Appendix.

Sleep History Questionnaire (modified to include only questions regarding symptoms of obstructive sleep apnea listed in Table 3)

PATIENT HISTORY QUESTIONNAIRE
NAME:		DATE:
1.	Do you snore?	▫ Yes ▫ No
2.	How loud would you, or your bed partner, rate your snoring? (please circle, 1 =mild, 2=moderate, 3=loud, 4=very loud)	1 2 3 4
3.	How disturbed is your bedpartner by your snoring? (please circle, 1=not at all, 2=mildly, 3=moderately, 4=severely)	1 2 3 4
4.	Does your snoring cause him or her to sleep in a separate room?	▫ Yes ▫ No
5.	Do you only snore if you are lying on your back?	▫ Yes ▫ No
6.	Has anyone ever told you that you stop breathing while you sleep?	▫ Yes ▫ No
7.	Do you ever wake up with the feeling that you are choking?	▫ Yes ▫ No
8.	Have you been told that you are a restless sleeper?	▫ Yes ▫ No
9.	Do you feel refreshed when you wake up?	▫ Yes ▫ No
10.	Do you often wake up with headaches in the morning?	▫ Yes ▫ No
11.	Do you have trouble concentrating or remembering things?	▫ Yes ▫ No