Interobserver reliability of ICSD-3 diagnostic criteria for disorders of arousal in adults

Giuseppe Loddo, Luca Vignatelli, Corrado Zenesini, Francesco Lusa, Luisa Sambati, Luca Baldelli, Valentina Favoni, Laura Rosa Pisani, Giulia Pierangeli, Sabina Cevoli, Federica Provini

Research output: Contribution to journalArticlepeer-review


Purpose: Disorders of arousal include confusional arousals, sleepwalking and sleep terrors. The diagnosis of disorders of arousal is based on the clinical criteria established in the International Classification of Sleep Disorders, third edition, although the interobserver reliability of these criteria has never been investigated. The aim of this study was to estimate the inter-rater reliability of the diagnostic criteria for disorders of arousal throughout the whole life in order to understand their feasibility in clinical daily activity and in multicenter observational studies. Methods: Three raters interviewed 126 subjects (patients complaining of sleep disorders, headache, and healthy subjects), aged 18–80 years, with a standardized questionnaire created by applying the International Diagnostic Criteria for Disorders of Arousal. Results: An “almost perfect” inter-rater reliability for disorders of arousal criteria and the final diagnosis was found among the raters (kappa 0.89 for confusional arousals, 0.87 for sleepwalking, and 0.87 for sleep terrors). Conclusions: The International Classification of Sleep Disorders, Third Edition criteria are adequate for a reliable diagnosis of disorders of arousal. Further validation studies, confirming DOA diagnosis with video polysomnography, are needed to investigate the predictive value of ICSD-3 criteria.

Original languageEnglish
Pages (from-to)1309-1314
Number of pages6
JournalSleep and Breathing
Issue number4
Publication statusPublished - Dec 1 2019


  • Confusional arousal
  • Movement disorders
  • NREM parasomnias
  • Questionnaires
  • Sleep terror
  • Sleepwalking

ASJC Scopus subject areas

  • Otorhinolaryngology
  • Clinical Neurology


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