What is a normal Nijmegen questionnaire score?

A score below 23 is below the clinical threshold for hyperventilation syndrome. A score of 23 or above is the standard positive screen threshold.

What does a Nijmegen score above 23 mean?

A score of 23 or above is a positive screen for hyperventilation syndrome or breathing pattern disorder. It suggests that further clinical assessment of breathing pattern may be helpful. Discuss your score with your doctor.

Nijmegen questionnaire: free online breathing pattern disorder screening tool

Nijmegen Questionnaire

Breathing Pattern Disorder Screening

The Nijmegen questionnaire is a 16-item self-report screening tool for hyperventilation syndrome and breathing pattern disorder. It was originally developed by van Dixhoorn and Duivenvoorden and has been widely used in respiratory and physiotherapy settings since the 1980s. Each item asks how often you experience a particular symptom on a scale from 0 (never) to 4 (very often), producing a total score between 0 and 64.

Breathing pattern disorder is common in post-viral conditions, POTS, and ME/CFS, and is often underdiagnosed. It can contribute to or worsen symptoms including breathlessness, dizziness, chest tightness, tingling in the hands and face, and brain fog. Because these symptoms overlap significantly with autonomic dysfunction and post-viral fatigue, breathing pattern disorder can be difficult to distinguish from other aspects of a post-viral condition without specific screening.

The Nijmegen questionnaire is not a definitive diagnostic test, but it is a useful first step. A score above 23 is the standard threshold for suspected hyperventilation syndrome, and it is commonly used by respiratory physiotherapists and in specialist post-viral clinics to decide whether further assessment of breathing pattern is warranted.

This is a free, interactive version. Complete it below and receive your score immediately. No sign-up or email is required.

This is not a diagnostic tool. A score above the threshold suggests that further clinical assessment of breathing pattern may be worthwhile; it does not establish a diagnosis. Breathing symptoms can have multiple causes. Discuss results with your doctor. Based on: van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen Questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199–206.

Your Nijmegen score

— out of 64

Item breakdown

Symptom	Your response	Score
Total

Understanding your score

The Nijmegen questionnaire produces a total score between 0 and 64. Higher scores indicate a greater number and frequency of symptoms associated with hyperventilation and disordered breathing.

The established clinical threshold is a score of 23 or above, which is considered a positive screen for hyperventilation syndrome or breathing pattern disorder.

0–22: below the clinical threshold. Your pattern of symptoms is not strongly suggestive of hyperventilation syndrome based on this screening, though individual symptoms may still be worth discussing with a clinician.

23 and above: positive screen. This score suggests that further assessment of breathing pattern may be helpful. Discuss your score with your doctor.

A positive score does not mean you definitely have breathing pattern disorder. Similarly, a score below 23 does not rule it out, particularly if you have symptoms that come and go or are triggered by specific situations.

In post-viral conditions, breathing pattern disorder often coexists with autonomic dysfunction, deconditioning, and anxiety. The two presentations can reinforce each other.

This is a screening tool only. It cannot establish a diagnosis. Discuss your score and any breathing symptoms with your doctor.