Diplomate, American Board of Otolaryngology – Head and Neck Surgery
Diplomate, American Board Facial Plastic and Reconstructive Surgery
Adult and Pediatric ENT – Facial Plastic Surgery – Hearing and Balance – Snoring and Sleep Apnea
200A Jones Rd – Falmouth, MA 02540 – 508.540.0900 – www.uppercapeENT.com
There is some correlation between your answers to this test and the severity of sleep apnea.
In contrast to feeling just tired, how likely are you to doze off or fall asleep in the following situations? ( Even if you have not done these particular things recently, try to imagine how you might behave in that situation.) Use the following scale for each situation:
0 = Would never doze
1 = Slight chance of dozing
2 = Moderate chance of dozing
3 = High chance of dozing
|
|
| Situation |
Chance
of dozing |
| Sitting and reading |
_______
|
| Watching TV |
_______
|
| Sitting inactive in a public place (e.g. theater) |
_______
|
| As a car passenger for an hour without a break |
_______
|
| Lying down to rest in the afternoon |
_______
|
| Sitting and talking to someone |
_______
|
| Sitting quietly after lunch without alcohol |
_______
|
| In a car, while stopping for a few minutes in traffic |
_______
|
| Total Score |
_______
|
| (Scoring : Sleepy > 10) |
|
