STOP BANG Questionnaire
S Do you Snore loudly (louder than talking or loud enough to be heard through closed doors?
T Do you often feel Tired, fatigued, or sleepy during the daytime?
O Has anyone Observed you stop breathing during your sleep?
P Do you have or are being treated for high blood pressure?
B Body Mass Index (BMI) greater than 35
A Age over 50?
N Neck circumference greater than 40 cm?
G Gender male?
Scoring:
- Yes to 3 or more indicates High Risk for Obstructive Sleep Apnea
- Yes to less than 3 indicates Low risk for Obstructive Sleep Apnea
Epworth Sleepiness Scale
How likely are you to doze off or fall asleep in the following situations? Scale (0-3)
0= Not Likely 1= Slight Chance 2=Moderate Chance 3 = High Chance
Sitting and Reading ? 0 1 2 3
Watching TV? 0 1 2 3
Sitting inactive in public place (e.g. a theater or meeting) 0 1 2 3
As a passenger in a car for an hour without a break 0 1 2 3
Lying down to rest in the afternoon when circumstances permit 0 1 2 3
Sitting and talking to someone 0 1 2 3
Sitting quietly after lunch without alcohol 0 1 2 3
In a car while stopped in a few minutes in traffic 0 1 2 3
Epworth Score:_____________
If your score is 9 or greater than you are at risk for Obstructive Sleep Apnea
Health Quiz
Do you Snore?
Do you gasp/choke during sleep, witnessed, Observed?
Do you feel sleepy, tired, fatigued, during the day?
Do you have or being treated for Diabetes?
Neck Collar Size greater than 15 inches?
