Table 5.

Classification and definition of sleep disorders of interest in patients with craniopharyngioma (19).

Term (abbreviation)	Definition	Diagnostic criteria (ICSD-3)
Central disorders of hypersomnolence	A group of disorders in which the primary complaint is daytime sleepiness not caused by disturbed nocturnal sleep or misaligned circadian rhythms. Other sleep disorders may be present, but they must be adequately treated before a diagnosis in this category can be established. This group includes (a) Narcolepsy type 1 (b) Narcolepsy type 2 (c) Idiopathic hypersomnia (d) Kleine-Levin syndrome (e) Hypersomnia due to a medical disorder (f) Hypersomnia due to a medication or substance (g) Hypersomnia associated with a psychiatric disorder (h) Insufficient sleep syndrome	Narcolepsy type 1 Criteria A and B must be met A. The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months B. The presence of one or both of the following: 1. Cataplexy (defined as more than one episode of generally brief (<2 min), usually bilaterally symmetrical, sudden loss of muscle tone with retained consciousness) and a mean sleep latency of ≤ 8 min and two or more sleep-onset REM periods (SOREMPs) on an MSLT performed according to standard techniques. A SOREMP (within 15 min of sleep onset) on the preceding nocturnal polysomnogram may replace one of the SOREMPs on the MSLT 2. CSF hypocretin-1 concentration, measured by immunoreactivity, is either ≤110 pg/mLor <1/3 of mean values obtained in normal subjects with the same standardized assay Narcolepsy type 2 Criteria A and E must be met A. The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months. B. A mean sleep latency of ≤8 min and two or more sleep-onset REM periods (SOREMPs) are found on a MSLT performed according to standard techniques. A SOREMP (within 15 min of sleep onset) on the preceding nocturnal polysomnogram may replace one of the SOREMPs on the MSLT C. Cataplexy is absent D. Either CSF hypocretin-1 concentration has not been measured or CSF hypocretin-1 concentration measured by immunoreactivity is either >110 pg/mL or >1/3 of mean values obtained in normal subjects with the same standardized assay E. The hypersomnolence and/or MSLT findings are not explained more clearly by other causes such as insufficient sleep, obstructive sleep apnea, delayed sleep phase disorder or the effect of medication or substances or their withdrawal Hypersomnia due to medical disorders Criteria A–D must be met A. The patient has daily periods of irrepressible need to sleep or daytime lapses into sleep occurring for at least 3 months B. The daytime sleepiness occurs as a consequence of a significant underlying medical or neurological condition C. If an MSLT is performed, the mean sleep latency is ≤ 8 min, and fewer than two sleep onset REM periods (SOREMPs) are observed D. The symptoms are not better explained by another untreated sleep disorder, a mental disorder, or the effects of medications or drugs. (a) If criteria for narcolepsy are fulfilled, a diagnosis of narcolepsy type 1 or type 2 due to a medical condition should be used rather than hypersomnia due to a medical condition; (b) In patients with severe neurological or medical disorders in whom it is not possible or desirable to perform sleep studies, the diagnosis can be made by clinical criteria
Circadian rhythm sleep wake disorders (CRSWDs)	Chronic or recurrent patterns of sleep-wake rhythm disruption primarily caused by an alteration in the endogenous circadian timing system or misalignment between the endogenous circadian rhythm and the sleep-wake schedule. This group includes 1. Delayed sleep–wake phase disorder; 2. Advanced sleep–wake phase disorder; 3. Irregular sleep–wake rhythm disorder; 4. Non-24 h sleep-wake rhythm disorder; 5. Shift work disorder; 6. Jet lag disorder; 7. Circadian sleep–wake disorder not otherwise specified	General criteria for circadian rhythm sleep–wake disorder Criteria A–C must be met A. A chronic or recurrent pattern of sleep–wake rhythm disruption due primarily to alteration of the endogenous circadian timing system or misalignment between the endogenous circadian rhythm and the sleep–wake schedule desired or required by an individual's physical environment or social/work schedules B. The circadian rhythm disruption leads to insomnia symptoms, excessive sleepiness or both C. The sleep and wake disturbances cause clinically significant distress or impairment in mental, physical, social, occupational, educational, or other important areas of functioning
