Non-24-hour sleep-wake rhythm disorder (N24HSWD) questionnaire and outcome scoring

	Points
What is your level of vision in the better eye?
Able to see the top letter on the vision chart	0
Unable to see the chart but can see to count fingers	0
Unable to count fingers but can see shadows and hand movement	0
Unable to see shadows but can see light	0
Unable to see light	4
Have either of your eyes been enucleated (removed)?
No	0
Yes, one eye	4
Yes, both eyes	4
Is your sleep pattern cyclic?
No	0
Yes	1
Do you feel that your sleep pattern has changed since the deterioration of your vision?
No	0
Yes	11
Not applicable	8
During the past month, how often have you had trouble sleeping because you cannot get to sleep within 30 minutes?
Not during the past month	0
Less than once a week	–3
Once or twice a week	–8
Three or more times a week	–14
During the past month, how much of a problem has it been for you to show enthusiasm to get things done?
No problem at all	0
Only a very slight problem	6
Somewhat of a problem	–2
A very big problem	8
During the past month, how often have you taken medicine (prescribed or "over the counter") to help you sleep
Not during the past month	0
Less than once a week	–4
Once or twice a week	9
Three or more times a week	13
During the past month, how many hours of actual sleep did you get at night? (This may be different from the number of hours spent in bed.)
Hours of sleep per night	hours sleep × –2

Sum the total score. Patients with scores ≥0 should be evaluated for N24HSWD. Patients with scores <0 should be evaluated for other sleep disorders.

Republished with permission of the American Association of Sleep Medicine, from: Flynn-Evans EE, Lockley SW. A pre-screening questionnaire to predict non-24-hour sleep-wake rhythm disorder (N24HSWD) among the blind. J Clin Sleep Med 2016; 12:703. Copyright © 2016. Permission conveyed through Copyright Clearance Center, Inc.

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Non-24-hour sleep-wake rhythm disorder (N24HSWD) questionnaire and outcome scoring