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Sleep Heart Health Study

Name Label Folder
formdate_ql
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Date completed
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Date completed

Date of Quality of Life (QOL) form

Questionnaires/SHHS2/Quality Of Life
ql201
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): General health
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): General health

1. In general, would you say your health is: (Check one box.)

Questionnaires/SHHS2/Quality Of Life
ql202
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health compared to one year ago
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health compared to one year ago

2. Compared to one year ago, how would you rate your health in general now? (Check one box.)

Questionnaires/SHHS2/Quality Of Life
ql203a
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits vigorous activities
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits vigorous activities

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) a. Vigorous activities, such as running, lifting heavy objects, participating in strenuous sports.

Questionnaires/SHHS2/Quality Of Life
ql203b
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits moderate activities
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits moderate activities

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) b. Moderate activities, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf.

Questionnaires/SHHS2/Quality Of Life
ql203c
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits lifting or carrying groceries
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits lifting or carrying groceries

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) C. Lifting or carrying groceries.

Questionnaires/SHHS2/Quality Of Life
ql203d
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits climbing several flights of stairs
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits climbing several flights of stairs

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) d. Climbing several flights of stairs.

Questionnaires/SHHS2/Quality Of Life
ql203e
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits climbing one flight of stairs
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits climbing one flight of stairs

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) e. Climbing one flight of stairs.

Questionnaires/SHHS2/Quality Of Life
ql203f
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits bending, kneeling, or stooping
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits bending, kneeling, or stooping

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) f. Bending, kneeling, or stooping

Questionnaires/SHHS2/Quality Of Life
ql203g
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits walking more than a mile
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits walking more than a mile

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) g. Walking more than a mile.

Questionnaires/SHHS2/Quality Of Life
ql203h
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits walking several blocks
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits walking several blocks

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) h. Walking several blocks.

Questionnaires/SHHS2/Quality Of Life
ql203i
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits walking one block
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits walking one block

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) i. Walking one block.

Questionnaires/SHHS2/Quality Of Life
ql203j
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits bathing and dressing
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits bathing and dressing

3. The following questions are about activities you might do during a typical day. Does your health now limit you in these activities? If so, how much? (Check one box for each question.) j. Bathing and dressing yourself.

Questionnaires/SHHS2/Quality Of Life
ql204a
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits time on work
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits time on work

4. During the past four weeks, have you had any of the following problems with your work or other regular daily activities as a result of your PHYSICAL HEALTH? a. Cut down on the amount of time you spent on work or other activities.

Questionnaires/SHHS2/Quality Of Life
ql204b
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits accomplishment
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits accomplishment

4. During the past four weeks, have you had any of the following problems with your work or other regular daily activities as a result of your PHYSICAL HEALTH? b. Accomplished less than you would like.

Questionnaires/SHHS2/Quality Of Life
ql204c
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits kind of work or activities
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limits kind of work or activities

4. During the past four weeks, have you had any of the following problems with your work or other regular daily activities as a result of your PHYSICAL HEALTH? c. Were limited in the kind of work or other activities you were able to do.

Questionnaires/SHHS2/Quality Of Life
ql204d
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health causes difficulty performing work
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health causes difficulty performing work

4. During the past four weeks, have you had any of the following problems with your work or other regular daily activities as a result of your PHYSICAL HEALTH? d. Had difficulty performing the work or other activities. (For example, it took extra effort).

Questionnaires/SHHS2/Quality Of Life
ql205a
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Emotional problems limit time on work
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Emotional problems limit time on work

5. During the past four weeks, have you had any of the following problems with regular daily activities as a result of EMOTIONAL PROBLEMS (such as feeling depressed or anxious)? (Please check either Yes or No for each question) a. Cut down on the amount of time you spent on work or other activities.

