STOP BANG QUESTIONNAIRE

PATIENT DETAILS

First Name

Last Name

Email Address

Gender

MaleFemale

Height *

Weight *

BMI *

Collar size of shirt *

SMLXL

Neck circumference measurement (cm) *

QUESTIONS

1. SNORING - Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? *

YesNo

2. TIRED - Do you often feel tired, fatigued, or sleepy during daytime? *

YesNo

3. OBSERVED - Has anyone observed you stop breathing during your sleep? *

YesNo

4. BLOOD PRESSURE - Do you have or are you being treated for high blood pressure? *

YesNo

5. BMI - BMI more than 35 kg/m2 ? *

YesNo

6. AGE - Age over 50 yr old? *

YesNo

7. NECK CIRCUMFERENCE - Neck circumference greater than 40 cm? *

YesNo

8. GENDER - Gender male? *

YesNo

STOP BANG SCORE

Score calculated from your answers above *

* Neck circumference is measured by staff

High risk of OSA: answering yes to three or more items

Low risk of OSA: answering yes to less than three items

Adapted from:

STOP Questionnaire
A Tool to Screen Patients for Obstructive Sleep ApneaFrances Chung, F.R.C.P.C.,* Balaji Yegneswaran, M.B.B.S.,† Pu Liao, M.D.,‡ Sharon A. Chung, Ph.D.,§Santhira Vairavanathan,M.B.B.S.,_ Sazzadul Islam, M.Sc.,_ Ali Khajehdehi, M.D.,† Colin M. Shapiro, F.R.C.P.C.#Anesthesiology 2008; 108:812–21 Copyright © 2008, the American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc.

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