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The Ruhrland-Hospital in Essen-Heidhausen (Germany), Department of Sleep Medicine, compiled the following questionnaire for the diagnosis of Sleep Apnoea. Complete all sections fully.
By adding up your score, you can determine whether it is likely that you suffer from Sleep Apnoea and whether therefore you should consult your doctor who may refer you to a sleep laboratory for sleep study.
Score your answer to each question as follows:
0 = Never, 1 = Rarely, 2 = Often, 3 = Frequently
| Never | Rarely | Often | Frequently | ||
| 1. | Do you feel sleepy during the day? | 0 | 1 | 2 | 3 |
| 2. | Do you doze off during the day spontaneously? | 0 | 1 | 2 | 3 |
| 3. | Do you find it hard to concentrate for long periods of time? | 0 | 1 | 2 | 3 |
| 4. | Do you feel less efficient than you used to feel? | 0 | 1 | 2 | 3 |
| 5. | Do you snore loudly or do others say you do? | 0 | 1 | 2 | 3 |
| 6. | Has your partner witnessed you stopping breathing during your sleep? | 0 | 1 | 2 | 3 |
| 7. | Do you wake up in the morning with a headache? | 0 | 1 | 2 | 3 |
| 8. | Do you feel tired and dizzy in the morning? | 0 | 1 | 2 | 3 |
| 9. | Do you fall asleep when watching TV, reading, working at the office, driving or talking to others? | 0 | 1 | 2 | 3 |
| 10. | Do you have difficulty falling asleep at night? | 0 | 1 | 2 | 3 |
| 11. | Do you wake up during the night? | 0 | 1 | 2 | 3 |
| 12. | Do you wake up earlier than you used to or is it taking you longer to get back to sleep than it used to take you? | 0 | 1 | 2 | 3 |
| 13. | Do you fidget in your sleep and/or is your bed rumpled in the morning? | 0 | 1 | 2 | 3 |
The likelihood with which Sleep Apnea may be present depends upon the total score as follows:
- 0 – 14: Unlikely, everything appears to be O.K.
- 15 – 25: Quite probable
- > 25: Very probable
The publication of this questionnaire was gratefully authorised by the Federal Sleep Apnoea Association of Germany e.V. (www.bsd-web.de)
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