• Source: Classification of sleep disorders

Classification of sleep disorders comprises systems for classifying medical disorders associated with sleep. Systems have changed, increasingly using technological discoveries to advance the understanding of sleep and recognition of sleep disorders.
Three systems of classification are in use worldwide: the International Classification of Diseases (ICD), the Diagnostic and Statistical Manual of Mental Disorders (DSM), and the International Classification of Sleep Disorders (ICSD). The ICD and DSM lump different disorders together, while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three systems of classification. The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of sleep medicine.




Classification systems



Systems for the classification of sleep disorders are used to classify medical disorders related to human sleep patterns. Three systems of classification are in use worldwide:

the International Classification of Diseases (ICD) developed by the World Health Organization (WHO) and intended for use by general and more specialized practitioners,
the Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association (APA) for psychiatrists and general practitioners, and
the International Classification of Sleep Disorders (ICSD), an advanced system cultured by the American Academy of Sleep Medicine (AASM) for sleep specialists.
The ICD and DSM lump different disorders together, while the ICSD tends to split related disorders into multiple discrete categories. There has, over the last 60 years, occurred a slow confluence of the three major classification systems.




History






= Milestones

=
The first book on sleep was published in 1830 by Robert MacNish; it described sleeplessness, nightmares, sleepwalking and sleep-talking. Narcolepsy, hypnogogic hallucination, wakefulness and somnolence were mentioned by other authors of the nineteenth century. Westphal, in 1877, described first case of narcolepsy, the name coined later by Gelineu in 1880 in association with cataplexy. Lehermitte called it paroxysmal hypersomnia in 1930 to differentiate it from prolonged hypersomnia. Roger in 1932 coined the term parasomnia and classified hypersomnia, insomnia and parasomnia. Kleitman in 1939 recognized types of parasomnias as nightmares, night terrors, somniloquy (sleep-talking), somnambulism (sleepwalking), grinding of teeth, jactatians, enuresis, delirium, nonepileptic convulsions and personality dissociation. Broughton in 1968 developed classification of the arousal disorders as confusional arousals: night terrors and sleep walking. Insomnias were classified as primary and secondary until 1970 when they were recognized as symptoms of other disorders. Sir William Osler in 1906 correlated snoring, obesity and somnolence (sleepiness) to Dicken's description of Joe. Charles Burwell in 1956 recognized obstructive sleep apnea as Pickwickian syndrome. Circadian rhythm sleep disorders were discovered in 1981 by Weitzman as delayed sleep phase syndrome in contrast to advanced sleep phase syndrome in 1979.




= Evolution of classifications of sleep disorders

=
Classification of sleep disorders, as developed in the 19th century, used primarily three categories: insomnia, hypersomnia and nightmare. In the 20th century, increasingly in the last half of it, technological discoveries led to rapid advances in the understanding of sleep and recognition of sleep disorders. Major sleep disorders were defined following the development of electroencephalography (EEG) in 1924 by Hans Berger.




Validity and reliability


Diagnoses of sleep disorders are based on self-assessment questionnaires, clinical interview, physical examination and laboratory procedures. The validity and reliability of various sleep disorders are yet to be proved and need further research within the ever-changing field of sleep medicine. Admittedly, the development of sleep disorder classification remains as much an art as it is a science.




The International Classification of Sleep Disorders (ICSD)



The International Classification of Sleep Disorders (ICSD) was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979.

Disorder of initiating and maintain sleep (DIMS) - Insomnias
Disorder of Excessive sleep (DOES) - Hypersomnias
Disorder of sleep wake schedule
Parasomnias
The International Classification of Sleep Disorders (ICSD) uses a multiaxial system for stating and coding diagnoses both in clinical reports or for data base purposes. The axial system uses International Classification of Diseases (ICD-9- CM) coding wherever possible. Additional codes are included for procedures and physical signs of particular interest to sleep disorders clinicians and researchers. Diagnoses and procedures are listed and coded on three main "axes." The axial system is arranged as follows:

Axis A ICSD Classification of Sleep Disorders
Axis B ICD-9-CM Classification of Procedures
Axis C ICD-9-CM Classification of Diseases (nonsleep diagnoses).




