What is your Risk for Sleep Apnea?
count Each “YES”
0-2= Low Risk, 3-4= Intermediate Risk, 5-8= High Risk
Snoring? __Yes __No
Do you Snore Loudly (Louder than talking or loud enough to be heard through closed doors?
Tired? __Yes __No
So you often feel TIRED, FATIGUED, or SLEEPY during the daytime?
Observed? __Yes __No
Has anyone observed you STOP BREATHING during your sleep?
Pressure? __Yes __No
Do you have or are you being treated for HIGH BLOOD PRESSURE?
Body Mass index more then 35? __Yes __No
See chart below
Age older than 50? __Yes __No
Neck size larger than 16 inches at Adam’s Apple? __Yes __No
Gender- are you male? __Yes __No
Questionnaire adapted from Chung F et al Anesthesiology 2008; 108: 812821, and Chung F et al Br J Anaesth. 2012; 108: 768-775