Forms

STOP-BANG Questionnaire

Submit this form to find out if you have low, intermediate or high risk of obstructive sleep apnea.

Date of birth

Is it possible that you have obstuctive sleep apnea (OSA)?

Please answer the following questions below to determine if you might be at risk.

S

Snoring? Do you snore loudly? (loud enough to be heard through closed doors or your bed-partner "elbows" you for snoring at night?)

Yes

T

Tired? Do you often feel tired, fatigued or sleepy during the daytime (such as falling asleep during driving or talking to someone?)

Yes

O

Observed? Has anyone observed you stop breathing or choking/gasping during sleep?

Yes

P

Pressure? Do you have or are being treated for high blood pressure?

Yes

B

Body mass index more than 35kg/m2? Calculate your BMI on the link below: https://www.nhlbi.nih.gov/health/educational/lose_wt/BMI/bmicalc.htm

Yes

A

Age older than 50?

Yes

N

Neck size large? (measured around Adams apple): For male, is your shirt collar 17 inches / 43 cm or greater? For female, is your shirt collar 16 inches / 41 cm or greater?

Yes

G

Gender = Male?

Yes