= ICSD - I Revised 1997

=



Dyssomnias

Intrinsic Sleep Disorders
Extrinsic Sleep Disorders
Circadian Rhythm Sleep Disorders



Parasomnias

Arousal Disorders
Sleep-Wake Transition Disorders
Parasomnias Usually Associated with REM Sleep
Other Parasomnias



Sleep Disorders Associated with Mental, Neurologic, or Other Medical Disorders

Associated with Mental Disorders
Associated with Neurologic Disorders
Associated with Other Medical Disorders



Proposed Sleep Disorders

ICSD 2 is tabulated in the main article International Classification of Sleep Disorders




= ICSD - 3

=
The last edition of ICSD-3 is a unified classification of sleep disorders. It includes seven major categories: insomnia disorders, sleep-related breathing disorders, central disorders of hypersomnolence, circadian rhythm sleep-wake disorders, sleep-related movement disorders, parasomnias, and other sleep disorders. Each of these categories has several subgroups:



1. Insomnia

Chronic insomnia disorder
Short-term insomnia disorder
Other insomnia disorder



2. Sleep-related breathing disorders

Obstructive sleep apnea (OSA) disorders
OSA, adult
OSA, pediatric
Central sleep apnea syndromes
Central sleep apnea with Cheyne-Stokes breathing
Central sleep apnea due to a medical disorder without Cheyne-Stokes breathing
Central sleep apnea due to high altitude periodic breathing
Central sleep apnea due to a medication or substance
Primary central sleep apnea
Primary central sleep apnea of infancy
Primary central sleep apnea of prematurity
Treatment-emergent central sleep apnea
Sleep-related hypoventilation disorders
Obesity hypoventilation syndrome
Congenital central alveolar hypoventilation syndrome
Late-onset central hypoventilation with hypothalamic dysfunction
Idiopathic central alveolar hypoventilation
Sleep-related hypoventilation due to a medication or substance
Sleep-related hypoventilation due to a medical disorder
Sleep-related hypoxemia disorder
Isolated symptoms and normal variants



3. Central disorders of hypersomnolence

Narcolepsy type 1
Narcolepsy type 2
Idiopathic hypersomnia
Kleine-Levin syndrome
Hypersomnia due to a medical disorder
Hypersomnia due to a medication or substance
Hypersomnia associated with a psychiatric disorder
Insufficient sleep syndrome



4. Circadian rhythm sleep-wake disorders

Delayed sleep-wake phase disorder
Advanced sleep-wake phase disorder
Irregular sleep-wake rhythm disorder
Non-24-h sleep-wake rhythm disorder
Shift work disorder
Jet lag disorder
Circadian sleep-wake disorder not otherwise specified



5. Sleep-related movement disorders

Restless legs syndrome
Periodic limb movement disorder
Sleep-related leg cramps
Sleep-related bruxism
Sleep-related rhythmic movement disorder
Benign sleep myoclonus of infancy
Propriospinal myoclonus at sleep onset
Sleep-related movement disorder due to a medical disorder
Sleep-related movement disorder due to a medication or substance
Sleep-related movement disorder, unspecified
Isolated symptoms and normal variants
Excessive fragmentary myoclonus
Hypnagogic foot tremor and alternating leg muscle activation
Sleep starts (hypnic jerks)



6. Parasomnias

NREM-related parasomnias
Confusional arousals
Sleepwalking
Sleep terrors
Sleep-related eating disorder
REM-related parasomnias
REM sleep behavior disorder
Recurrent isolated sleep paralysis
Nightmare disorder
Other parasomnias
Exploding head syndrome
Sleep-related hallucinations
Sleep enuresis
Parasomnia due to a medical disorder
Parasomnia due to a medication or substance
Parasomnia, unspecified
Isolated symptoms and normal variants
Sleep talking



7. Other sleep disorders





International Classification of Disease (ICD)






= ICD-7R 1955

=
780.7 Disturbance of sleep




= ICD-8 1965

=

306.4 Specific disorder of sleep
780.6 Disturbance of sleep




= ICD-9 1975

=



327 Organic sleep disorders




= 327.0 Organic disorders of initiating and maintaining sleep [organic insomnia]
=
327.00 Organic insomnia, unspecified
327.01 Insomnia due to medical condition classified elsewhere
327.02 Insomnia due to mental disorder
327.09 Other organic insomnia



