The aim of this European initiative is to facilitate a structured discussion to improve the next edition of the International Classification of Sleep Disorders (ICSD), particularly the chapter on central disorders of hypersomnolence. The ultimate goal for a sleep disorders classification is to be based on the underlying neurobiological causes of the disorders with clear implication for treatment or, ideally, prevention and or healing. The current ICSD classification, published in 2014, inevitably has important shortcomings, largely reflecting the lack of knowledge about the precise neurobiological mechanisms underlying the majority of sleep disorders we currently delineate. Despite a clear rationale for the present structure, there remain important limitations that make it difficult to apply in routine clinical practice. Moreover, there are indications that the current structure may even prevent us from gaining relevant new knowledge to better understand certain sleep disorders and their neurobiological causes. We suggest the creation of a new consistent, complaint driven, hierarchical classification for central disorders of hypersomnolence; containing levels of certainty, and giving diagnostic tests, particularly the MSLT, a weighting based on its specificity and sensitivity in the diagnostic context. We propose and define three diagnostic categories (with levels of certainty): 1/"Narcolepsy" 2/"Idiopathic hypersomnia", 3/"Idiopathic excessive sleepiness" (with subtypes).

Center for Narcolepsy and Hypersomnias University Witten Herdecke Witten Germany

Danish Center for Sleep Medicine Department of Clinical Neurophysiology Rigshospitalet Copenhagen Denmark

Department of Biomedical and Neuromotor Sciences University of Bologna Bologna Italy; IRCCS Istituto delle Scienze Neurologiche di Bologna Bologna Italy

Department of Neurology and Center of Clinical Neuroscience 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Neurology Hephata Klinik and Philipps Universität Marburg Germany

Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland; Department of Neurology Sechenov 1st State Medical University Moscow Russia

Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland; Department of Neurology Sechenov 1st State Medical University Moscow Russia; Center for Sleep Medicine Sleep Research and Epileptology Klinik Barmelweid AG Barmelweid Switzerland

Department of Neurology Inselspital Bern University Hospital University of Bern Bern Switzerland; Department of Neurology Sechenov 1st State Medical University Moscow Russia; Sleep and Epilepsy Center Neurocenter of Southern Switzerland Civic Hospital of Lugano Lugano Switzerland

Department of Neurology James Cook University Hospital Middlesbrough UK

Helsinki Sleep Clinic Vitalmed Research Centre Helsinki Finland; Department of Clinical Neurosciences University of Helsinki Helsinki Finland

Institute of Clinical Neurophysiology University Medical Centre University of Ljubljana Ljubljana Slovenia

Neurology Service Multidisciplinary Sleep Unit Hospital Clinic de Barcelona IDIBAPS CIBERNED Universitat de Barcelona Barcelona Spain

Pediatric Sleep Center Hospital Robert Debré Paris France; National Reference Centre for Orphan Diseases Narcolepsy Idiopathic Hypersomnia and Kleine Levin Syndrome Paris France

Sleep Wake Centre SEIN Achterweg 5 Heemstede the Netherlands; Department of Neurology Leiden University Medical Centre Leiden the Netherlands

Sleep Wake Disorders Center National Reference Network for Narcolepsy Department of Neurology Gui de Chauliac Hospital INSERM U1061 University of Montpellier CHU Montpellier France

Sleep Med Rev. 2020 Aug;52:101329. doi: 10.1016/j.smrv.2020.101329. PubMed

Sleep Med Rev. 2020 Aug;52:101326. doi: 10.1016/j.smrv.2020.101326. PubMed

Sleep Med Rev. 2020 Aug;52:101328. doi: 10.1016/j.smrv.2020.101328. PubMed

Sleep Med Rev. 2020 Aug;52:101343. doi: 10.1016/j.smrv.2020.101343. PubMed

Sleep Med Rev. 2020 Aug;52:101327. doi: 10.1016/j.smrv.2020.101327. PubMed

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