Berlin Questionaire

Question Response


Has your weight changed?

Increase
Decreased
No change


Do you snore?

Yes
No
Do not Know


Snoring loudness

Loud as breathing
Loud as talking
Louder than talking
Very loud


Snoring frequency

Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never


Does your snoring bother other people?

Yes
No


How often have your breathing pauses been noticed?

Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never


Are you tired after sleeping?

Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never


Are you tired during waketime?

Almost every day
3 to 4 times per week
1 to 2 times per week
1 to 2 times per month
Never or almost never


Have you ever fallen asleep while driving?

Yes
No


Do you have high blood pressure?

Yes
No
Do not Know


Scoring Categories: Category 1 is positive with 2 or more positive responses to questions 2-6 ??Category 2 is positive with 2 or more positive responses to questions 7-9 ??Category 3 is positive with 1 or more positive responses and/or a BMI>30 ??Final Results: 2 or more positive categories indicates a high likelihood of sleep disordered breathing.