Stop-Bang Sleep Apnea Questionnaire Template - Dental Creations
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1Name _________________________________
Height ___________ Weight _________
Age __________ Male / Female ___________
STOP-BANG Sleep Apnea Questionnaire
Chung F et al Anesthesiology 2008 and BJA 2012
STOP
Do you SNORE loudly (louder than talking or loud
Yes
No
enough to be heard through closed doors)?
Do you often feel TIRED, fatigued, or sleepy during
Yes
No
daytime?
Has anyone OBSERVED you stop breathing during
Yes
No
your sleep?
Do you have or are you being treated for high blood
Yes
No
PRESSURE?
BANG
BMI more than 35kg/m2?
Yes
No
AGE over 50 years old?
Yes
No
NECK circumference > 16 inches (40cm)?
Yes
No
GENDER: Male?
Yes
No
TOTAL SCORE
High risk of OSA: Yes 5 - 8
Intermediate risk of OSA: Yes 3 - 4
Low risk of OSA: Yes 0 - 2
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Parent category: Life