Questionnaire for sleep apnea risk
Assess your risk for sleep apnea. The total score for all five sections is your Apnea Risk Score. Print this questionnaire, write in your best answer for each question, and see where you stand.
A. How frequently do you experience, or have you been told about, snoring loud enough to disturb the sleep of others?
1. Never
2. Rarely (less than once a week)
3. Occasionally (1 – 3 times a week)
4. Frequently (More than 3 times a week)
Answer _____
B. How often have you been told that you have “pauses” in breathing, or that you stop breathing during sleep?
1. Never
2. Rarely (less than once a week)
3. Occasionally (1 – 3 times a week)
4. Frequently (More than 3 times a week)
Answer _____
C. How much are you overweight?
1. Not at all
2. Slightly (10 – 20 pounds)
3. Moderately (20 – 40 pounds)
4. Severely (more than 40 pounds)
Answer _____
D. What is your Epworth Sleepiness Score?
1. Less than 8
2. 9 – 13
3. 14 – 18
4. 19 or greater
Answer _____
E. Does your medical history include:
1. High blood pressure
2. Stroke
3. Heart disease
4. More than three awakenings per night (on average)
5. Excessive fatigue
6. Difficulty concentrating or staying awake during the day
Answer _____
If you answered 3 or 4 for questions A through D, especially if you have one or more of the conditions listed in question E, then you may be at risk for sleep apnea, and should discuss this with your physician.