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Sleep Apnea Quality of Life Index (SQLI)
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Sleep Apnea Quality of Life Index (SQLI)
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Gender
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Date of Birth
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Sleep Apnea Quality of Life Index (SQLI)
We would like to understand the impact that sleep apnea and/or snoring have had on your daily activities, emotions, social interactions, and about symptoms that may have resulted.
How much have you had to push yourself to remain alert during a typical day (e.g. work, school, childcare, housework?)
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How often have you had to use all your energy to accomplish your most important activity (e.g. work, school, childcare, housework?)
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much difficulty have you had finding the energy to do other activities (e.g. work, school, childcare, housework?)
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much difficulty have you had fighting to stay awake?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much difficulty have you had fighting to stay awake?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much of a problem has it been to be told that your snoring is irritating?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much of a problem have frequent conflicts or arguments been?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How often have you looked for excuses for being tired?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How often have you looked for excuses for being tired?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How often have you not wanted to do things with your family/or friends?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How many times have you felt depressed, down, or hopeless?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How often have you been impatient?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much of a problem has it been to cope with everyday issues?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much of a problem have you had with decreased energy?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much of a problem have you had with fatigue?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
How much of a problem have you had waking up feeling unrefreshed?
Not at all
A small amount
A small to moderate amount
A moderate to large amount
A large amount
A very large amount
Signature
(Required)
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Treatment Options
Oral Appliance Therapy
Snoring and Sleep Apnea
Toggle child menu
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Snoring
Sleep Apnea
Sleep Assessment​
Forms & Resources
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Expand
Patient Care
Pre-Treatment Sleep Questionnaire
New Patient Form
Insurance Package
