Stop-Bang Obstructive Sleep Apnea

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All questions marked with a * are mandatory

Personal Details
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Questions

Snoring?

Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?: *

Tired?

Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?: *

Observed?

Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep : *

Pressure?

Do you have or are being treated for High Blood Pressure ?: *

Body Mass

What unit of measurement are you using?: *

Your Body Mass index (BMI): 

Your Body Mass index (BMI): 

Is your BMI Greater than 35?:

Age older than 50?

Are you over 50 year old?: *

Neck size large?

(Measured around Adams apple)

Is your shirt collar 16 inches / 40cm or larger?: *

Gender?

Are you Male?: *
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Results

Low Risk  

You have a score of /8

Your answers suggest you are at Low Risk for Obstructive Sleep Apnea (OSA)

  • If you would like to send this assessment to the surgery please continue to the next page

Intermediate Risk

You have a score of /8

Your answers suggest you are at Intermediate Risk for Obstructive Sleep Apnea (OSA)

  • If you would like to send this assessment to the surgery please continue to the next page

High Risk

You have a score of /8

Your answers suggest you are at High Risk for Obstructive Sleep Apnea (OSA)

  • Please submit this assessment to the surgery by continuing to the next page

High Risk

You have a score of /8 + Male

Your answers suggest you are at High Risk for Obstructive Sleep Apnea (OSA)

  • Please submit this assessment to the surgery by continuing to the next page
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