berlin questionnaire - snoremart.com questionnaire.pdf · 1. do you snore? a. yes b. no c. don’t...
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1. Do you snore?
a. Yes
b. No
c. Don’t know
2. If you do snore, your snoring is:
a. Slightly louder than breathing
b. As loud as talking
c. Louder than talking
d. Very loud – can be heard in
adjacent rooms
3. How often do you snore?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
4. Has your snoring ever bothered other
people?
a. Yes
b. No
c. Don’t know
5. Has anyone noticed that you quit
breathing during your sleep?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
6. How often do you feel tired or fatigued
after your sleep?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
7. During your waking time, do you feel
tired, fatigued or not up to par?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
8. Have you ever nodded off or fallen
asleep while driving a vehicle?
a. Yes
b. No
9. If yes to #8, How often does this occur?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
10. Do you have high blood pressure?
a. Yes
b. No
c. Don’t know
Berlin Questionnaire
The Berlin Questionnaire is a simple test that can help determine the likelihood that you have sleep
apnea. Answer the below questions to learn if you are at high or low risk for sleep apnea.
1. Do you snore?
a. Yes
b. No
c. Don’t know
If answered YES, assign 1 point
2. If you do snore, your snoring is:
a. Slightly louder than breathing
b. As loud as talking
c. Louder than talking
d. Very loud – can be heard in
adjacent rooms
If answered C or D, assign 1 point
3. How often do you snore?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
If answered A or B, assign 1 point
4. Has your snoring ever bothered other
people?
a. Yes
b. No
c. Don’t know
If answered A, assign 1 point
5. Has anyone noticed that you quit
breathing during your sleep?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
If answered A or B, assign 1 point
Category 1 overall points: ________
(2 or more points = “Positive”)
6. How often do you feel tired or fatigued
after your sleep?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
If answered A or B, assign 1 point
7. During your waking time, do you feel
tired, fatigued or not up to par?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
If answered A or B, assign 1 point
8. Have you ever nodded off or fallen
asleep while driving a vehicle?
a. Yes
b. No
If answered A, assign 1 point
Category 2 overall points: ________
(2 or more points = “Positive”)
9. If yes to #8, How often does this occur?
a. Nearly every day
b. 3-4 times a week
c. 1-2 times a week
d. 1-2 times a month
e. Never or nearly never
10. Do you have high blood pressure?
a. Yes
b. No
c. Don’t know
Category 3: If answered Yes = “Positive”
Berlin Questionnaire Scoring
The Berlin Questionnaire scoring system allows you to tally your own score based on 3 categories. If you have 2 or more
Categories with a positive score, then you are at High Risk for Sleep Apnea