Do You Have a Sleep Disorder?

Assess your risk for sleep apnea:

1. Do you have a history of snoring?

___ No, I have never been told of this. (0)
___ Yes, but mild or infrequent. (0)
___ Yes, but only moderate and incontinuous. (2)
___ Yes, severe and consistent. (8)

2. Have you been told that you have “pauses” in breathing during your sleep?

___ No, I have never been told of this. (0)
___ Yes, but infrequent (2)
___ Yes, inconsistent but most nights (8)
___ Yes, severly so (10)

3. Are you overweight?

___ No (0)
___ Yes < 20 lbs. (2)
___ Yes 20 – 50 lbs. (3)
___ Yes > 50 lbs. (8)

4. Evaluate your sleepiness (Epworth Sleepiness Scale)

___ Score < 8 (0)
___ Score 9 – 13 (1)
___ Score 14 – 18 (6)
___ Score > 19 (8)

5. Does your medical history include?

___ a. High Blood Pressure (6)
___ b. Stroke (1)
___ c. Heart Disease (1)
___ d. Morning Headaches (1)
___ e. More than 3 awakenings/night (4)
___ f. Excess fatique (1)
___ Depression (1)
___ Diabetes, even borderline (1)

The total score of all 5 sections denotes your “Apnea Risk Score

TOTAL “Apnea Risk Score”_______

APNEA RISK SCORE SCALE

5 – 9   Discuss complaints with your doctor.

10 – 14   Important to discuss complaints with your doctor
(consider sleep evaluation).

15 – 19   Sleep consulation or sleep study suggested.

> 20    Significant risk of sleep apnea.
This suggests a sleep study should be scheduled.