Sleep Screening (Epworth Sleepiness Scale Questionnaire)

Epworth Sleepiness Scales (ESS)

Screening for Obstructive Sleep Apnea (OSA)

 

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?

 

Use the following scale to choose the most appropriate number for each situation:

0 - Would never doze

1 - Slight chance of dozing

2 - Moderate chance of dozing

3 - High chance of dozing

 

1. 
Sitting and reading

2. 
Watching TV

3. 
Sitting, inactive in a public place (e.g. a theater or a meeting)

4. 
As a passenger in a car for an hour without a break

5. 
Lying down to rest in the afternoon when circumstances permit

6. 
Sitting and talking to someone

7. 
Sitting quietly after a lunch without alcohol

8. 
In a car, while stopped for a few minutes in the traffic

Name
Email
Contact No.

Epworth Sleepiness Scales (ESS)

Screening for Obstructive Sleep Apnea (OSA)

 

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired?

 

Use the following scale to choose the most appropriate number for each situation:

0 – Would never doze

1 – Slight chance of dozing

2 – Moderate chance of dozing

3 – High chance of dozing

 

1. 
Sitting and reading

2. 
Watching TV

3. 
Sitting, inactive in a public place (e.g. a theater or a meeting)

4. 
As a passenger in a car for an hour without a break

5. 
Lying down to rest in the afternoon when circumstances permit

6. 
Sitting and talking to someone

7. 
Sitting quietly after a lunch without alcohol

8. 
In a car, while stopped for a few minutes in the traffic

Name
Email
Contact No.