Snoring?
Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?
YES
NO
Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?
Do you often feel Tired, Fatigued, or Sleepy during the daytime (tired enough that you could fall asleep while driving?
Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?
Do you have or are you being treated for High Blood Pressure?
For male, is your shirt collar 17 inches/43 cm or larger?
For female, is your shirt collar 16 inches/41 cm or larger ?
(Rate with 0 - 3 scale)
0 = Would never doze
2 = Moderate chance of dozing
1 = Slight chance of dozing
3 = High chance of dozing
How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:
It is important that you answer each question as best you can.
0
1
2
3
Sitting and reading
Watching TV
Sitting, inactive in a public place
(e.g. a theater or a meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
In a car, while stopped for a few minutes in the traffic