STOP-BANG Sleep Apnea Questionnaire

Fill all required fields (★) to submit the form.

Patient details:

Stop

1. Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?

No
Yes


2. Do you often feel TIRED, fatigued, or sleepy during daytime?

No
Yes


3. Has anyone OBSERVED you stop breathing during your sleep?

No
Yes


4. Do you have or are you being treated for high blood PRESSURE?

No
Yes


Bang

5. BMI more than 35kg/m2?

No
Yes


6. AGE over 50 years old?

No
Yes


7. NECK circumference > 16 inches (40cm)?

No
Yes


8. GENDER: Male?

No
Yes



I acknowledge for the safety of others that I have provided true and accurate details and I agree that may details can be used for contact tracing.

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