1 i es (1998) Sap MSS Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints MARKKU PARTINEN! and THORARINN GISLASON* *Dopurent of Newry, Unie of Hck, Fan, * Deparment of Pumsiy Min, Villa, lend SUMMARY Sleeprelated breathing disturbances, especially obstructive sleep apnoea syndrome (OSAS), are commonly» encountered. Epidemiological studies. from diferent ‘countries have shown that poor sleep and complaints aboot isfcen sleep or poor Seep ate often elated to poor health. Difeent studies ae, however, dificult to ‘compare wih each other: One of the main reasons for this is the frequent methodological ferences between questionnires. There is @ need for uniform methods: we need to know the prevalene and incidence of seep disorders, judged ting the same eritera, and also the severity of each problem, Le. how often a problem or a symptom happens/ occur. In 1988 the Scandinavian Sleep Research Society formed a task group for developing. a standardized questionnaire that could be used as a bass for ‘questonnires used in the Nordie counties. In this article we describe the Base ‘Nord Slep Questionnaire (BNSQ). The mai change compared to many previous questionnaires is the five point seale (Sale fom I to 5) stressing on how many Slaba/days per weck something happens. ‘ho basic ale newer a les than les than once pot week 3, "on 1-2 nights per week's 4 ‘on 3-5 right per week’ and 5, “every night oF almost every night”. For questions about specific are events the fist category may be divided imo ‘never’ and less than once per month. Habitualy oourring event such as “habitual snoring are defined here {snoring every nigh or almost every night. The BNSQ hs heen wsed widely in @ arely of studies performed in Nordic countries during the last years, and it has proven tobe a slid too, seywonos epidemiology insomnia, sleepiness, snoring. iow the every of each problem, Le, how often problem fora symptom happen occ. Many ferent types of questionaire with diferent ‘wordings have been wed in peli sta For thi Tesson somparions between such sues are dieu ‘Anos reat forthe ely in making comparisons are Poe cltral and lngutis Fctors. Tete a seat eed fr unr methods exits, We need to know what the prevlence and incidence of sleep dsorders Whe the ‘sin wording ned in diferent countries We sho need to Sern er ft Hebi, FINCK Helank, Pian 150 METHODS AND RESULTS lo 1988, to make comparisons between diferent sts ier, the Senaiavan Shep Research Society (SSRS) Toxmed a working task group. Each country nominated one fr tmo mares tothe tsk r00p. Al he partipats had Chperence ining quesionnazes. iderent questonnie that had Ween wad in epider loge! stots conering sleep spnoca or oer weep inorder in Scandinavia were cllerted (Akestedt and Tora! IRS, Ganon and Almas ONT; Gilson oa (© 195 Eugen Sep Rese Sxety1987; Gian of ol 198; Husby and Ligerde 1980 19K; Pree 198; Teak e NT, Tonal and ‘Akersed 1980) The mot commonly wed sna uestons formed the bas forthe new qestonna “sometimes” o ‘ten may have sgl diferent reanings depending on the language. In practice “ometins for ‘one person migt bean “fe! fr abother ime ae talking Shout the fequeney of the phenomenon in time, ‘xcurence per week of per month, AS an example 60 ‘women apsmered. wo ferent questions about the ‘ccuenee of insomnia. The fet woman’ (woman A) ‘complained of on’ having problems fling t0 deep. The Second (woman) chimed that she “ametmes had Problems “ling to seep. When they were asked {anttave qusions, woman A answered tha she had Problems to fall asleep "on I-2 nights per weck’ while Moma B ao amred Yon 1-2 nights per week’ Such Siferences ako oss mhen we ak aout snoring oF other slepin protien ‘ooge per month, lest than once per wosk “on 1-2 ‘ihta/sys per week’ on 3-5 night/aye per wick, ad ery nghi/day o amos every nih” (ee Append). [Normal the question shold ak aboot the past tree months Otter tine sees may be wsed if secs for “As el the Basle Nowe Step Questionnaire (BNSO) Tranaited into ferent Scandinavian languages. The [BNSO ha served a an nay eidemilopesl tain preformed i the Nova (Palo e 198, Hub a. 19S Palms 1991s Ginaon of 193) and ao note outses(Smiae eal 