Sleep Apnea Questionnaire

Sleep Apnea Questionnaire
Yes to 0 -2 Questions: Low Risk of Sleep Apnea

Yes to 3 - 4 Questions: Intermediate Risk of Sleep Apnea

Yes to 5- 8 Questions: High Risk of Sleep Apnea

OR Yes to 2 or more of questions + male gender

OR Yes to 2 or more of questions + BMI > 35 kg/m2

OR Yes to 2 ore more of questions + neck circumference > 16 inches / 40 cm
1. Do you snore loudly? (Loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night.)

YesNo
2. Do you often feel tired, fatigued, or sleepy during the daytime? (Such as falling asleep during driving or talking to someone.)

YesNo
3. Has anyone observed you stop breathing or choking/gasping during your sleep?

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

YesNo
5. Body mass index more than 35 kg/m2?

YesNo
Weight (kg)
Height (m)
Calculation
6. Age older than 50?

YesNo
7. Is your shirt collar 16 inches/40 cm or larger?

YesNo
8. Gender male?

YesNo
Should be Empty: