S3 Guideline Non restorative Sleep/Sleep Disorders

The evidence based S3-guideline has been published in november 2009. It has been written by members of the German Sleep Society (DGSM), and was consented with nine different Medical Societies, the Bundesverband für Pneumologen and three self-help groups from the sleep field. Out of thousands of articles those meeting the scientific quality according to evidence criteria (Oxford Centre for Evidence-based Medicine) were chosen and graded A-D.

The aim of the Guideline is to appropriately uncover the causes of sleep complaints by using an algorithm specifically designed fort his task, and to treat the disorders according to the underlying causes. The use of the new Guideline is meant to be pragmatic, i.e. it must not be worked up totally, rather should it be used to choose most recently approved diagnostic and therapeutic methods according to the grades of recommendation.

The Guideline is based on the coding framework of the „International Classification of Sleep Disorders (2005). It contains a new algorithm that includes the term Non restorative Sleep, which is discussed controversially, as well as Sleep Disorders. The term Non restorative Sleep represents an unspecific complaint, which can be classified by using the algorithm. By this patients who do not suffer from Non restorative Sleep like sleepwalkers can be included. Patients with a suspected or known sleep disorder must pass the same algorithm to ensure diffential diagnoses. Using the new algorithm the patient does not necessarily end in the sleep laboratory, because some sleep disorders can be diagnosed clinically. Furthermore, the new Guideline does not differentiate between in hospital and ambulant diagnostic and therapeutic procedures.

To ensure the transition from ICSD2 into the ICD-10 classification a cross-walk between these two systems has been elaborated. The cross-walk allows to perform the correct coding of sleep disorders that are much more complex in the ICSD2. It allows allow to perform correct coding in terms of reimbursement and its quality control.

The guideline report, definition of special „sleep terms and definitions, diagnostic procedures and the algorithm will be presented. The algorithm contains 1. insomnias, 2. sleep related breathing disorders, 3. hypersomnias of central nervous origin, 4. Circadian sleep rhythm disorders, 5. parasomnias and 6. sleep related movement disorders. Because of the diagnostic and therapeutic controversies for some sleep disorders and the partial lack of a sufficient number of evidence based literature, each chapter contains a research proposal, which shall challenge future research.

Reference: Mayer G et al. S-3 Leitlinie Nicht erholsamer Schlaf/Schlafstörungen. Somnologie 2009;13(suppl1):1–160.