= 327.1 Organic disorder of excessive somnolence [organic hypersomnia]
=
327.10 Organic hypersomnia, unspecified
327.11 Idiopathic hypersomnia with long sleep time
327.12 Idiopathic hypersomnia without long sleep time
327.13 Recurrent hypersomnia
327.14 Hypersomnia due to medical condition classified elsewhere
327.15 Hypersomnia due to mental disorder
327.19 Other organic hypersomnia



= 327.2 Organic sleep apnea
=
327.20 Organic sleep apnea, unspecified
327.21 Primary central sleep apnea
327.22 High altitude periodic breathing
327.23 Obstructive sleep apnea (adult)(pediatric)
327.24 Idiopathic sleep related non-obstructive alveolar hypoventilation
327.25 Congenital central alveolar hypoventilation syndrome
327.26 Sleep related hypoventilation/hypoxemia in conditions classifiable elsewhere
327.27 Central sleep apnea in conditions classified elsewhere
327.29 Other organic sleep apnea



= 327.3 Circadian rhythm sleep disorder
=
327.30 Circadian rhythm sleep disorder, unspecified
327.31 Circadian rhythm sleep disorder, delayed sleep phase type
327.32 Circadian rhythm sleep disorder, advanced sleep phase type
327.33 Circadian rhythm sleep disorder, irregular sleep-wake type
327.34 Circadian rhythm sleep disorder, free-running type
327.35 Circadian rhythm sleep disorder, jet lag type
327.36 Circadian rhythm sleep disorder, shift work type
327.37 Circadian rhythm sleep disorder in conditions classified elsewhere
327.39 Other circadian rhythm sleep disorder



= 327.4 Organic parasomnia
=
327.40 Organic parasomnia, unspecified
327.41 Confusional arousals
327.42 REM sleep behavior disorder
327.43 Recurrent isolated sleep paralysis
327.44 Parasomnia in conditions classified elsewhere
327.49 Other organic parasomnia



= 327.5 Organic sleep related movement disorders
=
327.51 Periodic limb movement disorder
327.52 Sleep related leg cramps
327.53 Sleep related bruxism
327.59 Other organic sleep related movement disorders



= 327.8 Other organic sleep disorders
=



= 307.4 Specific disorders of sleep of nonorganic origin
=
307.40 Nonorganic sleep disorder, unspecified
307.41 Transient disorder of initiating or maintaining sleep
307.42 Persistent disorder of initiating or maintaining sleep
307.43 Transient disorder of initiating or maintaining wakefulness
307.44 Persistent disorder of initiating or maintaining wakefulness
307.45 Circadian rhythm sleep disorder of nonorganic origin
307.46 Sleep arousal disorder
307.47 Other dysfunctions of sleep stages or arousal from sleep
307.48 Repetitive intrusions of sleep
307.49 Other specific disorders of sleep of nonorganic origin



= 780.5 Sleep disturbances
=
780.50 Sleep disturbance, unspecified
780.51 Insomnia with sleep apnea, unspecified
780.52 Insomnia, unspecified
780.53 Hypersomnia with sleep apnea, unspecified
780.54 Hypersomnia, unspecified
780.55 Disruption of 24 hour sleep wake cycle, unspecified
780.56 Dysfunctions associated with sleep stages or arousal from sleep
780.57 Unspecified sleep apnea
780.58 Sleep related movement disorder, unspecified
780.59 Other sleep disturbances



= 292.85 Drug induced sleep disorders
=




= ICD-NA (1997)

=



G47 Sleep disorders

Excl.: nocturnal myoclonus (G25.80), nightmares (F51.5), nonorganic sleep disorders (F51.-), sleep terrors (F51.4), sleepwalking (F51.3)



= G47.0 Disorders of initiating and maintaining sleep [insomnias], Excl. altitudinal insomnia (T70.2)
=