1988. Young ea. 1993. Moreover, {a Fnland and in clad the gueton fram the BNSO have tls teen adopted o routine cla patent questionnaires COMMENTS ON ASKING ABOUT SNORING Using the new question “habitual snoring’ canbe in 5 shoving every ig Fast everynight Those ‘who snore on 3-5 nighls per neck or mre seldom my be termed ‘fl snore of “osasonal mors, Thee ate Sgicant relation between ‘quale questions andi coms ou also whe these ew ‘tegrcs of soring ate sd inthe quesionnares. On the ‘her hand thee are no studs showing a leer relation etweenoscisonl (comatimes sering and arvana disease Shoring sometimes, eon 1-2 BMS pet week ‘Soares an independent sk factor of schaemie Beart {© 1% Eapean Seep Rens Sxey 1 Shp es (Sep) Basic Nordic Sleep Quesionnaire 181 seas, stroke or atrial hypertension the preven of shoving reais high the same phenomenon I probly ot being described and the rel can ot be compare. Hats storing i paolo and itmay be a pekiminary stage of obstructive ep apooca some. On the contrary Seovig sometimes’ und even anoing offen" are wapie terme which canbe totaly harmles i not sociated sth any-dayuine symptoms or complaints. In concsion, hey sight or almost ever ght sores should be foesed pon when ting bout habitual ston, ‘Use of mel Htory (patent erie and iatervew of lose relates or other ebabiting Sbjct) an important fool for primary ete physician, sue oF ay elacan. ‘Ovestonnaires can Help In hs work. However i more Precise information about upper away oburuction during Sleeps needed, bjeive quantitated recon should he ACKNOWLEDGEMENTS ‘We thnk Jus K,Bjemsion, ast Hansen, Jerker Het, Poa! Jennum, Jan Ovece, Torben Akentedt and Se ‘Wil for parpating in the working group. We alo want to thank ll oer who hive conbued tothe preset shape of this questions REFERENCES ‘gota Tea Lape st mek. er 3 Gam, an Almgeit ML Some demos and sep pin, npg uh o 5 Suh te. Onion. F, Angst M, En Gabe, Aa Boma, G Sco i pn ST ‘om Chv, si aT Udy ea Uno 0, ons of pn pene "etre, daring and ser mir sec (n Fh Med. Mi Fe 82.5 Sip) rN Ra Js Ro, Mad Laci ‘io dy of 100 aah Pant Sep Wate152M Paninen and. Gisleson Dim en Hen, Eels a Lm "pt fate iy Ena amin 8 ‘slr dese By Rp J 1961873 rein Pann Msn, Me Salm nd Kap esa hing a pin nce ad contol alin ‘idleagd ao Ng 1 Med 1 SOTO APPENDIX Basie Nordic Sleep questionnaire Scandinavian Society for Sleep Research (S5RS) ‘The working task group: Partinen M (Finland, chairman), Biéensson ox, (Ieeland), cislasen 7 (reeland), Hansen P {Oenmark), ‘Netea J (sweden), Jennum'P Denmark), Ovesen g (Donnark), Akerstedt 7 (Sweden), Wilson JA (worway) ‘the Basic Nordic Sleep Questionnaize consists of 27 different items in 21 main questions: Renenber to give instructions to fill the questionnaire with examples fan be done on page 1 ar os 2 separate coversheet. ask for demogsaphic data, age, weight, height etc... Always calculate body ate indew Bate amighe/heigne? (g/m). Collect necessary data for other Thdices i! needee the basic scale is as follows: 1 never of less than once per month 2 less than once per week 3 on 1-2 days per week 4 on 308 days per week 5 daily of almost daily Use “nights” instead of “days” £ more appropriate. This scale works in eliniesl work too. 1n questionning parasomias or other sarely occurring disorders in Epidemislogieal research a 6th category (never) may De added. Categories 1 GEa°S7aay then be sumed i¢-neesea for statiaticel purposes, (veanstomm 2 £2 APOE, Brees, Stee ane to 5 Terzenan once per month Ste than once per week on - days pec week on 3:5 days por sect Shy or Mines Sally ‘The questions should ask about the past three months, be used if necessary for specific purposes. other time scales ney ‘The basic questions are listed below. other questions may be added as Redes for'cach purpose. Use the same quantivative scale when ever possible Unstead of qualitative scales (zometines, often etc) if possible. (© 195 Ercan Step Reach Sc 1. Shey Rey 4 (S00asc Nordic Sleep Questionnaire 188 A. Mave you had aifticulties to fait sleep during the past three months? 