The following questions relate to the behavior that you have
observed in the patient is while he/she is asleep. Use the following
scale to choose the most appropriate number for each situation.
0=Never
1=Infrequently (1 night per week)
2=Frequently (2-3 nights per week)
3=Most of the time (4 or more nights per week)
• Loud, irritating
snoring ______
• Choking or gasping for air _______
• Pauses in breathing _______
• Twitching / kicking of arms or legs _______
• Snoring requiring separate bedrooms _______
• Falling asleep inappropriately (example: while driving or at
meetings)_______
Total score ______
A score of 5 or greater indicates symptoms which are affecting the
health, safety, or quality of life of the observed person.
Daniel T. Quevedo, DDS
- General Dentist treating Obstructive Sleep Apnea Serving Longwood, Alaqua, Heathrow, Lake Mary, Altamonte Springs,
Apopka, Winter Park, Maitland, Casselberry, Winter Springs, and the
Greater Orlando area.