1. Is there difficulty falling asleep or staying asleep?
2. Does the patient snore?
3. Is the patient tired during the day?
4. Has the patient been aware or told that they stop breathing during sleep?
5. Is the sleep refreshing?
If there are positive responses to these questions, further evaluation is recommended. Patients should complete the Epworth Sleepiness Scale (ESS) which is a questionnaire commonly used in sleep medicine to assess a patient’s risk for daytime sleepiness and other risk factors and STOP-BANG questionnaires.
|THE STOP-BANG QUESTIONNAIRE|
|First 4 questions||Additional 4 questions|
|S: snore loudly||B: body mass index > 28|
|T: feel tired during the day||A: age > 50 years|
|O: observed/witnessed to have stopped breathing||N: neck size: male ≥ 43 cm female ≥ 41 cm|
|P: high blood pressure||G; gender; are you male|
|YES to 2 or more of the above:
at risk for sleep apnoea
|YES to 1 or more from above:
Increased risk for moderate to severe sleep apnoea
It has been noted by Wright EF. (2013) that poor sleep and temporomandibular dysfunction are well-known to often coexist.
Epworth Sleepiness Scale
|Situation||Risk of Dozing|
|Sitting and reading|
|Sitting inactive in a public place|
|As a passenger in a car riding for an hour with no breaks|
|Lying down to rest in the afternoon|
|Sitting and talking with someone|
|Sitting quietly after lunch without alcohol|
|In a car while stopped for a few minutes in traffic|
0 = Unlikely
1 = Slight risk
2 = Moderate risk
3 = High likelihood
After ranking each category, the total score is calculated. The range is 0 to 24, with higher scores suggesting greater sleepiness. Scoring:
Breaking it down further, excessive daytime sleepiness is greater than 10. Primary snorers usually have a score less than 10, and individuals with moderate to severe sleep apnoea usually have a score greater than 16. Self-reported, subjective measures such as the Epworth Sleepiness Scale usually are combined with a thorough medical history. The history includes questions about:
A simple sleep apnoea screening questionnaire which is used to quickly identify the risk (low to high) of sleep disordered breathing.(Netzer. et al., 1999. (Netzer NC, Stoohs RA, Netzer CM,Clark K, Strohl KP. Ann Intern Med. 1999 Oct 5;131(7):485-91).
The questionnaire consists of 3 categories related to the risk of having sleep apnoea.
Patients can be classified into High Risk or Low Risk based on their responses to the individual items and their overall scores in the symptom categories.
(Positive if total points ≥ 2)
(Positive if total points ≥ 2)
(Positive if response as below)
|1||‘Yes’||+1||6||‘a’ or ‘b’||+1||10||‘Yes’
BMI is greater than 30kg/m2
|2||‘c’ or ‘d’||+1||7||‘a’ or ‘b’||+1|
|3||‘a’ or ‘b’||+1||8||‘a’||+1|
|5||‘a’ or ‘b’||+2|
High Risk if 2 or more categories are Positive
Low Risk if 1 or no category is Positive
Height (m) ________ Weight (kg)________ Age______ Male / Female
|Category 1||Category 2||Category 3|
1. Do you snore?
2. If you snore, your snoring is:
3. How often do you snore?
4. Has your snoring ever bothered other people?
5. Has anyone noticed that you quit breathing during your sleep?
6. How often do you feel tired or fatigued after your sleep?
8. Have you ever nodded off or fallen
10. Do you have high blood pressure?