2 never of less than once per month 2 Teas than once per week 3 oon 1-2 aye per week 4 on 3-9 days per week 5 daily or ainest daily 2, How long time (how many minutes az an average) do you stay avake in bed ‘before you fall asleep (after Lights off)? a, During working dayer Tt takes about minutes before 1 fail aeleep b, During freetime: it takes about inutes 3. How often have you avakened at night during the past three months? 2 Tess than once per week 3 on 1-2 nights per week 4 on 3-9 mghts per week 8 every night or sinost every night 4. 18 you use to wake up during ight, how many tines do you usually wake Ap during one night (during the past three months)? 2 usually 1 don't wake up at night 2 once per might 4 Snes 5. Now oftan nave yout avakaned too early in the morning without being able eS fail auleep again during che pest three months? 2 never or less then once per month 2 Tess ‘than once per week 3 on hz ays per’ week 3 fon 3-5 days per week Gasly of almost daily 6. Mow well have you been sleeping during the past three months? welt father well either well nor badly baaly, 1, nave you used some sleeping pills (by prescription) during the past, ‘Three monthe" 2 never or less than once per month 2 dese than once per week 5 on 1-2 ays per wook & on 308 days per week 3 dasiy of almost daily wnich sleeping pills) (© 1% Eup Seep Reensh Sve Sop es SPL)188 M. Partnen and T: Gistson 8, Do you feel excessively sleepy in the morning after awakening? never of less than once per month Tess than once per week on 1-2 gays per week on 3-5 days per week Gsily of almost daily 9. Do you feel excessively sleepy during daytine? never of less than once per month Ilse ehan once per week fon 1-2 days per week fon 3-5 days per week Selly of almost daily 20, ave you suffered from irresistible tendancy to fall asleep white ‘ai work during the past three montha? 2 never of less than once per month 2 less than once per week 3 on 1-2 days per week Gon 3:5 dave per week 5 daily o aisest daily 11, ave you suffered from irresistible tendancy to fall asieep during “Eres. time (leisure time) during the past three months? 2 less than once per week 3 on L-2 days per’ week 3 or less than once per month on 3-5 dave per week Saily of simost detly 12. How many hours do you usually sleep per night? x sleep about, hours per aight. 19. At what time do you umually go to Bed (in order to sleep)? a. during working wee) b. during tree days: at 14, At what Eime do you usually wake up? a. during working week: et b, during free days: at 358, How often do you sleep naps at daytine? 2 Tess than once per week 3 on 1-2 days per! week 4 on 305 days per week 3 dasly of almost daily 8b. If you sleep a nap, how Long do dows it My naps usually last for about. 8 nin {© 1% Enon Sep Ree Sse Sp Rs, (Sep thBasic None Sleep Questionnaire 155 6, Do you nore while aleeping (ak other people if you are not sure)? 3 never o less than once per month 2 Tees than once per week 3 on 1-2 nights per Wook 4 on 205 nignes per week 3 Svery night or ainsst every night 27. How do you anore (ask other people about the quality of your snoring)? 2 my snoring sounds regular and it is of iow voice 2 TE gounda xeguiae bor rather loud 4 it Sounds regular but it is very Loud (other people hear my ‘Pnoring in the next room) 5 1 snore very loudly and intermittently (there are silent ‘breathing pauses when snoring is not heard and at tines Very Loud snores wth gaepang) 28, ave you had breathing pauses (sleep apnea) at sleep (have other people noticed that you have pauses in respiration when You sleep)? 2 less than once per week 3 on i-2 nights per week Gon 205 nignee per week 3 every night of simost every night 19, XE you nore at least 1-2 tines per week, how many years have you been ‘shoring (ask other people if you don't know)? 1 have been enaeing for about years. 1 vas about, years oud when f started to snore 20. How many hours of sleep do you need per night (how many hours would you ‘ieep if you had possibility to sleep az long a= you need to)? need hours and nin of sleep per night. 21. X€ you have problans with your sleep, vhat kind of problems do you have (Gescribe your problens with your own words) Mariko Parinen and Thorrnn Gilson (© 19% Eumpean Sep Rees Sack Sap Rar (SPL