DHOSleepQuestionnaire
type: Questionnaire
node role: treeRoot
id:
  v: DHOSleepQuestionnaire
text:
  status:
    v: extensions
  div: Generated Narrative: Questionnaire DHOSleepQuestionnaire Structure LinkID Text Cardinality Type Description & Constraints<img src="[binary]" alt="doco" style="background-color: inherit"/> 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 …
url:
  v: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/DHOSleepQuestionnaire
identifier:
  use:
    v: official
  value:
    v: DHOSleepQuestionnaire
version:
  v: 1.0
name:
  v: DHOSleepQuestionnaire
title:
  v: Sleep Questionnaire
status:
  v: active
subject type:
  v: Patient
date:
  v: 2026-04-29T05:50:51+00:00
publisher:
  v: Te Whatu Ora
contact:
  name:
    v: Te Whatu Ora
  telecom:
    system:
      v: url
    value:
      v: https://www.tewhatuora.govt.nz/
contact:
  name:
    v: Te Whatu Ora Integration Team
  telecom:
    system:
      v: email
    use:
      v: work
description:
  v: The Questionnaire collects patient-reported sleep symptoms, habits, and risk factors to support assessment of sleep disorders such as sleep apnoea.
jurisdiction:
  coding:
    system:
      v: urn:iso:std:iso:3166
    code:
      v: NZ
    display:
      v: New Zealand
purpose:
  v: Enables clinicians to evaluate risk and guide further investigation and care.
item:
  link id:
    v: intro
  text:
    v: Sleep Service
  type:
    v: group
  item:
    link id:
      v: referral
    text:
      v: We have received a referral to our Sleep Service from your doctor.
    type:
      v: display
  item:
    link id:
      v: Studyresult
    text:
      v: Please note we cannot consider your referral/sleep study results until we have this information completed by you.
    type:
      v: display
item:
  link id:
    v: measurements
  text:
    v: Measurements
  type:
    v: group
  item:
    link id:
      v: weight
    text:
      v: Weight (kg)
    type:
      v: decimal
  item:
    link id:
      v: height
    text:
      v: Height (cm)
    type:
      v: decimal
  item:
    link id:
      v: neck
    text:
      v: Neck circumference (cm) - Please use tape measure provided
    type:
      v: decimal
  item:
    link id:
      v: dentures
    text:
      v: Do you have dentures? (full or partial)
    type:
      v: string
item:
  link id:
    v: sleep-apnoea
  text:
    v: Sleep Apnoea
  type:
    v: group
  item:
    link id:
      v: snoring
    text:
      v: According to what others have told you, how often do you think you snore?
    type:
      v: choice
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
  item:
    link id:
      v: stop-breathing
    text:
      v: Has anyone heard you stop breathing in your sleep?
    type:
      v: boolean
  item:
    link id:
      v: choking
    text:
      v: Do you sometimes wake with a choking or gasping sensation?
    type:
      v: boolean
  item:
    link id:
      v: family
    text:
      v: Does anyone in your family have obstructive sleep apnoea?
    type:
      v: boolean
  item:
    link id:
      v: toilet
    text:
      v: Do you get up to go to the toilet more than once a night?
    type:
      v: boolean
  item:
    link id:
      v: headache
    text:
      v: Do you regularly wake with headaches in the morning?
    type:
      v: boolean
item:
  link id:
    v: daytime
  text:
    v: Sleepiness during the Day
  type:
    v: group
  item:
    link id:
      v: refreshed
    text:
      v: Do you wake feeling refreshed?
    type:
      v: choice
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
  item:
    link id:
      v: sleepy
    text:
      v: How often do you feel sleepy and want to fall asleep in the daytime?
    type:
      v: choice

v: Always

v: Always

v: Often

v: Often

v: Sometimes

v: Sometimes

v: Rarely

v: Rarely

v: Never

v: Never

v: Always

v: Always

v: Often

v: Often

v: Sometimes

v: Sometimes

v: Rarely

v: Rarely

v: Never

v: Never

value: Coding
  system:
    v: https://fhir-ig.digital.health.nz/cs/general-scale
  code:
    v: Always
  display:
    v: Always

value: Coding
  system:
    v: https://fhir-ig.digital.health.nz/cs/general-scale
  code:
    v: Often
  display:
    v: Often

value: Coding
  system:
    v: https://fhir-ig.digital.health.nz/cs/general-scale
  code:
    v: Sometimes
  display:
    v: Sometimes

value: Coding
  system:
    v: https://fhir-ig.digital.health.nz/cs/general-scale
  code:
    v: Rarely
  display:
    v: Rarely

value: Coding
  system:
    v: https://fhir-ig.digital.health.nz/cs/general-scale
  code:
    v: Never
  display:
    v: Never

link id:
  v: epworth
text:
  v: Epworth Sleepiness Score
type:
  v: group
item:
  link id:
    v: fallasleep
  text:
    v: 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.
  type:
    v: display
item:
  link id:
    v: sittingandreading
  text:
    v: Sitting & Reading
  type:
    v: choice
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 0
      display:
        v: 0 -- NEVER doze
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 1
      display:
        v: 1 -- SLIGHT chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 2
      display:
        v: 2 -- MODERATE chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 3
      display:
        v: 3 -- HIGH chance of dozing
item:
  link id:
    v: watchingTV
  text:
    v: Watching TV
  type:
    v: choice
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 0
      display:
        v: 0 -- NEVER doze
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 1
      display:
        v: 1 -- SLIGHT chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 2
      display:
        v: 2 -- MODERATE chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 3
      display:
        v: 3 -- HIGH chance of dozing
item:
  link id:
    v: sittingactivity
  text:
    v: Sitting inactive in a public place (theatre, meeting, etc)
  type:
    v: choice
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 0
      display:
        v: 0 -- NEVER doze
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 1
      display:
        v: 1 -- SLIGHT chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 2
      display:
        v: 2 -- MODERATE chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 3
      display:
        v: 3 -- HIGH chance of dozing
item:
  link id:
    v: incarforanhour
  text:
    v: A passenger in a car for one hour
  type:
    v: choice
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 0
      display:
        v: 0 -- NEVER doze
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 1
      display:
        v: 1 -- SLIGHT chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 2
      display:
        v: 2 -- MODERATE chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 3
      display:
        v: 3 -- HIGH chance of dozing
item:
  link id:
    v: lyingdown
  text:
    v: Lying down in the afternoon (if circumstances permit)
  type:
    v: choice
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 0
      display:
        v: 0 -- NEVER doze
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 1
      display:
        v: 1 -- SLIGHT chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
      code:
        v: 2
      display:
        v: 2 -- MODERATE chance of dozing
  answer option:
    value: Coding
      system:
        v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale

