Berlin Questionnaire

Berlin Questionnaire is a sequence of questions which are devised to identify people suffering from sleep apnea. Sleep apnea is a sleeping disorder where a person pauses while breathing or takes shallow breath.  Each pause is called an apnea which can occur from a few to as many as 30 times within an hour. Berlin questionnaire are carried out by sleep therapists to analyze the snoring behavior of patients and resolve sleeping difficulties among them. It is also referred to as sleep evaluation test.

Berlin Questionnaire Sample

Name:       _____________________________________________________

Age:          ___________________        Weight (kgs):             ____________

Sex (M/F):  ___________________        Height (cms):             ____________

Waist:               ___________________

(circumference around your navels measured without any clothing)

Hips:         ____________________ (measured without clothing)

  1. Do you snore while sleeping (Y/N) :       ____________________
  2. How loud is your snoring? :
    1. louder than breathing
    2. as loud as talking
    3. louder than talking
    4. very loud
  1. How many times a week/month do you snore while sleeping? Give best approximation.


  1. Do people complain about your snoring (Y/N)? :              ________________________
  2. Did it ever happen that someone told you that you quit breathing while asleep? If yes then how often do they?


  1. Do you feel tired or restless after sleep? If yes then how often?


  1. Do you feel fatigued, tired and weak after wake up? If yes then how many times a week?


  1. Have you fallen asleep while in a vehicle? If yes then how often?


  1. Do you suffer from high blood pressure(Y/N)? :        ____________________

Category: Medical Questionnaire

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