SLEEP-DISORDERED BREATHING DIAGNOSIS AND TREATMENTkapak

INTERNATIONAL CLASSIFICATION OF SLEEP DISORDERS (ICSD-3-TR)

Nurbanu Koçdemir Erul

Beypazarı State Hospital, Department of Otorhinolaryngology, Ankara, Türkiye

Koçdemir Erul N. International Classification of Sleep Disorders (ICSD-3-TR). In: Özcan KM, editor. Sleep-Disordered Breathing: Diagnosis and Treatment. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.3-14.

ABSTRACT

The International Classification of Sleep Disorders Third Edition, Text Revision (ICSD-3-TR) represents the most updated and clinically comprehensive taxonomy for diagnosing sleep disorders, published by the American Academy of Sleep Medicine in 2023. The first version of the classification, published in 1990, examined sleep disorders under four main headings. Sleep disorders were classified under the headings of dyssomnias, parasomnias, secondary sleep disturbances, and provisional sleep disorders. The second version of the International Classification of Sleep Disorders, published in 2005, detailed descriptions and diagnostic criteria for 77 different sleep disorders under eight main headings. The American Academy of Sleep Medicine published the third version of the classification in 2014. Significant changes were made to the classification due to significant advances in sleep medicine and contributions from numerous published articles. In line with scientific advancements, detailed information and diagnostic criteria were established for each sleep disorder. One of the most significant differences between the third version and the second is the acceptance of off-site sleep tests for the diagnosis of sleep-disordered breathing. In 2023, the classification underwent a text revision. This revision builds on previous editions by integrating emerging evidence and refining diagnostic criteria across multiple categories of sleep disorders. This chapter provides an in-depth overview of the ICSD-3-TR, focusing especially on its application in classifying sleep-related breathing disorders. The classification is organized into six major categories: insomnia disorders, sleep-related breathing disorders, central hypersomnolence disorders, circadian rhythm sleep-wake disorders, parasomnias, and sleep-related movement disorders. Among these, sleep-related breathing disorders including obstructive sleep apnea (OSA), central sleep apnea (CSA), sleep-related hypoventilation, and sleep-related hypoxemia1 are presented with greater clinical nuance and pathophysiological detail compared to earlier systems. ICSD-3-TR marks a shift away from dichotomous classifications such as “primary” versus “secondary” insomnia, reflecting the recognition that many sleep disorders coexist with other medical or psychiatric conditions but still require independent diagnostic and therapeutic attention. The updated manual also acknowledges advancements in portable diagnostic methods like out-of-center sleep testing (OCST), particularly for OSA. The classification system is widely favored by otolaryngologists and multidisciplinary sleep professionals for its detailed clinical criteria, structured diagnostic approach, and capacity to enhance diagnostic precision in real-world settings. It harmonizes with ICD and DSM5 classifications while maintaining its role as the gold standard in sleep medicine.

Keywords: Sleep apnea syndromes; Sleep apnea, obstructive; Sleep initiation and maintenance disorders; Parasomnias

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