Sleep Screening (Berlin Questionnaire)

Berlin Questionnaire

Screening for Obstructive Sleep Apnea (OSA)

Is it possible that you have ...
Obstructive Sleep Apnea (OSA)?

 

Please answer the following questions below to determine if you might be at risk.

[Category 1]

1. Do you snore?

If you snore:

2. Your snoring is?

3. How often do you snore?

4. Has your snoring ever bothered other people?

5. Has anyone noticed that you stop breathing
during your sleep?

[Category 2]

6. How often do you feel tired or
fatigued after your sleep?

7. During your waking time, do you
feel tired, fatigued or not up to
par?

8. Have you ever nodded off or fallen asleep
while driving a vehicle?

If you answered 'Yes'

9. How often does this occur?

[Category 3]

10. Do you have high blood
pressure or BMI is greater than 30kg/m2.?
BMI Calculator Click HERE

Name
Email
Contact No.

Berlin Questionnaire

Screening for Obstructive Sleep Apnea (OSA)

Is it possible that you have …
Obstructive Sleep Apnea (OSA)?

 

Please answer the following questions below to determine if you might be at risk.

[Category 1]

1. Do you snore?

If you snore:

2. Your snoring is?

3. How often do you snore?

4. Has your snoring ever bothered other people?

5. Has anyone noticed that you stop breathing
during your sleep?

[Category 2]

6. How often do you feel tired or
fatigued after your sleep?

7. During your waking time, do you
feel tired, fatigued or not up to
par?

8. Have you ever nodded off or fallen asleep
while driving a vehicle?

If you answered 'Yes'

9. How often does this occur?

[Category 3]

10. Do you have high blood
pressure or BMI is greater than 30kg/m2.?
BMI Calculator Click HERE

Name
Email
Contact No.