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We have developed this self-scoring questionnaire as a guide to help identify sleep disorder breathing problems. Please check the appropriate box if you have experience any of the symptom(s) on a regular basis. Your doctor will discuss these results with you during your follow up visit to his/her office.
SCORING: If you have Marked 3 or More Boxes, you show Symptoms of Sleep Apnea, a life threatening sleep disorder that causes you to stop breathing during your sleep.