1) Do you snore loudly?
(Louder than talking or loud enough to be heard through a closed door?)
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
2) Do you often feel tired, foggy, or sleepy during the day?
(Even after what should be a full night’s sleep?)
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
3) Has anyone seen you stop breathing while sleeping?
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
4) Do you have high blood pressure?
(Or take medication for it?)
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
5) Is your BMI 35 or higher?
(If you’re not sure, you can use a BMI calculator.)
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
6) Are you over 50 years old?
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
7) Is your neck size larger?
Over 17 inches (men) or over 16 inches (women)
Yes
No
Note: This is a screening tool and does not provide a medical diagnosis.
8) Sex assigned at birth:
Male
Female
Note: This is a screening tool and does not provide a medical diagnosis.
Important: This questionnaire is a screening tool and does not diagnose obstructive sleep apnea.
Diagnosis requires a sleep study interpreted by a qualified medical professional.
If this is a medical emergency, call 911 or go to the nearest emergency room.
