Sleep Questionnaire

The questionnaire below is a common tool for screening your risk-level for Obstructive Sleep Apnea. Answer the questions honestly and see your risk level immediately below.

Snoring: Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Yes No

Tired: Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during during driving or talking to someone)?

Yes No

Observed: Has anyone Observed you Stop Breathing or Choking/Gasping 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

Age older than 50 years?

Yes No

Neck size large? For males, is your shirt collar 17 inches or larger? For females, is shirt collar 16 inches or larger?

Yes No

Gender = Male?

Yes No

OSA Risk Level: