OSA Quiz

1

Have you ever been diagnosed with high blood pressure?* This field is required.1 Point

YESNO

2

Have you been diagnosed with heart disease?* This field is required.1 Point

YESNO

3

Have you had a stroke?* This field is required.1 Point

YESNO

4

Do you have diabetes?* This field is required.1 Point

YESNO

5

Have you been diagnosed with depression?* This field is required.1 Point

YESNO

6

Have you been diagnosed with sleep apnea?* This field is required.6 Points

YESNO

7

On average in the following situations how likely are you to doze off in the following situations? Sitting, reading, watching TV, a passenger in a car, lying down to rest during the day, after lunch without alcohol, sitting in traffic.* This field is required.0-2 Points

I would never doze off.

Slight chance of dozing off.

Moderate chance of dozing off.

High chance of dozing.

8

On average in the past month, how often have you snored or been told that you snored?* This field is required.0-4 Points

Never

Rarely

Sometimes

Frequently

Almost Always

10

Have you been told you wake up choking or gasping?* This field is required.0-4 Points

Never

Rarely

Sometimes

Frequently

Almost Always

11

If you are a male is your neck bigger than 16.5 inches? If female, is your neck bigger than 15 inches?* This field is required.Use dental floss or similar to go around your neck. Measure length of floss with a tape measure. 2 Points

YESNO

12

See your score below. Scores 0-5 are eligible for a snoring mandibular advancement device. Scores 6+ should get a sleep study and medical diagnosis before being fitted for a mandibular advancement device.