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. 2012 Jun 7;142(6):1508–1515. doi: 10.1378/chest.11-3164

Table 1.

—The 37 Questions in Our Sleep Questionnaire

Question
On the average, how long does your child sleep at night?
At what time does your child go to bed?
At what time does your child wake up?
Have you seen or heard your child having nightmares that he/she does not remember the next day?
Has he/she expressed fear of sleeping in the dark?
Is your child easy to wake up in the morning?
Does your child go to bed willingly?
Is he/she a restless sleeper?
Have you seen your child smiling during sleep?
Does he/she wake up at night?
Have your heard your child talking in his/her sleep?
Have you observed him/her sleepwalking?
While asleep, does he/she ever sit up in bed?
Does he/she grind his/her teeth during sleep?
Have you heard your child laugh during sleep?
Has your child told you about having a frightening dream?
Have you observed repetitive actions such as rocking or head banging during sleep?
Does he/she have problems with bed wetting?
Have your observed your child having a nightmare during which he/she appeared extremely afraid or terrified?
Have you looked in on your child and discovered he/she was crying while asleep?
Has he/she told you about having a pleasant dream?
Does your child complain about difficulties going to sleep?
Does your child get up to go to the bathroom during the night?
Does your child stop breathing during sleep? (Apnea during sleep) (Q2)
Does your child struggle to breathe while asleep? (Struggle breathing when asleep) (Q3)
Does your child fall asleep easily?
Do you ever shake your child to make him/her breathe again when asleep? (Shake child to breath) (Q1)
Do your child’s lips ever turn blue or purple while asleep?
Are you ever concerned about your child’s breathing during sleep? (Breathing concerns while asleep) (Q4)
How loud is the snore? (Loudness of snoring) (Q5)a
How often does your child snore? (Snoring during sleep) (Q6)
How often does your child have a sore throat?
Does your child complain of morning headaches?
Is your child a daytime mouth breather?
Is your child sleepy during the daytime?
Does your child fall asleep at school?
Does your child fall asleep while watching television?

Q refers to questions in the Mokken Scale Analyses.

a

Q5 is scored as 0: mildly quiet; 1: medium loud; 2: loud; 3: very loud; 4: extremely loud.