= G47.1 Disorders of excessive somnolence [hypersomnias]
=



= G47.2 Disorders of the sleep-wake schedule
=
G47.20 Transient sleep wake schedule disorder
G47.21 Advanced sleep phase disorder
G47.22 Delayed sleep phase syndromes
G47.23 Irregular sleep-wake pattern
G47.24 Non 24 hour sleep wake cycle
G47.28 Other disorder of sleep wake schedule



= G47.3 Sleep apnoea
=
Sleep related respiratory failure (ondine)
Excl. pickwickian syndrome (E66.2), sleep apnoea of newborn (P28.3)
G47.30 Alveolar hypoventilation syndrome
G47.31 Central sleep apnoea
G47.32 Obstructive sleep apnoea
G47.38 Other sleep apnoea



= G47.4 Narcolepsy and cataplexy
=
G47.40 Narcolepsy
G47.41 Cataplexy
G47.42 Sleep paralysis
G47.43 Hypnogogic and hypnopompic hallucination
G47.44 Any combination of narcolepsy, cataplexy, Sleep paralysis, Hypnogogic and hypnopompic hallucination
G47.48 Other forms of narcolepsy and cataplexy



= G47.8 Other sleep disorders
=
Excl: Other sudden death, cause unknown (R96-)
Sleep apnoea (G47.3)
newborn (R96.-)
Sudden infant death syndrome (R95)
G47.80 Other REM sleep related parasomnias
Excl. nightmares (F51.5), Sleep paralysis (G47.42 )
G47.800 REM sleep related behavior disorder (phantasmagorias)
G47.801 Impaired REM sleep related non painful penile erection
G47.802 REM sleep related painful penile erection
G47.803 REM sleep related cardiac sinus arrest
G47.804 REM sleep related headache (use additional code if required to indicate type of headache)
G47.81 Other non REM sleep related parasomnias
Excl: benign neonatal sleep syndrome (G25.37)
G47.810 Sleep related bruxism
G47.811 Sleep related enuresis
G47.812 Non-REM-sleep related abnormal swallowing syndrome
G47.813 Nocturnal paroxysmal dystonia
G47.82 Sleep arousal disorders, confusional arousal, Sleep drunkenness
G47.83 Sleep-wake transition disorders
Excl. nocturnal leg cramps (R25.20)
G47.830 Sleep related rhythmic movement disorder, head-banging (jactatio capitis noctunus)
G47.831 Sleep starts
G47.832 Sleepwalking
G47.84 Kleine-Levin syndrome, Recurrent hypersomnia
G47.88 Other specified sleep disorders



= G47.9 Sleep disorder, unspecified
=



F51 Nonorganic sleep disorders

Excl.: sleep disorders (organic) (G47.-)



= F51.0 Nonorganic insomnia Excl.: insomnia (organic) (G47.0)
=



= F51.1 Nonorganic hypersomnia Excl.: hypersomnia (organic) (G47.1), narcolepsy (G47.4)
=



= F51.2 Nonorganic disorder of the sleep-wake schedule
=
Psychogenic inversion of:
circadian
nyctohemeral
sleep rhythm
Excl.: disorders of the sleep-wake schedule (organic) (G47.2)



= F51.3 Sleepwalking [somnambulism]
=



= F51.4 Sleep terrors [night terrors]
=



= F51.5 Nightmares, Dream anxiety disorder
=



= F51.8 Other nonorganic sleep disorders
=



= F51.9 Nonorganic sleep disorder, unspecified, Emotional sleep disorder NOS
=



P28.3 Primary sleep apnoea of newborn

Sleep apnoea of newborn:
central
NOS
obstructive



P28.4 Other apnoea of newborn

Apnoea (of):
newborn, obstructive
prematurity Excl.: obstructive sleep apnoea of newborn (P28.3)




= ICD-10-CM 2016

=



G47 Sleep disorders




= G47.0 Insomnia
=
G47.00 ...... unspecified
G47.01 ...... due to medical condition
G47.09 Other insomnia



= G47.1 Hypersomnia
=
G47.10 ...... unspecified
G47.11 Idiopathic hypersomnia with long sleep time
G47.12 Idiopathic hypersomnia without long sleep time
G47.13 Recurrent hypersomnia
G47.14 ...... due to medical condition
G47.19 Other hypersomnia



