Name: _______________________________________ Height: _____________ Weight: _____________ Age:____________ Male/Female:_____________ STOP-BANG Sleep Apnea Questionnaire STOP Do you SNORE loudly(louder Yes No than talking or loud enough to be heard through closed doors)? Do you often feel TIRED, Yes No fatigues, or sleepy during daytime? Has anyone OBSERVED you Yes No stop breathing during your sleep? Do you have or are you being Yes No treated for high blood PRESSURE? BANG BMI more than 35kg/m2? Yes No AGE over 50 years old? Yes No NECK circumference > 16 Yes No inches (40 cm)? Gender: Male? Yes No TOTAL SCORE High Risk of OSA: Yes 5-8 Intermediate Risk of OSA: Yes 3-4 Low Risk of OSA: Yes 0-2
Name: _______________________________________ Height: _____________ Weight: _____________ Age:____________ Male/Female:_____________ STOP-BANG Sleep Apnea Questionnaire STOP Do you SNORE loudly(louder than talking or loud enough to be heard through closed doors)? Yes No Do you often feel TIRED, fatigues, or sleepy during daytime? Yes No Has anyone OBSERVED you stop breathing during your sleep? Yes No Do you have or are you being treated for high blood PRESSURE? Yes No BANG BMI more than 35kg/m2? Yes No AGE over 50 years old? Yes No NECK circumference > 16 inches (40 cm)? Yes No Gender: Male? Yes No TOTAL SCORE High Risk of OSA: Yes 5-8 Intermediate Risk of OSA: Yes 3-4 Low Risk of OSA: Yes 0-2