睡眠呼吸障礙評估問卷

睡眠呼吸障礙評估問卷
Sleep-Disordered Breathing Assessment Questionnaire

患者姓名 / Patient Name:

日期 / Date:

請選擇最適合您情況的選項。 Please select the option that best describes your situation.

0 = 從不 / Never, 1 = 偶爾 / Occasionally, 2 = 經常 / Often, 3 = 總是 / Always

  1. 您是否經歷在睡眠中感到嗆到或大力喘氣?
    Do you experience choking or gasping during sleep?

  2. 睡眠時您是否感到呼吸不順暢或不夠氣?
    Do you feel your breathing is labored or short of breath during sleep?

  3. 您是否有鼻鼾?
    Do you snore?

  4. 您是否經常在夜間醒來?
    Do you frequently wake up during the night?

  5. 您是否有晨起頭痛的情況?
    Do you experience morning headaches?

  6. 您白天是否感到疲勞?
    Do you feel fatigued during the day?

  7. 您是否感到注意力難以集中?
    Do you have difficulty concentrating?

  8. 您是否容易感到容易生氣或煩躁?
    Do you feel easily irritable or moody?

  9. 這些症狀是否影響您的日常功能和工作表現?
    Do these symptoms affect your daily functions and work performance?

  10. 您是否因為疲勞/嗜睡而感到有安全隱憂(如行走,開車,操作機器時)?
    Do you have safety concerns due to fatigue/sleepiness (e.g., while walking, driving, operating machinery)?

  11. 您的伴侶或家人是否觀察到您每晚睡眠中有超過5次睡眠暫停且每次暫停至少10秒的情況?
    Has your partner or family observed more than 5 sleep pauses lasting at least 10 seconds each night during your sleep?

  12. 您是否曾經使用CPAP 機器(睡眠時戴上口鼻正壓呼吸機)來改善睡眠障礙症狀?
    Have you ever used a CPAP machine to improve sleep disorder symptoms?

  13. 您是否對睡眠時戴住CPAP (正壓呼吸機)感到抗拒或不耐受?
    Do you feel resistant or intolerant to wearing a CPAP during sleep?

 

Epworth嗜睡量表 (ESS)

Epworth 嗜睡量表 (ESS) / Epworth Sleepiness Scale (ESS)

在以下情況下,您有多大可能打盹或睡著?請使用以下評分標準:
How likely are you to doze off or fall asleep in the following situations? Use the following scale:

0 = 從不打盹 / Would never doze
1 = 偶爾打盹 / Slight chance of dozing
2 = 經常打盹 / Moderate chance of dozing
3 = 總是打盹 / High chance of dozing

情況 / Situation 評分 / Score
坐著閱讀 / Sitting and reading
看電視 / Watching TV
坐著不活動(如在公共場合)/ Sitting inactive in a public place
乘車1小時不休息 / As a passenger in a car for an hour without a break
下午躺下休息 / Lying down to rest in the afternoon
坐著與人交談 / Sitting and talking to someone
午餐後安靜坐著(無酒精)/ Sitting quietly after lunch without alcohol
開車時遇到幾分鐘的交通阻塞 / In a car, while stopped for a few minutes in traffic

總分 / Total Score: 0 / 24

0-5: 正常 / Normal
6-10: 輕度 / Mild
11-15: 中度 / Moderate
16-24: 嚴重 / Severe