/* Screening Tools for Sleep Disorders */ SLEEPEZ SCREENING TOOLS Validated screening questionnaires for sleep disorder assessment in clinical practice EPWORTH SLEEPINESS SCALE (ESS) ------------------------------ Purpose: Measures daytime sleepiness Scoring: 0-24 (higher scores indicate more daytime sleepiness) Interpretation: - 0-5: Lower normal daytime sleepiness - 6-10: Higher normal daytime sleepiness - 11-12: Mild excessive daytime sleepiness - 13-15: Moderate excessive daytime sleepiness - 16-24: Severe excessive daytime sleepiness Instructions: How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven't done some of these things recently, try to work out how they would have affected you. 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 Situations: 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 traffic ___ TOTAL SCORE: ___ Reference: Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991;14(6):540-545. STOP-BANG QUESTIONNAIRE ---------------------- Purpose: Screens for Obstructive Sleep Apnea (OSA) Scoring: 0-8 (higher scores indicate higher risk of OSA) Interpretation: - 0-2: Low risk of OSA - 3-4: Intermediate risk of OSA - 5-8: High risk of OSA Questions (1 point for each "Yes" answer): S - Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)? □ Yes □ No T - Do you often feel TIRED, fatigued, or sleepy during daytime? □ Yes □ No O - Has anyone OBSERVED you stop breathing during your sleep? □ Yes □ No P - Do you have or are you being treated for high blood PRESSURE? □ Yes □ No B - BMI more than 35 kg/m²? □ Yes □ No A - AGE over 50 years old? □ Yes □ No N - NECK circumference > 16 inches (40 cm)? □ Yes □ No G - GENDER: Male? □ Yes □ No TOTAL SCORE: ___ Reference: Chung F, et al. STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea. Chest. 2016;149(3):631-638. INSOMNIA SEVERITY INDEX (ISI) ---------------------------- Purpose: Assesses the nature, severity, and impact of insomnia Scoring: 0-28 (higher scores indicate more severe insomnia) Interpretation: - 0-7: No clinically significant insomnia - 8-14: Subthreshold insomnia - 15-21: Clinical insomnia (moderate severity) - 22-28: Clinical insomnia (severe) For each question, please CIRCLE the number that best describes your answer. 1. Please rate the SEVERITY of your current sleep problem(s): None Mild Moderate Severe Very Severe a. Difficulty falling asleep 0 1 2 3 4 b. Difficulty staying asleep 0 1 2 3 4 c. Problem waking up too early 0 1 2 3 4 2. How SATISFIED/DISSATISFIED are you with your current sleep pattern? Very Satisfied Satisfied Moderately Satisfied Dissatisfied Very Dissatisfied 0 1 2 3 4 3. To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g., daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, etc.)? Not at all A Little Somewhat Much Very Much 0 1 2 3 4 4. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? Not at all A Little Somewhat Much Very Much 0 1 2 3 4 5. How WORRIED/DISTRESSED are you about your current sleep problem? Not at all A Little Somewhat Much Very Much 0 1 2 3 4 TOTAL SCORE: ___ Reference: Morin CM, et al. The Insomnia Severity Index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601-608. BERLIN QUESTIONNAIRE ------------------ Purpose: Identifies risk factors for sleep apnea Scoring: 3 categories, high risk if 2 or more categories are positive Interpretation: - High Risk: 2-3 positive categories - Low Risk: 0-1 positive categories Category 1: 1. Do you snore? □ Yes □ No □ Don't know If you snore: 2. Your snoring is: □ Slightly louder than breathing □ As loud as talking □ Louder than talking □ Very loud – can be heard in adjacent rooms 3. How often do you snore? □ Nearly every day □ 3-4 times a week □ 1-2 times a week □ 1-2 times a month □ Never or nearly never 4. Has your snoring ever bothered other people? □ Yes □ No 5. Has anyone noticed that you quit breathing during your sleep? □ Nearly every day □ 3-4 times a week □ 1-2 times a week □ 1-2 times a month □ Never or nearly never Category 2: 6. How often do you feel tired or fatigued after your sleep? □ Nearly every day □ 3-4 times a week □ 1-2 times a week □ 1-2 times a month □ Never or nearly never 7. During your waking time, do you feel tired, fatigued or not up to par? □ Nearly every day □ 3-4 times a week □ 1-2 times a week □ 1-2 times a month □ Never or nearly never 8. Have you ever nodded off or fallen asleep while driving a vehicle? □ Yes □ No If yes: 9. How often does this occur? □ Nearly every day □ 3-4 times a week □ 1-2 times a week □ 1-2 times a month □ Never or nearly never Category 3: 10. Do you have high blood pressure? □ Yes □ No □ Don't know 11. BMI > 30 kg/m²? □ Yes □ No Reference: Netzer NC, et al. