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Sleep Clinic
About Dr. Lee
FAQ
Sleep Apnea Risk Quiz
Contact

Adult Sleep Screening Questionnaire

"*" indicates required fields

STOP-Bang Questionnaire

Please answer the following questions by checking "Yes" or "No" for each one:

S - Snoring

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

Yes

No

T- Tiredness

Do you often feel tired, fatigued, or sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Yes

No

O - Observed Apnea

Has anyone observed you stop breathing or choking/gasping during your sleep?

Yes

No

P - High Blood Pressure

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

Yes

No

B - BMI*

Is your body mass index greater than 35 kg/m2?

Yes

No

A - Age

Are you older than 50 years old?

Yes

No

N - Neck circumference

For male, is your shirt collar 17 inches / 43cm or larger? For female, is your shirt collar 16 inches / 41cm or larger?

Yes

No

G - Gender

Are you male?

Yes

No

Your Results

Your Total Score

Score 1 point for each positive "YES" response

You score low risk

You score intermediate risk

You score high risk

Analyze Your Score

0-2: OSA - Low Risk
3-4: OSA - Intermediate Risk
5-8: OSA - High Risk

If you meet the following criteria you also rank as high risk

Yes to 2 or more of 4 STOP questions + male gender
Yes to 2 or more of 4 STOP questions + BMI > 35kg/m2
Yes to 2 or more of 4 STOP questions + neck circumference 17 inches / 43 cm (male) or 16 inches / 41cm (female)

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High Risk Stop 2+ and Male

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High Risk Stop 2+ and BMI

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High Risk Stop 2+ and Neck Circumference

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Stop Score

Next Steps

Would you like to email these results?

If you'd like to email yourself a copy of this survey, add your email and hit submit.

Yes

Email*

Book a FREE Consultation Today!

Email

This field is for validation purposes and should be left unchanged.

* Chung F et al. Aoesthesiology 2008; 108: 812-821, Chung F et al Br J Aoaesth 2012; 108: 768-775, Chung F et al J Clio Sleep Med Sept 2014.

Contact Us For a FREE Consultation

To request an appointment please complete the form below. Our office will contact you and confirm within 1 business day.

** This form is for new appointment requests. If you have changes to an existing appointment please call us.
Are you an existing patient?*
- Existing patient
- New patient
Your Name*
Email*
Phone*
Preferred Appointment Day*
Check all that apply
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Any
Preferred Appointment Time*
Check all that apply
- Morning
- Early Afternoon
- Later Afternoon
- Any
Preferred Method Of Communication*
- Phone
- Email
Nature Of Appointment / Comments
Name
This field is for validation purposes and should be left unchanged.

Apollonia Sleep Clinic

Our clinic is located in Apollonia Dental Clinic.

Dr. Lee is a dentist with a special focus in dental sleep medicine. We strongly believe in the importance of interdisciplinary health, and we work with many doctors and sleep specialists to come up with a treatment plan that works for you. More...

Apollonia Dental Clinic

Connect

780-432-5842 | Email Us

Monday 9am-4pm
Tuesday 9am-4pm
Wednesday 9am-4pm
Thursday 9am-4pm
Friday 9am-4pm

Location

Conveniently located just off Whitemud Drive, in the Tamarack/Larkspur area of South East Edmonton, our dentists serve clients throughout Edmonton.

1936 – 38 Avenue, Edmonton, AB

Map & Directions

© 2024 Apollonia Breathe Clinic Edmonton.
Website by Somnia.ca

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Sleep Clinic
About Dr. Lee
FAQ
Sleep Apnea Risk Quiz
Contact