| Do
You Have Sleep Apnea?
The
following questionaire* will help measure your general level of
daytime sleepiness, which is related to Obstructive Sleep Apnea
(OSA).
Each
of the following questions is rated from 0 to 3, with 0 meaning
you would never doze or fall asleep in a given situation, and 3
meaning that there is a very high likelihood that you would dozre
or fall asleep in that situation.
0 |
= |
would
never doze |
1 |
= |
slight
chance of dozing |
2 |
= |
moderate
chance of dozing |
3 |
= |
high
chance of dozing |
*Epworth
Sleepiness Scale |
| Situation |
0 |
1 |
2 |
3 |
| |
|
|
|
|
| Sitting
and Reading |
|
|
|
|
| |
|
|
|
|
| Watching
TV |
|
|
|
|
| |
|
|
|
|
Sitting,
inactive in a public place
(e.g. a theater or 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 lunch without alcohol |
|
|
|
|
| |
|
|
|
|
| In
a car, while stopped for a few minutes in traffic |
|
|
|
|
Total |
|
|
A
score of 10 or more indicates potentially pathologic sleepiness, and
I would like you to call our office, immediately, to schedule an appoitment
for further evaluation. |