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Pediatric Sleep Questionnaire (Age 16 years old) Patient Name Date of Birth Doctor Date Completed Reason for visit Referring Doctor Please mark if you experience any of the following symptoms: Snoring.

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Small plastic prongs at the nose will measure your child's exhaled air. Elastic or cloth belts will be placed on your child's chest and stomach, usually over her pajamas. Stick-on electrodes will be placed on your child's face and chest to measure eye movements, heart rate and muscle tone during sleep.

A score of 10 or more is considered sleepy. A score of 18 or more is very sleepy. If you score 10 or more on this test, you should consider whether you are obtaining adequate sleep, need to improve your sleep hygiene and/or need to see a sleep specialist. These issues should be discussed with your personal physician.

Use the following scale to choose the most appropriate number for each situation. 0=would never doze or sleep 1=slight chance of dozing or sleeping 2=moderate chance of dozing or sleeping 3=high chance of dozing or sleeping.

The PSQ is a 22-item questionnaire developed and validated at the University of Michigan as a research tool to identify children at risk for sleep-related breathing disorders. It includes items intended to measure childhood sleep-related breathing disorder with subscores for snoring, sleepiness, and behavior.

The Pediatric Sleep Questionnaire (PSQ) scores 22 items that investigate presence and intensity of snoring, presence of obstructive apneas and breathing difficulties, sleepiness, and other symptoms that correlate with pediatric OSA.

Paediatric Sleep Questionnaire (PSQ) For children aged 2–18 years, the scale has good internal consistency (α =0.88) with a sensitivity of 0.85 and specificity of 0.87 for identifying children with sleep related breathing disorders.

Each scored question is rated on a 3-point scale as occurring “usually” (i.e., 5–7 times within the past week), “sometimes” (i.e., 2–4 times within the past week), or “rarely” (i.e., never or 1 time within the past week).

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232