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Sleep Questionnaire - OSA Sleep Questionnaire



Identify each of the following that apply:

  • Snoring, interrupted by pauses in breathing
  • Gasping or choking during sleep
  • Restless Sleep
  • Excessive sleepiness or fatigue during the day
  • Large neck size (greater than 17" in men; greater than 16" in women)
  • Crowded airway
  • Morning headaches
  • Sexual dysfunction
  • Frequent urination at night
  • Poor judgment or concentration
  • Irritability
  • Memory loss
  • High blood pressure
  • Depression
  • Obesity

If you or someone you know snores regularly and has one or more of these symptoms, it may be Obstructive Sleep Apnea. Please talk with your physician, or call our sleep center for more information.

Idaho Sleep Specialists, 403 South 11th Street Suite 210, Boise, ID 83702
Phone (208) 895-0411   -   Fax (208) 895-0406

OSA Sleep Questionnaire Epworth Sleepiness Score Sleepiness Scale Narcolepsy Sleep Questionnaire
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