Questionnaires-English

BMI Calculator

BMI Calculator

Weight

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BMI (Kg/m2)

NoSAS

1. Is your neck circumference greater than 40 cm?yesno

2. is your BMI greater than 25 kg/m2 and less than 30 kg/m2?yesno

3. Is your BMI equal to or greater than 30 kg/m2?yesno

4. Do you snore?yesno

5. Are you older than 55 years?yesno

6. Are you male?yesno

Calculations

You have a low risk of obstructive sleep apnea

You have a high risk of obstructive sleep apnea

Please, answer all the questions to see the result

STOP-BANG

1. Do you snore loudly (loud enough to be heard through closed doors or your partner comments on it)?yesno

2. Do you often feel tired, fatigued, or sleepy during the daytime?yesno

3. Has anyone observed you stop breathing during your sleep?yesno

4. Do you have or are you being treated for high blood pressure?yesno

5. Is your body mass index higher than 35?yesno

6. Are you over 50 years old?yesno

7. Is your neck circumference larger than 40 cm for women or 43 cm for men?yesno

8. Are you male or female?malefemale

Total

You have a low risk of obstructive sleep apnea

You have an intermediate risk of obstructive sleep apnea

You have a high risk of obstructive sleep apnea

Please, answer all the questions to see the result

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Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations, in comparison to feeling just tired?

This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you.

1. Sitting and readingWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

2. Watching televisionWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

3. Sitting inactive in a public place, for example, a theatre or a meetingWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

4. As a passenger in a car for an hour without breakWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

5. Lying down to rest in the afternoonWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

6. Sitting and talking to someoneWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

7. Sitting quietly after lunchWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

8. In a car while stopped in trafficWould never dozeSlight chance of dozingModerate chance of dozingHigh chance of dozing

Score

Normal range of sleepiness

Please, answer all the questions to see the result

Mild sleepiness

Moderate sleepiness

Severe sleepiness

Berlin

1. Do you snore?yesnodon’t know

2. Your snoring is? (if you snore)slightly louder than breathingas loud as talkinglouder than talkingvery loud. Can be heard in adjacent rooms

3. How often do you snore?nearly every day3-4 times a week1-2 times a week1-2 times a monthnever or nearly never

4. Has your snoring ever bothered other people?yesno

5. Has anyone noticed that you quit breathing during your sleep?nearly every day3-4 times a week1-2 times a week1-2 times a monthnever or nearly never

Category1

6. How often do you feel tired or fatigued after your sleep?nearly every day3-4 times a week1-2 times a week1-2 times a monthnever or nearly never

7. During your wake time, do you feel tired, fatigued or not up to par?nearly every day3-4 times a week1-2 times a week1-2 times a monthnever or nearly never

8. Have you ever nodded off or fallen asleep while driving a vehicle?yesno

if yes, how often does it occur?nearly every day3-4 times a week1-2 times a week1-2 times a monthnever or nearly never

Category2

9. Do you have high blood pressure?yesnodon’t know

10. BMI > 30yesno

Category3

You are positive for category 1

You are positive for category 2

You are positive for category 3

You are negative for all categories

If you are positive for two or more categories, you have a high likelihood of sleep apnea.

Please, answer all the questions to see the result

Risk Factor Test

Many instances of snoring are benign, but it is important to talk with a doctor if there are signs of potential sleep apnea. Not sleeping well, for whatever reason, can seriously affect your health and even your life expectancy.

Sleep is essential for the body and brain to repair and renew itself. Chronic lack of sleep can contribute to a range of medical conditions. If you have noticed these signs below, it is important to address the issue with a doctor who can determine if additional testing or treatment is necessary. There are several warning signs that may indicate if you are suffering from OSA.

Obesity or recent weight gainDiabetes (type 2)High blood pressureHeart diseaseDepression and anxietyInsomnia

During the night:Snoring that occurs three or more times per weekVery loud snoring or bothersome snoringSnoring with gasping or snorting soundsWitnessed apnea or choking during sleepSleeping on backNighttime teeth grindingDry mouthWaking up at night with a sore throatFrequent nighttime urinationRestless feetGoing to bed with alcohol in bloodAcid refluxAllergies or other sources of nasal congestionSweating at nightBreathing through mouth

During the day:Waking up feeling unrefreshedWaking up with a headacheWaking up with sore throatWaking up with dry mouthFeeling excessively sleepy during the dayDecreased energy and motivationDifficulty to concentrateIrritabilityLack of focus or mental sharpness

Craniofacial features. Patients with obstructive sleep apnea may exhibit various craniofacial phenotypes, including:1. Retrognathia2. Micrognathia3. Narrowed maxilla4. Hypertrophic turbinates5. Enlarged tonsils and adenoids6. High arched and narrow palate