S3 guideline – non-restorative sleep/sleep disorders

Abstract

Non-restorative sleep and sleep disorders are associated with impairments in health, mental and physical performance, and participation in occupational and social life. The aim of the guideline is to use the algorithm developed for this purpose to identify the causes of sleep-medicine complaints while taking the respective requirements into account and to treat them according to their causes.

Sleep disorders are diverse and common. To ensure appropriate treatment, it is necessary to identify in a timely manner those affected individuals who require specific sleep-medicine diagnostics and therapy. Physicians and psychologists with expertise in sleep medicine can make many diagnoses directly and without specific instrumental diagnostics, solely on the basis of history and clinical assessment. Affected individuals themselves, if adequately informed about the relevant relationships, can often contribute to improvement through behavioral changes and prevent chronicity. For some patients, instrument-based diagnostic assessment by specialists with additional qualifications in sleep medicine is required. Some of the resulting therapies must in turn be carried out under their guidance and supervision.

Today, good options for prevention and treatment are available in relation to the extent and severity of the health and economic damage caused by sleep disorders. Their use depends on correct diagnostic classification of the underlying health problem. For the diagnosis and treatment of many sleep disorders and sleep-medicine conditions, study results of the highest levels of evidence are now available and are presented clearly in the guideline. In areas where the evidence base is not yet secured at a high level, findings from studies with lower levels of evidence are reviewed. At individual points, recommendations on diagnosis and treatment were agreed upon in the consensus conference on the basis of the available evidence. The chapters identify under research needs those problem areas requiring clarification through clinical research.

The guideline covers the sleep-medicine diagnoses of the current International Classification of Sleep Disorders ICSD-2 (American Academy of Sleep Medicine 2005). Compared with previous versions, ICSD-2 for the first time establishes a link to the coding system of the internationally valid general diagnostic classification ICD (DIMDI 2009). Given the widespread prevalence of sleep disorders and complaints of non-restorative sleep, practical diagnostic and therapeutic procedures require consideration of severity in addition to the algorithm. For this purpose, the guideline conference agreed on a severity classification (see Section 4.1), developed on the basis of the corresponding concept from the ICSD-R (American Sleep Disorders Association 1997).

The core scope of the guideline concerns adult patients. An excursus contains additional information on sleep disorders in childhood.

The guideline is intended for everyone involved in diagnosing and treating patients with non-restorative sleep/sleep disorders. It can also be used for information by patients and health care decision-makers.

The guideline “Non-restorative sleep/sleep disorders” was developed by members of the DGSM in collaboration with experts from other participating scientific medical societies; representatives of professional associations and self-help groups were also involved. It follows the S2 guideline (Fischer 2002) and corresponds to level 3 of the three-level guideline-development concept of the Association of the Scientific Medical Societies in Germany (AWMF). The guideline was developed under the direction of the steering committee and discussed and adopted in a formal consensus procedure. The procedure used for development of the guideline was a nominal group process.