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med. 1999;131(7):485-491. INTERNATIONAL RESTLESS LEGS SYNDROME STUDY GROUP RATING SCALE (IRLS) ------------------------------------------------------------------- Purpose: Assesses severity of Restless Legs Syndrome (RLS) symptoms Scoring: 0-40 (higher scores indicate more severe symptoms) Interpretation: - 0: None - 1-10: Mild - 11-20: Moderate - 21-30: Severe - 31-40: Very severe For each question, please circle one answer only. 1. Overall, how would you rate the RLS discomfort in your legs or arms? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 2. Overall, how would you rate the need to move around because of your RLS symptoms? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 3. Overall, how much relief of your RLS arm or leg discomfort do you get from moving around? Complete relief (0) Almost complete relief (1) Moderate relief (2) Slight relief (3) No relief (4) 4. How severe is your sleep disturbance due to your RLS symptoms? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 5. How severe is your tiredness or sleepiness during the day due to your RLS symptoms? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 6. How severe is your RLS as a whole? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 7. How often do you get RLS symptoms? Never (0) Occasionally (1) Sometimes (2) Often (3) Very often (4) 8. When you have RLS symptoms, how severe are they on an average day? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 9. Overall, how severe is the impact of your RLS symptoms on your ability to carry out your daily affairs? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) 10. How severe is your mood disturbance due to your RLS symptoms? None (0) Mild (1) Moderate (2) Severe (3) Very severe (4) TOTAL SCORE: ___ Reference: Walters AS, et al. Validation of the International Restless Legs Syndrome Study Group rating scale for restless legs syndrome. Sleep Med. 2003;4(2):121-132. PITTSBURGH SLEEP QUALITY INDEX (PSQI) ----------------------------------- Purpose: Measures sleep quality and disturbances over a one-month period Scoring: 0-21 (higher scores indicate worse sleep quality) Interpretation: - ≤5: Good sleep quality - >5: Poor sleep quality The PSQI contains 19 self-rated questions and 5 questions rated by the bed partner or roommate (if available). Only self-rated questions are included in the scoring. The 19 self-rated items are combined to form seven "component" scores, each of which has a range of 0-3 points. In all cases, a score of "0" indicates no difficulty, while a score of "3" indicates severe difficulty. The seven component scores are then added to yield one global score, with a range of 0-21 points, "0" indicating no difficulty and "21" indicating severe difficulties in all areas. Components: 1. Subjective sleep quality 2. Sleep latency 3. Sleep duration 4. Habitual sleep efficiency 5. Sleep disturbances 6. Use of sleeping medication 7. Daytime dysfunction Reference: Buysse DJ, et al. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. MORNINGNESS-EVENINGNESS QUESTIONNAIRE (MEQ) ----------------------------------------- Purpose: Determines chronotype (morning or evening preference) Scoring: 16-86 (higher scores indicate morning preference) Interpretation: - 16-30: Definite evening type - 31-41: Moderate evening type - 42-58: Intermediate type - 59-69: Moderate morning type - 70-86: Definite morning type The MEQ consists of 19 questions about sleep habits and preferences. Each question has a point value, and the sum of all points gives the final score. Reference: Horne JA, Östberg O. A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol. 1976;4(2):97-110. USAGE GUIDELINES -------------- 1. These screening tools should be used as part of a comprehensive clinical evaluation 2. Positive screens require follow-up assessment and should not be used alone for diagnosis 3. Consider patient literacy and language needs when administering questionnaires 4. Electronic versions of these tools can be integrated into electronic health records 5. Regular rescreening is recommended for high-risk patients or those with persistent symptoms © 2025 SleepEz. All rights reserved. These screening tools are provided for clinical use only.