.00Sleep-Related Breathing DisordersCentral Sleep Apnea SyndromesPrimary Central Sleep Apnea780.51G
9、 47.31Other Central Sleep Apnea due to a medical condition780.57G 47.39Cheyne Stokes Breathing Pattern-High Altitude Periodic Breathing-Central Sleep Apnea due to a medical condition, not Cheyne Stokes or High Altitude-Central Sleep Apnea due to a drug or substance995.2G 47.36Other Sleep-Related Bre
10、athing Disorder due to a drug or substance-Primary Sleep Apnea of Infancy (formerly Primary Sleep Apnea of Newborn)770.81P 28.3Obstructive Sleep Apnea SyndromesObstructive Sleep Apnea, Adult780.53G 47.32Obstructive Sleep Apnea, Pediatric780.53G 47.32Sleep-Related Hypoventilation/Hypoxemic SyndromesS
11、leep-Related Non-obstructive Alveolar Hypoventilation, Idiopathic780.57G 47.34Congenital Central Alveolar Hypoventilation Syndrome780.57G 47.35Sleep-Related Hypoventilation/Hypoxemia due to a medical condition780.57G 47.37Sleep-Related Hypoventilation/Hypoxemia due to pulmonary parenchymal or vascul
12、ar pathology-Sleep-Related Hypoventilation/Hypoxemia due to lower airways obstruction-Sleep-Related Hypoventilation/Hypoxemia due to neuromuscular or chest wall disorders-Other Sleep-Related Breathing DisorderSleep Apnea/Sleep-Related Breathing Disorder, unspecified (Sleep-Related Breathing Disorder
13、, NOS)780.57G 47.30Hypersomnias Not Due to a Sleep-Related Breathing DisorderNarcolepsyNarcolepsy with Cataplexy347.01G 47.41Narcolepsy without Cataplexy347.00G 47.42Narcolepsy due to a medical condition347.1G 47.43Narcolepsy, unspecified347G 47.0Other HypersomniasRecurrent Hypersomnia780.54G 47.11K
14、leine-Levin Syndrome-Menstrual-Related Hypersomnia-Idiopathic Hypersomnia with long sleep time780.54G 47.12Idiopathic Hypersomnia without long sleep time780.54G 47.13Behaviorally Induced Insufficient Sleep Syndrome307.44F 51.11Hypersomnia due to a medical condition780.54G 47.15Hypersomnia due to a d
15、rug or substance995.2G 47.14Hypersomnia not due to a substance or known physiological condition (Nonorganic Hypersomnia, NOS)307.44F 51.10Physiological (Organic) Hypersomnia, unspecified (Organic Hypersomnia, NOS)780.54G 47.10Circadian Rhythm Sleep DisordersPrimary Circadian Rhythm Sleep DisordersCircadian Rhythm Sleep Disorder, Delayed sleep phase type780.55G 47.21Circadian Rhythm Sleep Disorder, Advanced sleep phase
