The Berlin Questionnaire

Please select one response from each question below, Select Print Now button when finished

Has your weight changed?

Increased Decreased No Change

Do you snore?

Yes No Do not know

Snoring loudness:

Loud as breathing Loud as talking Louder than talking Very loud

Snoring frequency:

Almost every day 3 to 4 times per week 1 to 2 times per week 1 to 2 times per month Never or almost never

Does your snoring bother other people?

Yes No

How often have your breathing pauses been noticed?

Almost every day 3 to 4 times per week 1 to 2 times per week 1 to 2 times per month Never or almost never

Are you tired after sleeping?

Almost every day 3 to 4 times per week 1 to 2 times per week 1 to 2 times per month Never or almost never

Are you tired during waketime?

Almost every day 3 to 4 times per week 1 to 2 times per week Never or almost never

Have you ever fallen asleep while driving?

Yes No

Do you have high blood pressure?

Yes No Do not know

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Adapted with permission from Netzer NC, Stoohs RA, Netzer CM, Clark K, Strohl KP. Using the Berlin Questionnaire to identify patients at risk for the sleep apnea syndrome. Ann Intern Med 1999;131:488.