STOP-BANG Patient Questionnaire

Please answer the questions below to help us see if you might have sleep apnea. This is when your breathing pauses sometimes while you are sleeping.

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

Do you often feel tired, fatigued, or sleepy during the daytime, even after a “good” night’s sleep?

Has anyone ever observed you to stop breathing during your sleep?

Do you have or are you being treated for high blood pressure?

Body Mass Index:

More then 35? (BMI Formula: weight (lb) / Height (in)2 x 703)

Age older than 50?

Neck size:
Does your neck measure more than 15 ¾ inches (40 cm) around?

Are you male?

Epworth Sleepiness Scale

The Epworth Sleepiness Scale is widely used in the field of medicine as a subjective measure of a patient’s sleepiness. How likely are you to doze off or fall asleep during he following situations, in contrast to just feeling tired?

For each of the situations listed below, give yourself a score of 0 to 3
0= Would never doze; 1= Slight chance; 2= Moderate chance; 3=High chance

Chance of dozing (0-3)
Sitting and reading
Watching television
Sitting inactively in a public place (For example, a theater or meeting)
As a passenger in a car for an hour without a break
Lying down to rest in the afternoon
Sitting and talking to someone
Sitting quietly after lunch (when you've had no alcohol)
In a care, while stopped in traffic

Total Score:
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