Albemarle Dental
Proudly serving Charlottesville, VA

Sleep Apnea Questionnaire

Updated STOP-Bang Questionnaire

Answer each of the follwing questions with a YES or NO:

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

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

_____ Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

_____ Do you have or are being treated for High Blood Pressure?

_____ Is your Body Mass Index more than 35 kg/m2?

_____ Are you older than 50 years old?

Neck size (Measured around Adams apple):
_____ For male, is your shirt collar 17 inches/43 cm or larger?
_____ For female, is your shirt collar 16 inches/41 cm or larger?

_____ Are you male?

Scoring Criteria for general population:
Low risk of OSA (Obstructive Sleep Apnea):
Yes to 0-2 questions
Intermediate risk of OSA:
Yes to 3-4 questions
High risk of OSA:
Yes to 5-8 questions
or Yes to 2 or more of 4 STOP questions + male gender
or Yes to 2 or more of 4 STOP questions + BMI > 35 kg/m2
or Yes to 2 or more of 4 STOP questions + neck circumference

Proprietary to University Health Network.
Modified from: Chung F et al. Anesthesiology 2008; 108:812-­‐21; Chung F et al. Br J Anaesth 2012, 108:768–75; Chung F et al. J Clin Sleep Med 2014;10:951-­‐8.