v: 3

v: 3 -- HIGH chance of dozing

link id:
  v: sittingtalking
text:
  v: Sitting talking to someone
type:
  v: choice
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 0
    display:
      v: 0 -- NEVER doze
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 1
    display:
      v: 1 -- SLIGHT chance of dozing
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 2
    display:
      v: 2 -- MODERATE chance of dozing
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 3
    display:
      v: 3 -- HIGH chance of dozing

link id:
  v: trafficlights
text:
  v: In a car whilst stopped in traffic or traffic lights
type:
  v: choice
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 0
    display:
      v: 0 -- NEVER doze
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 1
    display:
      v: 1 -- SLIGHT chance of dozing
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 2
    display:
      v: 2 -- MODERATE chance of dozing
answer option:
  value: Coding
    system:
      v: https://fhir-ig.digital.health.nz/cs/EpworthSleepScale
    code:
      v: 3
    display:
      v: 3 -- HIGH chance of dozing

link id:
  v: medical
text:
  v: Medical History
type:
  v: group
item:
  link id:
    v: hayfever
  text:
    v: Hayfever or constantly blocked nose
  type:
    v: boolean
  required:
    v: true
item:
  link id:
    v: nasal
  text:
    v: Previous nasal surgery
  type:
    v: boolean
item:
  link id:
    v: airway
  text:
    v: Previous airway surgery? (e.g. tonsils removed)
  type:
    v: boolean
item:
  link id:
    v: heart
  text:
    v: Heart disease (heart failure, heart attack, angina, arrhythmia e.g. atrial fibrillation, stent or bypass?)
  type:
    v: boolean
item:
  link id:
    v: bp
  text:
    v: High blood pressure
  type:
    v: boolean
  item:
    link id:
      v: controldifficulty
    text:
      v: If yes, is it difficult to control?
    type:
      v: boolean
    enable when:
      question:
        v: bp
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: all
item:
  link id:
    v: stroke
  text:
    v: Previous stroke or TIA ‘mini-stroke’?
  type:
    v: boolean
item:
  link id:
    v: diabetes
  text:
    v: Diabetes
  type:
    v: boolean
  item:
    link id:
      v: yescontroldifficulty
    text:
      v: If yes, is it difficult to control?
    type:
      v: boolean
    enable when:
      question:
        v: diabetes
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: any
item:
  link id:
    v: depression
  text:
    v: Depression
  type:
    v: boolean
  item:
    link id:
      v: depression_11
    text:
      v: If yes, is it difficult to control?
    type:
      v: boolean
    enable when:
      question:
        v: depression
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: any
item:
  link id:
    v: asthma
  text:
    v: Asthma/COPD
  type:
    v: boolean
item:
  link id:
    v: neuro
  text:
    v: Neuromuscular disease
  type:
    v: boolean
item:
  link id:
    v: epilepsy
  text:
    v: Epilepsy
  type:
    v: boolean
  item:
    link id:
      v: neurodisease
    text:
      v: If yes, is it difficult to control?
    type:
      v: string
    enable when:
      question:
        v: epilepsy
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: any

link id:
  v: lifestyle
text:
  v: Lifestyle
type:
  v: group
item:
  link id:
    v: breath
  text:
    v: Do you get short of breath during your daily activities?
  type:
    v: boolean
item:
  link id:
    v: occupation
  text:
    v: What is your Occupation?
  type:
    v: string
item:
  link id:
    v: job-risk
  text:
    v: Has your job been at risk due to sleepiness or loss of concentration?
  type:
    v: boolean
item:
  link id:
    v: doze-driving
  text:
    v: Do you have a vehicle licence?
  type:
    v: boolean
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: licenseclass
    text:
      v: What is your vehicle licence class?
    type:
      v: choice
    enable when:
      question:
        v: doze-driving
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: any
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
  item:
    extension:
      url:
        v: http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl
      value: CodeableConcept
    link id:
      v: licenseendorsement
    text:
      v: What is your vehicle licence endorsement?
    type:
      v: choice
    enable when:
      question:
        v: doze-driving
      operator:
        v: =
      answer: boolean
        v: true
    enable behavior:
      v: any
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding
    answer option:
      value: Coding

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: radio-button
display:
  v: Radio Button

v: 1

v: Class 1 (motorcar)

v: 2

v: Class 2

v: 3

v: Class 3

v: 4

v: Class 4

v: 5

v: Class 5

v: 6

v: Class 6 (Motorcycle)

system:
  v: http://hl7.org/fhir/questionnaire-item-control
code:
  v: radio-button
display:
  v: Radio Button

v: P

v: P

v: V

v: V

v: D

v: D

v: F

v: F

v: R

v: R

v: T

v: T

v: W

v: W

v: I

v: I

v: O

v: O