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Sleep Disordered Breathing - Self Assessment Questionnaire

sleep-disordered-breathing-self-assessmentComplete our online sleep disordered breathing (SDB) self assessment questionnaire to estimate your likelihood of having a serious SDB condition.

Our unique questionnaire combines a range of scientifically validated and professionally approved screening systems (including the Epworth Sleepiness Scale, the Karolinska Scale, the Flemons Predictor, and more). Combined as they are in this questionnaire, a remarkably accurate assessment is possible.

First, an important note:

The results of this questionnaire will provide a very good indication of whether you have a significant sleep disordered breathing (SDB) condition – but the results are not conclusive. The only truly accurate and professionally recognised method of diagnosis is via a diagnostic sleep study. This questionnaire, in no way, replaces the need for a diagnostic sleep study.

A diagnostic sleep study, or polysomnogram (PSG) is the ‘gold standard’ for the professional diagnosis of SDB. A professional sleep study will monitor your breathing, cardiac activity, brain activity, limb movement, sleeping position, blood oxygen levels and much more, while you sleep.

If you suspect you have an SDB condition, it is important that you either speak to your doctor and arrange for a diagnostic sleep study to be conducted. Or click the link below to organise a professional diagnostic sleep study in the comfort, privacy, and convenience of your own home.

CLICK HERE TO BOOK YOUR DIAGNOSTIC SLEEP STUDY NOW.

If you'd like to discuss your results with a friendly Sleep Therapist, submit your details here and we'll give you a call.

All information provided via the SDB self assessment questionnaire will remain strictly confidential.

Section 1. What is your Body Mass Index (BMI)?
(e.g. 92)
(eg. 180)
{weight}/({height}*{height})*10000

If your BMI total does not display automatically after entering both your weight and height details, check that these values have been entered correctly and please try again (kilograms and centimetres).

Section 2. What is your 'Adjusted Neck Circumference'?
Start with your normally measured neck circumference (i.e., your collar size). Then add the relevant amounts to arrive at your ‘ANC’
(cm)
Enter 3 for YES or 0 for NO.
Enter 3 for YES or 0 for NO.
Enter 4 for YES or 0 for NO.
{neck} + {habitual_snoring} + {wakes_choking_or_gasping} + {hypertension_high_blood_pressure}
Section 3. What are your general sleep/waking patterns?
Section 4. Epworth Sleepiness Scale
In the section below, enter the number that best describes your likelihood of dozing in the corresponding situations. 0=Never    1=Sometimes    2=Likely    3=Highly Likely
{sitting_reading} + {watching_tv} + {sitting_inactive_in_public_place} + {passenger_in_car_1_hour} + {lying_down_rest_afternoon} + {sitting_talking} + {sitting_after_lunch_no_alcohol} + {car_while_stopped_3_minutes}
Section 5. Karolinska Scale
In this section, describe your level of alertness ‘right now’ as you complete this form
Preliminary Assessment
Note: This assessment is not a substitute for a full diagnostic sleep study.
Contact Details
Please enter your contact details so a therapist can contact you regarding the results of your questionnaire.
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