Insomnia	A persistent difficulty with sleep initiation, duration, consolidation, or quality that occurs despite adequate opportunity and circumstances for sleep, and results in some form of daytime impairment	Chronic Insomnia Criteria A–F must be met A. The patient reports, or the patient's parent or caregiver observes, one or more of the following: 1. Difficulty initiating sleep
		2. Difficulty maintaining sleep 3. Waking up earlier than desired 4. Resistance to going to bed on appropriate schedule 5. Difficulty sleeping without parent or caregiver intervention B. The patient reports, or the patient's parent or caregiver observes, one or more of the following related to the nighttime sleep difficulty: 1. Fatigue/malaise 2. Attention, concentration or memory impairment 3. Impaired social, family, occupational, or academic performance 4. Mood disturbance/irritability 5. Daytime sleepiness 6. Behavioral problems (e.g., hyperactivity, impulsivity, aggression) 7. Reduced motivation/energy/initiative 8. Proneness for errors/accidents 9. Concerns about or dissatisfaction with sleep C. The reported sleep/wake complaints cannot be explained purely by inadequate opportunity (i.e., enough time is allotted for sleep) or inadequate circumstances (i.e., the environment is safe, dark, quiet, and comfortable) for sleep D. The sleep disturbance and associated daytime symptoms occur at least three times per week E. The sleep disturbance and associated daytime symptoms have been present for at least 3 months F. The sleep/wake difficulty is not explained more clearly by another sleep disorder
Sleep-Related breathing disorders (SDBs)	A range of conditions characterized by abnormal breathing during sleep; in many cases this is associated with narrowing or obstruction of the upper airway (pharynx). The disordered breathing ranges from intermittent, partial obstruction of the airway without sleep disturbance (snoring) to frequent apneas associated with repetitive hypoxaemia and arousals leading to sleep disruption and daytime sleepiness. This group includes obstructive sleep apnea (OSA) syndrome, central sleep apnea disorders, sleep-related hypoventilation disorders and sleep-related hypoxaemia disorders. OSA is a sleep disorder involving cessation or significant decrease in airflow in the presence of breathing effort	OSA (ADULT) (A and B) or C satisfy the criteria A. The presence of one or more of the following: The patient complains of sleepiness, non-restorative sleep, fatigue or insomnia symptoms The patient wakes with breath holding, gasping or choking The bed partner or other observer reports habitual snoring, breathing interruptions or both during the patient's sleep The patient has been diagnosed with hypertension, a mood disorder, cognitive dysfunction, coronary artery disease, stroke, congestive heart failure, atrial fibrillation, or type 2 diabetes mellitus B. Polysomnography (PSG) or HSAT (Home Sleep Apnea Test) demonstrates: Five or more predominantly obstructive respiratory events [obstructive and mixed apneas, hypopneas or respiratory effort-related arousals (RERAs)] per hour of sleep during a PSG or per hour of monitoring (HSAT) or C. PSG or HSAT demonstrates: Fifteen or more predominantly obstructive respiratory events (apneas, hypopnoeas, or RERAs) per hour of sleep during a PSG or per hour of monitoring (HSAT)
		OSA (PEDIATRIC)
		Criteria A and B must be met The presence of one or more of the following: 1. Snoring 2. Labored, paradoxical, or obstructed breathing during the child's sleep 3. Sleepiness, hyperactivity, behavioral problems, or learning problems PSG demonstrates one or more of the following: 1. One or more obstructive apneas, mixed apneas, or hypopneas, per hour of sleep 2. A pattern of obstructive hypoventilation, defined as at least 25% of total sleep time with hypercapnia (PaCO2 > 50 mm Hg) in association with one or more of the following: (a) Snoring, (b) Flattening of the inspiratory nasal pressure waveform, (c) Paradoxical thoracoabdominal motion

ICSD-3: International Classification of Sleep Disorders - Third Edition (19).