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STOP-BANG Sleep Apnea Questionnaire

Step 1 of 2

50%

Name(Required)

First Last

Email(Required)

Phone(Required)

Height (in cm)(Required)

Weight (in Pound)(Required)

Age(Required)

STOP

Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?(Required)

Yes

No

Do you often feel TIRED, fatigued, or sleepy during daytime?(Required)

Yes

No

Has anyone OBSERVED you stop breathing during your sleep?(Required)

Yes

No

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

Yes

No

BANG

BMI more than 35kg/m2 ?(Required)

Yes

No

AGE over 50 years old ?(Required)

Yes

No

NECK circumference > 16 inches (40cm) ?(Required)

Yes

No

Gender : Male?(Required)

Yes

No

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Result

Δ

STOP-BANG Sleep Apnea Questionnaire

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Clearwater

Phone: 727-477-3636
Email: Info@clearwateraesthetics.com
Office Address: 818 Chestnut St, Clearwater, FL 33756

Other Locations

Phone:
Office Address: West Chase Tampa.
10971 Countryway Blvd, Tampa, FL 33626

Other Locations

Phone:
Office Address: 910 Old Camp Rd #152,
The Villages, FL 32162

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