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Welcome to the Sleep Apnoea Questionnaire

This questionnaire involves 16 questions to test if you may be at risk of Obstructive Sleep Apnoea, the approximate time is around 5 minutes.

Sleep Apnoea Questionnaire – Part 1 of 2

Questions 1–8 / 16
Snoring
Do you snore loudly (loud enough to be heard through closed doors)?
Tired
Do you often feel tired, fatigued, or sleepy during the daytime (falling asleep while driving or talking to someone)?
Observed
Has anyone observed you stop breathing or choking/gasping during your sleep?
Pressure
Do you have or are you being treated for high blood pressure?
Body Mass Index
Is your Body Mass Index (BMI) more than 35kg/m2 according to your height and weight?
BMI -
Age
Are you older than 50?
Neck
Do you have a large sized neck?
For male, is your shirt collar 17 inches / 43 cm or larger?
For female, is your shirt collar 16 inches / 41cm or larger?
(measured around Adam’s apple)
Gender
Are you male?

Epworth Sleepiness Scale – Part 2 of 2

Questions 9–16 / 16
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
Sitting and reading:
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
Watching television:
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
Sitting inactive in a public place (e.g. a theatre/meeting):
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
As a passenger in a car for an hour with no break:
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
Lying down in the afternoon (when possible):
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
Sitting and talking to someone:
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
Sitting quietly after lunch without alcohol:
Please answer the following questions on how likely you would be to doze off or fall asleep, while doing the following activities.
In a car, while stopped for a few minutes in traffic: