Berlin test – VitalAire Schweiz AG

SNORING

Do you snore? *

Yes

No

I don't know

You snoring is: *

Slightly louder than breathing

As loud as talking

Louder than talking

Very loudly

How often do you snore? *

Almost every day

3-4 times per week

1-2 times per week

Rarely or never

Has your snoring ever bothered other people? *

Yes

No

Has anyone noticed that you stop breathing during your sleep? *

Almost every day

3-4 times per week

1-2 times per week

1-2 times per month

Rarely or never

FATIGUE

During your waking time, do you feel tired, fatigued or not up to par? *

Almost every day

3-4 times per week

1-2 times per week

1-2 times per month

Rarely or never

How often does this occur? *

Almost every day

3-4 times per week

1-2 times per week

1-2 times per month

Rarely or never

Have you ever nodded off or fallen asleep while driving a vehicle? *

Yes

No

I don't know

How often does this occur? *

Almost every day

3-4 times per week

1-2 times per week

1-2 times per month

Rarely or never

RISK FACTORS

Do you have high blood pressure? *

Yes

No

I don't know

VitalAire

Integrated Respiratory Care

Proximity

Reactivity

Expertise

Berlin test*

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