Testing the reliability and validity of DSM-IV-TR and ICSD-2 insomnia diagnoses. Results of a multitrait-multimethod analysis.

CONTEXT Distinctive diagnostic classification schemes for insomnia diagnoses are available, but the optimal insomnia nosology has yet to be determined. OBJECTIVES To test the reliability and validity of insomnia diagnoses listed in the American Psychiatric Association's DSM-IV-TR and the International Classification of Sleep Disorders, second edition (ICSD-2). DESIGN Multitrait-multimethod correlation design. SETTING Two collaborating university medical centers, with recruitment from January 2004 to February 2009. PARTICIPANTS A total of 352 adult volunteers (235 of whom were women) who met research diagnostic criteria for insomnia disorder. MAIN OUTCOME MEASURES Goodness-of-fit ratings of 10 DSM-IV-TR and 37 ICSD-2 insomnia diagnoses for each patient. Ratings were provided by 3 clinician pairs who used distinctive assessment methods to derive diagnostic impressions. Correlations computed within and across clinician pairs were used to test reliability and validity of diagnoses. RESULTS Findings suggested that the best-supported DSM-IV-TR insomnia categories were insomnia related to another mental disorder, insomnia due to a general medical condition, breathing-related sleep disorder, and circadian rhythm sleep disorder. The category of primary insomnia appeared to have marginal reliability and validity. The best-supported ICSD-2 categories were the insomnias due to a mental disorder and due to a medical condition, obstructive sleep apnea, restless legs syndrome, idiopathic insomnia, and circadian rhythm sleep disorder-delayed sleep phase type. Psychophysiological insomnia and inadequate sleep hygiene received much more variable support across sites, whereas the diagnosis of paradoxical insomnia was poorly supported. CONCLUSIONS Both the DSM-IV-TR and ICSD-2 provide viable insomnia diagnoses, but findings support selected subtypes from each of the 2 nosologies. Nonetheless, findings regarding the frequently used DSM-IV-TR diagnosis of primary insomnia and its related ICSD-2 subtypes suggest that their poor reliability and validity are perhaps due to significant overlap with comorbid insomnia subtypes. Therefore, alternate diagnostic paradigms should be considered for insomnia classification.

[1]  Janet B W Williams,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[2]  Medicaid Services,et al.  International Classification of Diseases, Ninth Revision, Clinical Modification , 2011 .

[3]  E. Walker,et al.  Diagnostic and Statistical Manual of Mental Disorders , 2013 .

[4]  R. Bootzin,et al.  Derivation of research diagnostic criteria for insomnia: report of an American Academy of Sleep Medicine Work Group. , 2004, Sleep.

[5]  Se-Kang Kim,et al.  Estimating Cognitive Profiles Using Profile Analysis via Multidimensional Scaling (PAMS) , 2004, Multivariate behavioral research.

[6]  A. Krystal,et al.  Subtyping primary insomnia: is sleep state misperception a distinct clinical entity? , 2003, Sleep medicine reviews.

[7]  Christopher J. Earley,et al.  Restless legs syndrome , 2003, Current treatment options in neurology.

[8]  Daniel J Buysse,et al.  Clinicians' use of the International Classification of Sleep Disorders: results of a national survey. , 2003, Sleep.

[9]  A. Krystal,et al.  NREM sleep EEG frequency spectral correlates of sleep complaints in primary insomnia subtypes. , 2002, Sleep.

[10]  M. Ohayon,et al.  Comparability of sleep disorders diagnoses using DSM-IV and ICSD classifications with adolescents. , 2001, Sleep.

[11]  M M Ohayon,et al.  Validation of the sleep-EVAL system against clinical assessments of sleep disorders and polysomnographic data. , 1999, Sleep.

[12]  Daniel J Buysse,et al.  Clinical factors contributing to the differential diagnosis of primary insomnia and insomnia related to mental disorders. , 1997, The American journal of psychiatry.

[13]  Daniel J Buysse,et al.  Effects of diagnosis on treatment recommendations in chronic insomnia--a report from the APA/NIMH DSM-IV field trial. , 1997, Sleep.

[14]  A. Krystal,et al.  The empirical identification of insomnia subtypes: a cluster analytic approach. , 1996, Sleep.

[15]  Mark L. Davison,et al.  Identifying Major Profile Patterns in a Population: An Exploratory Study of WAIS and GATB Patterns. , 1996 .

[16]  Daniel J Buysse,et al.  Diagnostic concordance for DSM-IV sleep disorders: a report from the APA/NIMH DSM-IV field trial. , 1994, The American journal of psychiatry.

[17]  C. Morin,et al.  Psychological management of insomnia: A clinical replication series with 100 patients , 1994 .

[18]  Daniel J Buysse,et al.  Sleep disorders related to another mental disorder (nonsubstance/primary): a DSM-IV literature review. , 1993, The Journal of clinical psychiatry.

[19]  G. Hajak,et al.  Test-retest reliability and validity of the Structured Interview for Sleep Disorders According to DSM-III-R. , 1993, The American journal of psychiatry.

[20]  J. Rabe-Jabłońska,et al.  [Affective disorders in the fourth edition of the classification of mental disorders prepared by the American Psychiatric Association -- diagnostic and statistical manual of mental disorders]. , 1993, Psychiatria polska.

[21]  P. Hauri,et al.  Wrist actigraphy in insomnia. , 1992, Sleep.

[22]  D. Greenblatt,et al.  The International Classification of Sleep Disorders , 1992 .

[23]  Daniel J Buysse,et al.  Quantification of subjective sleep quality in healthy elderly men and women using the Pittsburgh Sleep Quality Index (PSQI) , 1991, Sleep.

[24]  R. Daroff,et al.  The International Classification of Sleep Disorders , 1991, Neurology.

[25]  M. Thorpy.  Classification of Sleep Disorders , 1990, Neurotherapeutics.

[26]  P. Lachenbruch.  Statistical Power Analysis for the Behavioral Sciences (2nd ed.) , 1989 .

[27]  P. Hauri.  A cluster analysis of insomnia. , 1983, Sleep.

[28]  P. Hauri,et al.  Childhood-onset insomnia. , 1980, Sleep.

[29]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[30]  K. Ekbom.  Restless legs syndrome , 1960, Neurology.

[31]  D. Campbell,et al.  Convergent and discriminant validation by the multitrait-multimethod matrix. , 1959, Psychological bulletin.

[32]  J. Edinger,et al.  Subjective total insomnia: an example of sleep state misperception. , 1992, Sleep.

[33]  M. Bonnet,et al.  Training subjective insomniacs to accurately perceive sleep onset. , 1992, Sleep.

[34]  C. Guilleminault,et al.  EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. , 1992, Sleep.

[35]  R. Coleman.  Periodic movements in sleep (nocturnal myoclonus) and restless legs syndrome , 1982 .

[36]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .