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Sleep Questionnaire

STOP-BANG Sleep Apnea Questionnaire skip

Name

Phone

Email Address

Gender

Age

Height(cm)

Weight(kg)

Stop

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 daytime?

Has anyone OBSERVED you stop breathing during your sleep?

Do you have or are you being treated for high blood PRESSURE?

Bang

BMI more than 35kg/m2?

AGE over 50 years old?

NECK circumference > 16 inches (40cm)?

GENDER: Male?