Sleep Disorder Diagnosis Guideline

The STOP-BANG Questionnaire

1. Is there difficulty falling asleep or staying asleep?
2. Does the patient snore?
3. Is the patient tired during the day?
4. Has the patient been aware or told that they stop breathing during sleep?
5. Is the sleep refreshing?

If there are positive responses to these questions, further evaluation is recommended. Patients should complete the Epworth Sleepiness Scale (ESS) which is a questionnaire commonly used in sleep medicine to assess a patient’s risk for daytime sleepiness and other risk factors and STOP-BANG questionnaires.

THE STOP-BANG QUESTIONNAIRE
First 4 questions Additional 4 questions
S: snore loudly B: body mass index > 28
T: feel tired during the day A: age > 50 years
O: observed/witnessed to have stopped breathing N: neck size: male ≥ 43 cm  female ≥ 41 cm
P: high blood pressure G; gender; are you male
   
YES to 2 or more of the above:
at risk for sleep apnoea
YES to 1 or more from above:
Increased risk for moderate to severe sleep apnoea

It has been noted by Wright EF. (2013) that poor sleep and temporomandibular dysfunction are well-known to often coexist.

Epworth Sleepiness Scale

Situation Risk of Dozing
Sitting and reading  
Watching television  
Sitting inactive in a public place  
As a passenger in a car riding for an hour with no breaks  
Lying down to rest in the afternoon  
Sitting and talking with someone  
Sitting quietly after lunch without alcohol  
In a car while stopped for a few minutes in traffic  

0 = Unlikely
1 = Slight risk
2 = Moderate risk
3 = High likelihood

After ranking each category, the total score is calculated. The range is 0 to 24, with higher scores suggesting greater sleepiness.  Scoring:

  • 0 to 9 = Average daytime sleepiness
  • 10 to 15 = Excessive daytime sleepiness
  • 16 to 24 = Moderate to severe daytime sleepiness

Breaking it down further, excessive daytime sleepiness is greater than 10. Primary snorers usually have a score less than 10, and individuals with moderate to severe sleep apnoea usually have a score greater than 16. Self-reported, subjective measures such as the Epworth Sleepiness Scale usually are combined with a thorough medical history. The history includes questions about:

  • work performance
  • daytime sleepiness
  • driving and accident history
  • napping
  • falling asleep during meetings
  • decreased memory

Berlin Questionnaire

A simple sleep apnoea screening questionnaire which is used to quickly identify the risk (low to high) of sleep disordered breathing.(Netzer. et al., 1999. (Netzer NC, Stoohs RA, Netzer CM,Clark K, Strohl KP. Ann Intern Med. 1999 Oct 5;131(7):485-91).

The questionnaire consists of 3 categories related to the risk of having sleep apnoea.

Patients can be classified into High Risk or Low Risk based on their responses to the individual items and their overall scores in the symptom categories.

Category 1
(Positive if total points ≥ 2)
  Category 2
(Positive if total points ≥ 2)
  Category 3
(Positive if response as below)
Item Response Points Item Response Points Item Response
1 ‘Yes’ +1 6 ‘a’ or ‘b’ +1 10 ‘Yes’
Or
BMI is greater than 30kg/m2
2 ‘c’ or ‘d’ +1 7 ‘a’ or ‘b’ +1
3 ‘a’ or ‘b’ +1 8 ‘a’ +1
4 ‘a’ +1 9 Note separately
5 ‘a’ or ‘b’ +2

High Risk if 2 or more categories are Positive
Low Risk if 1 or no category is Positive

Berlin Questionnaire
Height (m) ________ Weight (kg)________ Age______ Male / Female

Category 1   Category 2   Category 3

1. Do you snore?
a. Yes
b. No
c. Don’t know

2. If you 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

8. Have you ever nodded off or fallen
asleep while driving a vehicle?
a. Yes
b. No

If yes:
9. 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?
Yes
No
Don’t know