Notum

Obstructive sleep apnoea questionnaire and Epworth Sleepiness Scale (Klausimynas dėl obstrukcinės miego apnėjos ir Epworth mieguistumo skalė)

Save time during your visit — you can submit the questionnaire in advance.

Your details

1. Sex
2. Age
3. Weight (kg)
4. Height (cm)
5. Have you ever dozed off while driving?
6. Have you been in a serious road accident (you were injured or the vehicle was badly damaged) because of sleepiness in the last 3 years?
7. Do you snore almost every night?
8. Has anyone told you that you stop breathing during sleep?
9. Do you wake up rested after a night’s sleep?
10. Is your blood pressure often high, or do you take medicines to lower your blood pressure?

Epworth Sleepiness Scale

Rate how likely you are to doze off or fall asleep in the situations below, regardless of tiredness. Your answers should describe your current way of life. If you have not been in one of these situations recently, try to imagine how you would feel in it. 0 = would never doze; 1 = slight chance of dozing; 2 = moderate chance of dozing; 3 = high chance of dozing.

Sitting and reading
Watching TV
Sitting inactive in a public place (e.g. a 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 and talking to someone
Sitting quietly after lunch without alcohol
In a car, while stopped for a few minutes in traffic

Epworth Sleepiness Scale total: 0 / 24