Generated Narrative: Questionnaire DHOSleepQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints DHOSleepQuestionnaire The Questionnaire collects patient-reported sleep symptoms, habits, and risk factors to support assessment of sleep disorders such as sleep apnoea. Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/DHOSleepQuestionnaire#1.0 #xD; intro Sleep Service 0..1 group #xD; referral We have received a referral to our Sleep Service from your doctor. 0..1 display #xD; Studyresult Please note we cannot consider your referral/sleep study results until we have this information completed by you. 0..1 display #xD; measurements Measurements 0..1 group #xD; weight Weight (kg) 0..1 decimal #xD; height Height (cm) 0..1 decimal #xD; neck Neck circumference (cm) - Please use tape measure provided 0..1 decimal #xD; dentures Do you have dentures? (full or partial) 0..1 string #xD; sleep-apnoea Sleep Apnoea 0..1 group #xD; snoring According to what others have told you, how often do you think you snore? 0..1 choice Options: 5 options #xD; stop-breathing Has anyone heard you stop breathing in your sleep? 0..1 boolean #xD; choking Do you sometimes wake with a choking or gasping sensation? 0..1 boolean #xD; family Does anyone in your family have obstructive sleep apnoea? 0..1 boolean #xD; toilet Do you get up to go to the toilet more than once a night? 0..1 boolean #xD; headache Do you regularly wake with headaches in the morning? 0..1 boolean #xD; daytime Sleepiness during the Day 0..1 group #xD; refreshed Do you wake feeling refreshed? 0..1 choice Options: 5 options #xD; sleepy How often do you feel sleepy and want to fall asleep in the daytime? 0..1 choice Options: 5 options #xD; epworth Epworth Sleepiness Score 0..1 group #xD; fallasleep How likely are you to doze off or fall asleep in the following situations - in contrast to feeling tired. This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. 0..1 display #xD; sittingandreading Sitting & Reading 0..1 choice Options: 4 options #xD; watchingTV Watching TV 0..1 choice Options: 4 options #xD; sittingactivity Sitting inactive in a public place (theatre, meeting, etc) 0..1 choice Options: 4 options #xD; incarforanhour A passenger in a car for one hour 0..1 choice Options: 4 options #xD; lyingdown Lying down in the afternoon (if circumstances permit) 0..1 choice Options: 4 options #xD; sittingtalking Sitting talking to someone 0..1 choice Options: 4 options #xD; trafficlights In a car whilst stopped in traffic or traffic lights 0..1 choice Options: 4 options #xD; medical Medical History 0..1 group #xD; hayfever Hayfever or constantly blocked nose 1..1 boolean #xD; nasal Previous nasal surgery 0..1 boolean #xD; airway Previous airway surgery? (e.g. tonsils removed) 0..1 boolean #xD; heart Heart disease (heart failure, heart attack, angina, arrhythmia e.g. atrial fibrillation, stent or bypass?) 0..1 boolean #xD; bp High blood pressure 0..1 boolean #xD; controldifficulty If yes, is it difficult to control? 0..1 boolean Enable When: bp = #xD; stroke Previous stroke or TIA ‘mini-stroke’? 0..1 boolean #xD; diabetes Diabetes 0..1 boolean #xD; yescontroldifficulty If yes, is it difficult to control? 0..1 boolean Enable When: diabetes = #xD; depression Depression 0..1 boolean #xD; depression_11 If yes, is it difficult to control? 0..1 boolean Enable When: depression = #xD; asthma Asthma/COPD 0..1 boolean #xD; neuro Neuromuscular disease 0..1 boolean #xD; epilepsy Epilepsy 0..1 boolean #xD; neurodisease If yes, is it difficult to control? 0..1 string Enable When: epilepsy = #xD; lifestyle Lifestyle 0..1 group #xD; breath Do you get short of breath during your daily activities? 0..1 boolean #xD; occupation What is your Occupation? 0..1 string #xD; job-risk Has your job been at risk due to sleepiness or loss of concentration? 0..1 boolean #xD; doze-driving Do you have a vehicle licence? 0..1 boolean #xD; licenseclass What is your vehicle licence class? 0..1 choice Enable When: doze-driving = Options: 6 options #xD; licenseendorsement What is your vehicle licence endorsement? 