Bed Partner Questionnaire
The following questions relate to the behavior that you have observed in your bed partner while he/she is asleep. Use the following scale and 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 _______
- 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 of Obstructive Sleep Apnea (OSA) which are affecting the health, safety, and/or quality of life of the observed person. Your bed partner's OSA is also affecting your quality of life as well. Getting help for your bed partner may be the best thing you can do for your on health.
Back to Obstructive Sleep Apnea (OSA)