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Sleep Apnea Screening Test

This is the Stop-Bang scoring model. The purpose is to determine if you are at ‘high’ or ‘low’ risk for Sleep Apnea. Answer the questions below to find out your risk factor.

If you answer ‘YES’ more than 3 times – you are at HIGH RISK for Sleep Apnea.
If you answer ‘YES’ less than 3 times – you are at LOW RISK for Sleep Apnea.

Please provide your contact information and click “Submit” if you would like someone from the FMH Sleep Center to follow-up with you regarding your results



* Indicates required information
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? * 
Has anyone observed you stop breathing during your sleep? * 
Do you have or are you being treated for high blood pressure? * 
Is your BMI greater than 35kg/m2? (Example: A person 5’ 9” tall, weighing 240 pounds or more) * 
Are you over 50 years old? * 
Is your neck circumference greater than 19 inches (for men)/ 17 inches (for women)? * 
Are you male? * 
Name * 
Email 
Phone * 
 

If you answered ‘YES’ more than 3 times – you are at HIGH RISK for Sleep Apnea.
If you answered ‘YES’ less than 3 times – you are at LOW RISK for Sleep Apnea.

Please provide your contact information and click “Submit” if you would like someone from the FMH Sleep Center to follow-up with you regarding your results

 

                   

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