Sleep Apnea Screening
Charm Smile Dental
STOP-BANG Sleep Apnea Screening
Patient Name:
Date:
STOP-BANG Questionnaire
Purpose: This questionnaire helps identify patients who may be at risk for obstructive sleep apnea (OSA). Please answer all questions honestly. This screening does not diagnose sleep apnea but helps determine if further evaluation is needed.
S - SNORING
Do you snore loudly (loud enough to be heard through closed doors or your bed partner elbows you for snoring at night)?
T - TIRED
Do you often feel tired, fatigued, or sleepy during daytime?
O - OBSERVED
Has anyone observed you stop breathing during your sleep?
P - PRESSURE
Do you have or are you being treated for high blood pressure?
B - BMI
Is your Body Mass Index (BMI) more than 35 kg/m²?
Height: __________ Weight: __________ Calculated BMI: __________
A - AGE
Are you over 50 years old?
Patient Age: __________
N - NECK
Is your neck circumference greater than 16 inches (40 cm)?
Measured Neck Circumference: __________ inches/cm
G - GENDER
Are you male?
STOP-BANG Score: 0/8
Risk Level: Low Risk
Low risk for obstructive sleep apnea. Continue routine care.