Clinical significance criteria in the ICSD and DSM sleep disorder classifications: a content overlap analysis using the Jaccard index
Journal of Clinical Sleep Medicine. 2025-06-01; 21(6): 1109-1121
DOI: 10.5664/jcsm.11570
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https://www.bordeaux-neurocampus.fr/12607
1. J Clin Sleep Med. 2025 Jun 1;21(6):1109-1121. doi: 10.5664/jcsm.11570.
Clinical significance criteria in the ICSD and DSM sleep disorder
classifications: a content overlap analysis using the Jaccard index.
Gauld C(1)(2)(3), Martin VP(4), Quilès C(5)(6), Geoffroy PA(7)(8)(9), Coelho
J(3)(5), Philip P(3)(5), Lopez R(10), Micoulaud-Franchi JA(3)(5).
Author information:
(1)Department of Child and Adolescent Psychopathology, Hospices Civils de Lyon,
Lyon, France.
(2)Institut des Sciences Cognitives Marc Jeannerod, Unité Mixte de Recherche
5229 Centre National de la Recherche Scientifique and Université Claude Bernard
Lyon 1, Lyon, France.
(3)Université de Bordeaux, Centre National de la Recherche Scientifique, SANPSY,
Unité Mixte de Recherche 6033, Bordeaux, France.
(4)Deep Digital Phenotyping Unit, Department of Precision Health, Luxembourg
Institute of Health, Strassen, Luxembourg.
(5)Université de Bordeaux, Institut National de la Santé et de la Recherche
Médicale, Bordeaux Population Health Research Center, Team Pharmacoepidemiology,
Unité Mixte de Recherche 1219, Bordeaux, France.
(6)Centre Hospitalier Charles Perrens, Bordeaux, France.
(7)Département de Psychiatrie et d’Addictologie, Assistance Publique des
Hôpitaux de Paris, Groupe Hospitalier Universitaire Paris Nord, Département
Médico-Universitaire Neurosciences, Hopital Bichat – Claude Bernard, Paris,
France.
(8)Centre ChronoS, Groupe Hospitalier Universitaire Paris – Psychiatry and
Neurosciences, Paris, France.
(9)Université Paris Cité, Institut National de la Santé et de la Recherche
Médicale, NeuroDiderot, Paris, France.
(10)Institut des Neurosciences de Montpellier, University Montpellier,
Montpellier, France.
STUDY OBJECTIVES: Both the International Classification of Sleep Disorders
(ICSD) and the sleep-wake disorders section of the Diagnostic and Statistical
Manual of Mental Disorders (DSM) emphasize the importance of clinical judgment
in distinguishing the normal from the pathological in sleep medicine. The fourth
edition of the DSM (DSM-IV, 1994) introduced the clinical significance criterion
(CSC) to standardize this judgment and enhance diagnostic reliability.
METHODS: This review conducts a theoretical and historical content analysis of
CSC presence, frequency, and formulation in the diagnostic criteria of sleep
disorders. Three steps were undertaken: (1) selecting main sleep disorder
classifications and main disorders within them, (2) systematically extracting
CSC-related content, and (3) analyzing the evolution of CSC presence through
quantification (Jaccard index) and visualization (radar plots).
RESULTS: The fifth edition, text revision of the DSM (DSM-5-TR) includes CSC in
5 of 9 main sleep disorders, compared to 2 in the third edition, text revision
of the ICSD (ICSD-3-TR) (circadian rhythm sleep-wake disorder and nightmare
disorder). The overlap between DSM-5-TR and ICSD-3-TR is moderate (Jaccard index
= 0.40). The overlap between DSM versions is higher (0.53). Conversely, ICSD
revisions exhibit minimal similarity (0.16). Radar plots reveal a gradual
increase in CSC use within ICSD versions.
CONCLUSIONS: These results highlight the variable application of CSC in sleep
disorder classifications. Universal CSC inclusion may not be essential, but
systematic discussion of its potential use can help refine diagnostic criteria.
This refinement is important for accurately diagnosing sleep disorders and
better differentiating the normal from the pathological, a major challenge in
sleep medicine.
CITATION: Gauld C, Martin VP, Quilès C, et al. Clinical significance criteria in
the ICSD and DSM sleep disorder classifications: a content overlap analysis
using the Jaccard index. J Clin Sleep Med. 2025;21(6):1109-1121.
© 2025 American Academy of Sleep Medicine.
DOI: 10.5664/jcsm.11570
PMCID: PMC12134593
PMID: 39862150 [Indexed for MEDLINE]
Conflict of interest statement: All authors have seen and approved the
manuscript. The authors report no conflicts of interest.