[jet_form]

SAI Scores & Significance

[radio label="1. Diagnosed with sleep disorder?" name="sleep_disorder" options="No:0;Yes:4" default="0"] [radio label="If Yes, Sleep Apnea?" name="sleep_apnea" options="No:0;Yes:4" default="0" conditional="sleep_disorder|equal|Yes"] [radio label="If No, select issue" name="other_sleep_issue" options="None:0;Insomnia:4;Parasomnia:4" default="0" conditional="sleep_disorder|equal|No"] [calculated_field name="sai_part1" formula="[sleep_disorder] + [sleep_apnea] + [other_sleep_issue"] [html]

SAI-Part1 Score: <%= [sai_part1] %> <% if ([sai_part1] < 4) { out += "(Not Significant)"; } else if ([sai_part1] <= 6) { out += "(Low Significance)"; } else if ([sai_part1] <= 9) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html] [radio label="2. Trouble staying asleep frequency?" name="stay_asleep" options="Never:0;Rarely:1;Sometimes:2;Often:3;Always:4"] [radio label="Worried about sleep?" name="worried_sleep" options="Never:0;Rarely:1;Sometimes:2;Often:3;Always:4"] [checkbox label=">30 mins to fall asleep" name="fall_asleep_delay" value="1"] [checkbox label="Nightmares" name="nightmares" value="1"] [checkbox label="Night terrors" name="night_terrors" value="1"] [checkbox label="Night walk" name="night_walk" value="1"] [checkbox label="Acted out dreams?" name="acted_dreams" value="1"] [checkbox label="Restless sleep?" name="restless_sleep" value="1"] [calculated_field name="sai_part2" formula="[stay_asleep] + [worried_sleep] + [fall_asleep_delay] + [nightmares] + [night_terrors] + [night_walk] + [acted_dreams] + [restless_sleep"] [html]

SAI-Part2 Score: <%= [sai_part2] %> <% if ([sai_part2] < 4) { out += "(Not Significant)"; } else if ([sai_part2] <= 6) { out += "(Low Significance)"; } else if ([sai_part2] <= 9) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html] [radio label="3. Feel upon waking?" name="waking_feeling" options="Refreshed:0;Slightly Tired:1;Tired:2;Exhausted:3;Very Exhausted:4"] [calculated_field name="sai_part3" formula="[waking_feeling]"] [html]

SAI-Part3 Score: <%= [sai_part3] %> <% if ([sai_part3] == 0) { out += "(Not Significant)"; } else if ([sai_part3] == 1) { out += "(Low Significance)"; } else if ([sai_part3] == 2) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html] [radio label="4. Do you snore?" name="snore" options="No:0;Yes:1"] [radio label="Loud snoring?" name="loud_snore" options="No:0;Yes:1" conditional="snore|equal|1"] [radio label="Gasping/choking?" name="gasping" options="No:0;Yes:1" conditional="snore|equal|1"] [radio label="Disturb partner?" name="partner_disturb" options="No:0;Yes:1" conditional="snore|equal|1"] [radio label="Dry mouth in AM?" name="dry_mouth" options="No:0;Yes:1" conditional="snore|equal|1"] [calculated_field name="sai_part4" formula="[snore] + [loud_snore] + [gasping] + [partner_disturb] + [dry_mouth]"] [html]

SAI-Part4 Score: <%= [sai_part4] %> <% if ([sai_part4] == 0) { out += "(Not Significant)"; } else if ([sai_part4] == 1) { out += "(Low Significance)"; } else if ([sai_part4] == 2) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html] [radio label="5. Sleepiness while sitting/reading?" name="sleepiness_reading" options="Never:0;Low:1;Moderate:2;High:3"] [radio label="Sleepiness watching TV?" name="sleepiness_tv" options="Never:0;Low:1;Moderate:2;High:3"] [calculated_field name="sai_part5" formula="[sleepiness_reading] + [sleepiness_tv] + ..."] [html]

SAI-Part5 Score: <%= [sai_part5] %> <% if ([sai_part5] < 2) { out += "(Not Significant)"; } else if ([sai_part5] <= 6) { out += "(Low Significance)"; } else if ([sai_part5] <= 10) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html] [calculated_field name="sai_final" formula=" const saiA = [sai_part1] + [sai_part2] + [sai_part3] + [sai_part4] + [sai_part5]; const saiB = [minor_health_total] + [major_health_total]; return (saiA < 8) ? saiA + saiB : saiA; "] [html]

SAI-Final Score: <%= [sai_final] %> <% if ([sai_final] < 8) { out += "(Not Significant)"; } else if ([sai_final] <= 20) { out += "(Low Significance)"; } else if ([sai_final] <= 32) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html]

ARI Scores & Significance

[number label="BMI" name="bmi" default="0"] [number label="Systolic BP" name="bp_systolic" default="0"] [number label="Diastolic BP" name="bp_diastolic" default="0"] [calculated_field name="ariA" formula=" let score = 0; // BMI Points if ([bmi] < 25) score += 0; else if ([bmi] <= 30) score += 1; else if ([bmi] <= 35) score += 2; else if ([bmi] <= 40) score += 3; else score += 4; // BP Systolic if ([bp_systolic] < 140) score += 0; else if ([bp_systolic] <= 160) score += 1; else score += 2; // BP Diastolic if ([bp_diastolic] < 85) score += 0; else if ([bp_diastolic] <= 95) score += 1; else score += 2; return score; "] [html]

ARI-Part1 Score: <%= [ariA] %> <% if ([ariA] < 3) { out += "(Not Significant)"; } else if ([ariA] <= 6) { out += "(Low Significance)"; } else if ([ariA] <= 11) { out += "(Median Significance)"; } else { out += "(High Significance)"; } %>

[/html] [calculated_field name="ariB" formula="[minor_sdb] + [major_sdb]"] [calculated_field name="ariPart2" formula="[ariA] + [ariB]"] [html]

ARI-Part2 Score: <%= [ariPart2] %> <% if ([ariPart2] < 12) { out += "(Not Significant)"; } else { out += "(Median Significance)"; } %>

[/html]

Co-Morbidities

[conditional_block if="[stay_asleep] > 2 || [fall_asleep_delay] > 2"] [html content="⚠️ The possibility of insomnia-related sleep issues exists."] [/conditional_block] [conditional_block if="[nightmares] == 1 || [night_terrors] == 1 || [acted_dreams] == 1"] [html content="⚠️ The possibility of a parasomnia exists."] [/conditional_block] [conditional_block if="[sai_part5] > 10"] [html content="⚠️ Evidence for significant hypersomnia exists."] [/conditional_block] [/jet_form]