Sleep Apnea Questionnaire

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 have not 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:

0 = would never doze 

1 = slight chance of dozing

2 = moderate chance of dozing

3 = high chance of dozing 

 

_______ Sitting & Reading 

_______ Watching TV

_______ Sitting, inactive in a public place (e.g. a movie theatre 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 & talking to someone

_______ Sitting quietly after a lunch without alcohol

_______ In a car, while stopped for a few minutes in traffic

_______ TOTAL

Subjects/Diagnoses Total Number Age in Years ESS Scores

Subjects (M/F) (mean ± SD) (mean ± SD)

Normal Controls 30 (14/16) 36.4 ± 9.9 5.9 ± 2.2

Primary snoring 32 (29/3) 45.7 ± 10.7 6.5 ± 3.0

Obstructive sleep 55 (53/2) 48.4 ± 10.7 11.7 ± 4.6

apnea syndrome

Narcolepsy 13 (8/5) 46.6 ± 12.0 17.5 ± 3.5

Idiopathic Hypersomnia 14 (8/6) 41.4 ± 14.0 17.9 ± 3.1

Insomnia 16 (6/12) 40.3 ± 14.6 2.2 ± 2.0

Periodic limb movement 18 (16/2) 52.5 ± 10.3 9.2 ± 4.0  

disorder