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STOP-Bang Questionnaire

Please answer the following questions below to determine if you are at risk of obstructive sleep
apnea (OSA).

Name*
FirstLast
Phone*
Email*
Company*
Snoring?
Do you SNORE Loudly (loud enough to be heard through closed doors or your partner has to wear ear plugs or elbow you at night)?*
- Yes
- No
Tired?
Do you often feel TIRED, Fatigued, or Sleepy during the daytime?*
- Yes
- No
Observed?
Has anyone OBSERVED you Stop Breathing during your sleep?*
- Yes
- No
Pressure?
Do you have or are being treated for High Blood PRESSURE?*
- Yes
- No
BODY Mass Index more than 35 kg/m2?*
- Yes
- No
Do you Weigh More for your height than is shown in the table below:
Click on chart to view larger
AGE older than 50 year old?*
- Yes
- No
Neck Size Large?
For male, is your shirt collar 17 inches or larger? For female, is your shirt collar 16 inches or larger?
- Yes
- No
GENDER = Male?*
- Yes
- No

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