Please answer Yes or No to the following questions.
It is important that you answer each question as best you can
Has the Patient been Diagnosed with OSA?
Is the Patient being Treated for OSA?
Is the Patient Compliant with Treatment for OSA?
Do You or Have Been Told That You Snore?
Disruptive Sleep (Waking up Multiple Times)
Disturbed or Restless Sleep (Tossing and Turning)
(Waking up Tired and Wanting to Sleep Longer)
Have You or Anyone Ever Noticed or Mentioned That You Stop Breathing during Sleep
Frequent Unexpected Awakenings from Sleep
Waking Up Gasping during Sleep
Waking Up Choking during Sleep
Do You Occasionally Fall Asleep or Nod-Off in Situations Where You Did Not Intend To
Excessive Daytime Sleepiness / Tiredness
Waking Up with Dry Mouth
Morning (Waking Up) Headaches
Teeth Grinding (Bruxism) During Sleep
Do You Have (or are being treated for) High Blood Pressure and/or Diabetes
Depression (Daytime Symptoms)*
Irritability / Moodiness (Daytime Symptoms)*
Note: Answering Yes to either or both questions marked with * increases your risk to the next severity category.