Mountain States Health Alliance Sleep Center
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Sleep Apnea Risk Assessment Questionnaire

 
 
 

Gender


Snoring: Do you snore loudly (louder than talking or loud enough to be heard through closed doors)?


 

Tired: Do you often feel tired or fatigued during the day?


 

Observed: Has anyone observed you stop breathing during your sleep?


 

Blood Pressure: Do you have or are you being treated for high blood pressure?


 

Body Mass Index (BMI): BMI greater than 35 kg/m^2



 

Age: Over 50 years old?


 

Neck Circumference: Neck Circumference greater than 17 inches?


 

Gender: Are you male?

 

High Risk of OSA:

Moderate Risk of OSA:

Low Risk of OSA

Using CPAP: