Sleep Apnea Self-Risk Assessment

Answer the following questions below to determine if you might be at risk. If you answer “true” to three or more of these questions, you may be at moderate to high risk for sleep apnea.* Take these results to your MDVIP-affiliated physician, who may suggest further evaluation.

Apnea Questionnaire
Answer the following questions below to determine if you might be at risk. If you answer “yes” to three or more of these questions, you may be at moderate to high risk for sleep apnea2. Take these results to your MDVIP-affiliated physician, who may suggest further evaluation.

1. Do you snore loudly (loud enough to be heard through closed doors or your bed-partner to elbow you for snoring at night)?
Yes/No

2. Do you often feel tired, fatigued or sleepy during the daytime (such as falling asleep while driving or talking to someone)?
Yes/No

3. Has anyone observed you stop breathing, choke or gasp while you slept?
Yes/No

4. Do you have or are you being treated for high blood pressure?
Yes/No

5. Do you have a Body Mass Index greater than 35?
Yes/No

6. Age older than 50?
Yes/No

7. If male, is your shirt collar 17 inches or larger? If female, is it 16 inches or larger?
Yes/No

8. Gender = Male
Yes/No

*STOP-Bang Questionnaire: A Practical Approach to Screen for Obstructive Sleep Apnea.; Chest. 2016 Mar;149(3):631-8. doi: 10.1378/chest.15-0903. Epub 2016 Jan 12.