Saletu B, Gruber G, Mandl M, Becker B, Ben-Chur R, Damianisch K, Parapatics S, Stanger E, Tschida U, Winkler A
Abteilung für Pharmakopsychiatrie und Schlafforschung, Universitätsklinik für Psychiatrie.
Wien Med Wochenschr. 1995;145(24):656-62.
For the diagnosis of sleep disorders, 3 different standardized classification systems are available: the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R/DSM-IV) and the International Classification of Sleep Disorders (ICSD). These 3 classification schemata were comparatively evaluated in 50 sleep-disturbed patients who were admitted within 1 year to a non-specialized sleep laboratory for diagnostic evaluation and treatment. 17 female and 33 male sleep-disturbed patients, aged 54 +/- 12 years, were recorded polysomnographically in 3 subsequent nights (adaptation night, baseline/diagnosis night, treatment night) for measuring objective sleep quality. The subjective sleep quality as well as the subjective and objective awakening quality was assessed by means of rating scales, as well as psychometric and psychophysiological test battery. During the day, EEG, EEG-mapping, psychodiagnostic tests as well as, in many cases, pulmonary function, otolaryngological, CT, MRT and pharyngometric investigations were carried out. Psychic disorders were the leading cause for sleep problems in all 3 classification systems. Based on the ICD-10, the most frequent diagnosis was non-organic insomnia (46%), followed by sleep apnea (18%) and other organic sleep disorders (14%). Based on the DSM-III-R, 46% of the patients were diagnosed as insomnias based on another mental disorder, 38% as organic hypersomnias and 14% as parasomnias. Based on the ICSD Classification, sleep disorders associated with anxiety disorders were leading (30%), followed by sleep disorders based on affective disorders (16%), obstructive snoring (14%), primary snoring (8%) and sleep disorders based on neurological disorders (6%). While the broader ICD-10 and DSM-III-R diagnoses are syndrome-etiologically oriented and may be easily utilized by the practicing physician, the more narrowly defined, extensive, pathogenetically oriented polysomnographic features including ICSD diagnoses are suited better for the specialist.
对于睡眠障碍的诊断，有3种不同的标准化分类系统可供使用：《国际疾病分类及相关健康问题统计分类》（ICD - 10）、《精神疾病诊断与统计手册》（DSM - III - R/DSM - IV）以及《国际睡眠障碍分类》（ICSD）。在1年之内被收治到一家非专科睡眠实验室进行诊断评估和治疗的50名睡眠障碍患者中，对这3种分类模式进行了比较评估。17名女性和33名男性睡眠障碍患者，年龄为54±12岁，在随后的3个夜晚（适应夜、基线/诊断夜、治疗夜）进行了多导睡眠图记录，以测量客观睡眠质量。主观睡眠质量以及主观和客观觉醒质量通过评定量表以及心理测量和心理生理测试组进行评估。在白天，进行脑电图、脑电地形图、心理诊断测试，并且在许多情况下还进行肺功能、耳鼻喉科、CT、磁共振成像和咽测量检查。在所有3种分类系统中，精神障碍都是睡眠问题的主要原因。根据ICD - 10，最常见的诊断是非器质性失眠（46%），其次是睡眠呼吸暂停（18%）和其他器质性睡眠障碍（14%）。根据DSM - III - R，46%的患者被诊断为基于其他精神障碍的失眠症，38%为器质性嗜睡症，14%为异态睡眠。根据ICSD分类，与焦虑症相关的睡眠障碍居首位（30%），其次是基于情感障碍的睡眠障碍（16%）、阻塞性打鼾（14%）、原发性打鼾（8%）以及基于神经障碍的睡眠障碍（6%）。虽然更宽泛的ICD - 10和DSM - III - R诊断是以综合征病因学为导向的，执业医师可能很容易使用，但定义更窄、更广泛、以发病机制为导向的包括ICSD诊断在内的多导睡眠图特征更适合专科医生。
