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1936 – 38 Avenue Edmonton
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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

T- Tiredness

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

Yes

O - Observed Apnea

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

Yes

P - High Blood Pressure

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

Yes

B - BMI*

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

Yes

A - Age

Are you older than 50 years old?

Yes

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

G - Gender

Are you male?

Yes

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)

Hidden

High Risk Stop 2+ and Male

Hidden

High Risk Stop 2+ and BMI

Hidden

High Risk Stop 2+ and Neck Circumference

Hidden

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*

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Name

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.

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

Hours

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

Saturday 9am-3pm
Saturdays from September to May only. Contact the office for availability

Connect

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To book an appointment call our office or fill out the online appointment request form and our office will be in touch to confirm. We look forward to serving you!

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About
- Our Team
- Blog
Services
New Patients/Forms
FAQ
Invisalign
Sleep Clinic
Make a Booking

780-432-5842
1936 – 38 Avenue Edmonton
Contact Us