= G47.2 Circadian rhythm sleep disorders
=
G47.20 Circadian rhythm sleep disorder, unspecified type
G47.21 Circadian rhythm sleep disorder, delayed sleep phase type
G47.22 Circadian rhythm sleep disorder, advanced sleep phase type
G47.23 Circadian rhythm sleep disorder, irregular sleep wake type
G47.24 Circadian rhythm sleep disorder, free running type
G47.25 Circadian rhythm sleep disorder, jet lag type
G47.26 Circadian rhythm sleep disorder, shift work type
G47.27 Circadian rhythm sleep disorder in conditions classified elsewhere
G47.29 Other circadian rhythm sleep disorder



= G47.3 Sleep apnea
=
G47.30 ...... unspecified
G47.31 Primary central sleep apnea
G47.32 High altitude periodic breathing
G47.33 Obstructive sleep apnea (adult) (pediatric)
G47.34 Idiopathic sleep related nonobstructive alveolar hypoventilation
G47.35 Congenital central alveolar hypoventilation syndrome
G47.36 Sleep related hypoventilation in conditions classified elsewhere
G47.37 Central sleep apnea in conditions classified elsewhere
G47.39 Other sleep apnea



= G47.4 Narcolepsy and cataplexy
=
G47.41 Narcolepsy
G47.411 ...... with cataplexy
G47.419 ...... without cataplexy
G47.42 Narcolepsy in conditions classified elsewhere
G47.421 ...... with cataplexy
G47.429 ...... without cataplexy



= G47.5 Parasomnia
=
G47.50 ...... unspecified
G47.51 Confusional arousals
G47.52 REM sleep behavior disorder
G47.53 Recurrent isolated sleep paralysis
G47.54 ...... in conditions classified elsewhere
G47.59 Other parasomnia



= G47.6 Sleep related movement disorders
=
G47.61 Periodic limb movement disorder
G47.62 Sleep related leg cramps
G47.63 Sleep related bruxism
G47.69 Other sleep related movement disorders



= G47.8 Other sleep disorders
=



= G47.9 Sleep disorder, unspecified
=



F51 Sleep disorders not due to a substance or known physiological condition




= F51.0 Insomnia not due to a substance or known physiological condition
=
F51.01 Primary insomnia
F51.02 Adjustment insomnia
F51.03 Paradoxical insomnia
F51.04 Psychophysiologic insomnia
F51.05 Insomnia due to other mental disorder
F51.09 Other insomnia not due to a substance or known physiological condition



= F51.1 Hypersomnia not due to a substance or known physiological condition
=
F51.11 Primary hypersomnia
F51.12 Insufficient sleep syndrome
F51.13 Hypersomnia due to other mental disorder
F51.19 Other hypersomnia not due to a substance or known physiological condition



= F51.3 Sleepwalking [somnambulism]
=



= F51.4 Sleep terrors [night terrors]
=



= F51.5 Nightmare disorder
=



= F51.8 Other sleep disorders not due to a substance or known physiological condition
=



= F51.9 Sleep disorder not due to a substance or known physiological condition, unspecified
=



P28.3

Applicable To

Central sleep apnea of newborn
Obstructive sleep apnea of newborn
Sleep apnea of newborn NOS
Approximate Synonyms

Neonatal primary apnea
Primary apnea in the newborn
Sleep apnea, primary, neonatal




= ICD-11-Beta - 10 Sleep Wake Disorder 2016

=



Insomnia disorders

8A00 Chronic insomnia
8A01 Short-term insomnia
8A02 Disorders of initiating and maintaining sleep
8A0Y Other specified insomnia disorders
8A0Z Insomnia disorders, unspecified



Sleep-related movement disorders

8A10 Restless legs syndrome
8A11 Secondary restless legs syndrome
8A12 Periodic limb movements disorder
8A13 Sleep-related bruxism
8A14 Sleep-related leg cramps
8A15 Sleep-related rhythmic movement disorder
8A16 Benign sleep myoclonus of infancy
8A1Y Other specified sleep-related movement disorders
8A1Z Sleep-related movement disorders, unspecified



