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OSA-50 and ESS Questionnaire

Please fill up both screening questionnaires below to qualify for a Medicare rebated Sleep Study.

OSA-50

Waist circumference (Measure at the level of the umbilicus) Male > 102cm | Females > 88cm
Has your snoring ever bothered other people?
Has anyone noticed you stop breathing during your sleep?
Are you aged 50 years or over?

ESS

How likely are you to doze off (fall asleep) in the following situations?

Use the following scale to choose the most appropriate answer:

0 - No chance

1 - Slight chance

2 - Moderate chance

3 - High chance

Sitting and reading
Watching television
Sitting inactive, in a public space
Lying down to rest in the afternoon when circumstances permit
Sitting and talking to someone
Sitting quietly after a lunch without alcohol
As a passenger in a car for an hour without a break
In a car, while stopped for a few minutes in traffic

You have successfully completed your questionnaires.

25 Molly Morgan Drive, East Maitland NSW 2323

 

Tel: 02 4018 7506

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