Questionnaires/SHHS2/Quality Of Life
ql205b
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Emotional problems limit accomplishment
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Emotional problems limit accomplishment

5. During the past four weeks, have you had any of the following problems with regular daily activities as a result of EMOTIONAL PROBLEMS (such as feeling depressed or anxious)? (Please check either Yes or No for each question) b. Accomplished less than you would like.

Questionnaires/SHHS2/Quality Of Life
ql205c
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Emotional problems limit being careful
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Emotional problems limit being careful

5. During the past four weeks, have you had any of the following problems with regular daily activities as a result of EMOTIONAL PROBLEMS (such as feeling depressed or anxious)? (Please check either Yes or No for each question.) c. Didn't do work or other activities as carefully as usual.

Questionnaires/SHHS2/Quality Of Life
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Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health or emotional problems limit social activities
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health or emotional problems limit social activities

6. During the past four weeks, to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbors, or groups? (Check one box.)

Questionnaires/SHHS2/Quality Of Life
ql207
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): bodily pain
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): bodily pain

7. How much bodily pain have you had during the past four weeks? (Check one box.)

Questionnaires/SHHS2/Quality Of Life
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Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Pain interferes with work
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Pain interferes with work

8. During the past four weeks, how much did pain interfere with your normal work (including both work outside the home and housework? (Check one box.)

Questionnaires/SHHS2/Quality Of Life
ql209a
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Feel full of pep
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Feel full of pep

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. a. Did you feel full of pep?

Questionnaires/SHHS2/Quality Of Life
ql209b
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Been a very nervous person
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Been a very nervous person

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. b. Have you been a very nervous person?

Questionnaires/SHHS2/Quality Of Life
ql209c
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt down in the dumps
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt down in the dumps

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. c. Have you felt so down in the dumps that nothing could cheer you up?

Questionnaires/SHHS2/Quality Of Life
ql209d
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt calm and peaceful
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt calm and peaceful

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. d. Have you felt calm and peaceful?

Questionnaires/SHHS2/Quality Of Life
ql209e
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Have a lot of energy
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Have a lot of energy

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. e. Did you have a lot of energy?

Questionnaires/SHHS2/Quality Of Life
ql209f
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt downhearted and blue
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt downhearted and blue

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. f. Have you felt downhearted and blue?

Questionnaires/SHHS2/Quality Of Life
ql209g
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt worn out
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt worn out

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. g. Did you feel worn out?

Questionnaires/SHHS2/Quality Of Life
ql209h
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Been a happy person
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Been a happy person

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. h. Have you been a happy person?

Questionnaires/SHHS2/Quality Of Life
ql209i
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt tired
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Felt tired

9. These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, check the box for the one answer that comes closest to the way you have been feeling. During the past 4 weeks, how much of the time. i. Did you feel tired?

Questionnaires/SHHS2/Quality Of Life
ql210
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limited your social activities
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health limited your social activities

10. During the past 4 weeks, how much of the time has your health limited your social activities (like visiting with friends or close relatives)? (Check one box.)

Questionnaires/SHHS2/Quality Of Life
ql211a
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Get sick easier than other people
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Get sick easier than other people

11. Please choose the answer that best describes how true or false each of the following statements is for you. a. I seem to get sick a little easier than other people.

Questionnaires/SHHS2/Quality Of Life
ql211b
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): As healthy as anybody
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): As healthy as anybody

11. Please choose the answer that best describes how true or false each of the following statements is for you. b. I am as healthy as anybody I know.

Questionnaires/SHHS2/Quality Of Life
ql211c
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Expect health to get worse
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Expect health to get worse

11. Please choose the answer that best describes how true or false each of the following statements is for you. c. I expect my health to get worse.

Questionnaires/SHHS2/Quality Of Life
ql211d
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health is excellent
Quality of Life (QOL) (Sleep Heart Health Study Visit Two (SHHS2)): Health is excellent

11. Please choose the answer that best describes how true or false each of the following statements is for you. d. My health is excellent.

Questionnaires/SHHS2/Quality Of Life