8A20 Hypersomnolence disorders

8A20.1 Narcolepsy, Type 1
8A20.2 Narcolepsy, Type 2
8A20.3 Idiopathic hypersomnolence disorder
8A20.4 Kleine-Levin syndrome
8A20.5 Behaviourally induced hypersomnolence
8A20.6 Hypersomnolence due to substances including medications
8A20.Y Other specified hypersomnolence disorders
8A20.Z Hypersomnolence disorders, unspecified



Sleep-related breathing disorders

8A30 Central sleep apnoeas
8A31 Obstructive sleep apnoea
8A32 Sleep-related hypoventilation or hypoxemia disorders
8A3Y Other specified sleep-related breathing disorders
8A3Z Sleep-related breathing disorders, unspecified



Circadian rhythm sleep-wake disorders

8A40 Circadian rhythm sleep-wake disorder, delayed type
8A41 Circadian rhythm sleep-wake disorder, advanced type
8A42 Circadian rhythm sleep-wake disorder, irregular sleep-wake rhythm type
8A43 Circadian rhythm sleep-wake disorder, non-24 hour type
8A44 Circadian rhythm sleep-wake disorder, shift work type
8A45 Circadian rhythm sleep-wake disorder, jet lag type
8A4Y Other specified circadian rhythm sleep-wake disorders
8A4Z Circadian rhythm sleep-wake disorders, unspecified



Parasomnia disorders




= Disorders of arousal in non-REM sleep
=
8A50 Confusional arousals
8A51 Sleepwalking disorder
8A52 Sleep terrors
8A5Y Other specified disorders of arousal in non-REM sleep
8A5Z Disorders of arousal in non-REM sleep, unspecified
8A60 Sleep-related eating disorder



= 8A61 REM sleep behavior disorder
=
8A62 Recurrent isolated sleep paralysis
8A63 Nightmare disorder 8A63 Nightmare disorder
8A64 Hypnogogic exploding head syndrome
8A65 Recurrent isolated sleep-related hallucinations



= 8A66 Parasomnia disorder due to substances including medications
=
8A6Y Other specified parasomnia disorders
8A6Z Parasomnia disorders, unspecified
7B60.1 Nocturnal enuresis
8A70 Disorders of the sleep-wake schedule
8A71 Parasomnia
8A72 Sleeptalking
8A7Y Other specified sleep-wake disorders
8A7Z Sleep-wake disorders, unspecified
ME21 Dyssomnia




DSM Classification of Sleep Disorders



Diagnostic and Statistical Manual (DSM) classification of sleep disorder was first introduced in 1968.




= DSM II - 1968

=
Disorders of Sleep




= DSM III - 1980

=
Other disorders with physical manifestation
Sleep walking
Sleep terror




= DSM III-R 1987

=



Sleep Disorder




= Dysomnias (disorders of amount, quality or time of sleep)
=
Insomnia
Hypersomnia
Sleep wake schedule disorder



= Parasomnia (abnormal event during sleep)
=
Nightmare disorder
Sleep terror
Sleep walking




= DSM IV TR Sleep Disorders

=




= DSM-5 Sleep Wake Disorders

=



Major changes from DSM IV

Sleep-wake disorders comprise 11 diagnostic groups:

M00 Insomnia disorder
M01 Hypersomnolence Disorder
M02 Narcolepsy/Hypocretin Deficiency
M03 Obstructive Sleep Apnea Hypopnea Syndrome
M04 Central Sleep Apnea
M05 Sleep-Related Hypoventilation
M06 Circadian Rhythm Sleep-Wake Disorder
M07 Disorder of Arousal
M08 Nightmare Disorder
M09 Rapid Eye Movement Sleep Behavior Disorder
M10 Restless Legs Syndrome
M11 Substance-Induced Sleep disorder
Sleep-Wake Disorders Not Elsewhere Classified
Insomnia Disorder Not Elsewhere Classified
Major Somnolence Disorder (Hypersomnia Not Elsewhere Classified) The following specifiers apply to Sleep-Wake Disorders where indicated: Specify if: Episodic, Persistent, Recurrent Specify if: Acute, Subacute, Persistent Specify current severity: Mild, Moderate, Severe




References






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• Classification of sleep disorders
• International Classification of Sleep Disorders
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