STOP BANG Questionnaire

Answer the following questions to find out if you are at risk for obstructive sleep APNEA (OSA).

If you respond yes to 3 or more, you are considered high risk for OSA and should have a Sleep Study.

SNORING Do you snore loudly?Louder than talking, or to be heard through closed doors?*  Yes No
TIRED Do you feel tired,fatigued, or sleepy during the daytime?*  Yes No
OBSERVED Has anyone observed you stop breathing during your sleep?*  Yes No
(BLOOD) PRESSURE Do you have, or are you being treated for high blood pressure?*  Yes No
BMI BMI greater than 35?*  Yes No
AGE Age over 50 Years Old?*  Yes No
NECK Is you neck circumference greater than 40cm (16 in)?*  Yes No
GENDER Is your gender male?*  Yes No

Your Name *

Your Email *

Phone *

Family Doctor*

City*