0..1 choice Enable When: doze-driving = Options: 9 options #xD; Documentation for this format Options Sets Answer options for snoring https://fhir-ig.digital.health.nz/cs/general-scale#Always ("Always") https://fhir-ig.digital.health.nz/cs/general-scale#Often ("Often") https://fhir-ig.digital.health.nz/cs/general-scale#Sometimes ("Sometimes") https://fhir-ig.digital.health.nz/cs/general-scale#Rarely ("Rarely") https://fhir-ig.digital.health.nz/cs/general-scale#Never ("Never") Answer options for refreshed https://fhir-ig.digital.health.nz/cs/general-scale#Always ("Always") https://fhir-ig.digital.health.nz/cs/general-scale#Often ("Often") https://fhir-ig.digital.health.nz/cs/general-scale#Sometimes ("Sometimes") https://fhir-ig.digital.health.nz/cs/general-scale#Rarely ("Rarely") https://fhir-ig.digital.health.nz/cs/general-scale#Never ("Never") Answer options for sleepy https://fhir-ig.digital.health.nz/cs/general-scale#Always ("Always") https://fhir-ig.digital.health.nz/cs/general-scale#Often ("Often") https://fhir-ig.digital.health.nz/cs/general-scale#Sometimes ("Sometimes") https://fhir-ig.digital.health.nz/cs/general-scale#Rarely ("Rarely") https://fhir-ig.digital.health.nz/cs/general-scale#Never ("Never") Answer options for sittingandreading https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for watchingTV https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for sittingactivity https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for incarforanhour https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for lyingdown https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for sittingtalking https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for trafficlights https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#0 ("0 -- NEVER doze") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#1 ("1 -- SLIGHT chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#2 ("2 -- MODERATE chance of dozing") https://fhir-ig.digital.health.nz/cs/EpworthSleepScale#3 ("3 -- HIGH chance of dozing") Answer options for licenseclass https://fhir-ig.digital.health.nz/cs/Licence-Class#1 ("Class 1 (motorcar)") https://fhir-ig.digital.health.nz/cs/Licence-Class#2 ("Class 2") https://fhir-ig.digital.health.nz/cs/Licence-Class#3 ("Class 3") https://fhir-ig.digital.health.nz/cs/Licence-Class#4 ("Class 4") https://fhir-ig.digital.health.nz/cs/Licence-Class#5 ("Class 5") https://fhir-ig.digital.health.nz/cs/Licence-Class#6 ("Class 6 (Motorcycle)") Answer options for licenseendorsement https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#P ("P") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#V ("V") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#D ("D") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#F ("F") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#R ("R") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#T ("T") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#W ("W") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#I ("I") https://fhir-ig.digital.health.nz/cs/Vehicle-licence-endorsement#O ("O")
The Questionnaire collects patient-reported sleep symptoms, habits, and risk factors to support assessment of sleep disorders such as sleep apnoea.
Enables clinicians to evaluate risk and guide further investigation and care.
We have received a referral to our Sleep Service from your doctor.
Please note we cannot consider your referral/sleep study results until we have this information completed by you.
Neck circumference (cm) - Please use tape measure provided
According to what others have told you, how often do you think you snore?
Has anyone heard you stop breathing in your sleep?
Do you sometimes wake with a choking or gasping sensation?
Does anyone in your family have obstructive sleep apnoea?
Do you get up to go to the toilet more than once a night?
Do you regularly wake with headaches in the morning?
How often do you feel sleepy and want to fall asleep in the daytime?
How likely are you to doze off or fall asleep in the following situations - in contrast to feeling tired. This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you.
Sitting inactive in a public place (theatre, meeting, etc)
Lying down in the afternoon (if circumstances permit)
In a car whilst stopped in traffic or traffic lights
Previous airway surgery? (e.g. tonsils removed)
Heart disease (heart failure, heart attack, angina, arrhythmia e.g. atrial fibrillation, stent or bypass?)
Do you get short of breath during your daily activities?
Has your job been at risk due to sleepiness or loss of concentration?
What is your vehicle licence endorsement?