Self-Check Questionnaire for Snorers

The Ruhrland-Hospital in Essen - Heidhausen (Germany), Dept. 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 = very often

Enter the figures into the boxes below.

Questions	Grading
1. Are you 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 difficult to concentrate for long periods?	0 1 2 3
4. Do you feel less efficient than you used to?	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 car and/or talking to others?	0 1 2 3
10. Do you have difficulties getting to sleep at night?	0 1 2 3
11. Do you wake up during the night?	0 1 2 3
12. Dou you wake up earlier than you used to and are unable to fall back to sleep, or is it taking you longer to get back to sleep once you've awoken than it used to take?	0 1 2 3
13. Do you fidget in your sleep and/or is your bed rumpled in the morning?	0 1 2 3
Your score

The publication of this questionnaire was gratefully authorized by the Federal Sleep Apnoea Association of Germany e.V., Deipenbecktal 171, 45289 Essen; Phone: +49-201-57 06 57, Fax +49-201-57 27 98; Internet: www.bsd-web.de

The likelihood with which sleep apnoea may be present, depends upon the total score as follows:

0 - 14:	Unlikely, everything appears to be O.K.
15 - 25:	Rather probable
> 25:	Very probable

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