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Downloads 2019-10-18T00:18:55+00:00

Our resources are available for downloads. Please see individual tabs for the printable versions.

A STOP-BANG* questionnaire is used to screen for Obstructive Sleep Apnea (OSA). It is commonly used to assess if you are at low, moderate or high risk for Sleep Apnea.

Please answer Yes or No to the following questions.

  1. Do you snore loudly? Loud enough to be heard through closed doors?
  2. Do you often feel tired, fatigued or sleepy during the daytime?
  3. Has anyone observed you stop breathing during your sleep?
  4. Do you or are you being treated for high blood pressure?
  5. Is your Body Mass Index (BMI)^ more than 35?
  6. Are you older than 50 years of age?
  7. Is your neck size large? (Males >17″; Females >16″)
  8. Are you male?

Yes to 2 or less questions: Low risk

Yes to 3-4 questions: Moderate risk

Yes to 5 or more questions: High risk

*Chung F, Yegneswaran B, Liao P, et al. STOP questionnaire: a tool to screen patients for obstructive sleep apnea. Anesthesiology. 2008;108:812–21.
^Body Mass Index (BMI) is determined by your weight (in kg) divided by your height (in m squared).

Download printable copy here

The OSA-50 Screening Questionnare is used to screen for Obstructive Sleep Apnoea (OSA) and assesses if you are at risk for Sleep Apnoea.

Please answer Yes or No to the following questions and tabulate the scores accordingly.

OSA 50 Screening Questionnaire

If YES, score

Waist circumference*: Male > 102cm Females > 88cm

3

Has your snoring ever bothered other people?

3

Has anyone noticed you stop breathing during your sleep?

2

Are you aged 50 years or over?

2

TOTAL SCORE

OUT OF 10

*Waist measurement to be measured at the level of the umbilicus

If you score more than 5 out of 10, consult your doctor to see if you need to investigate further as you may be at risk of Sleep Apnoea. The Epworth Sleepiness Scale can also be used to further determine the necessity for a Sleep Study.

Download printable copy here

The ESS* is meant to complement the STOP-BANG questionnaire to determine the need for further investigation into the presence of Sleep Apnea.

How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the following scale to choose the most appropriate number for each situation:

  • 0 = would never doze
  • 1 = slight chance of dozing
  • 2 = moderate chance of dozing
  • 3 = high chance of dozing

Situation chance of dozing:

  1. Sitting and reading
  2. Watching television
  3. Sitting inactive in a public place (e.g. a theatre or meeting)
  4. As a passenger in a car for an hour without a break
  5. Lying down to rest in the afternoon when circumstances permit
  6. Sitting and talking to someone
  7. Sitting quietly after a lunch without alcohol
  8. In a car, while stopped for a few minutes in traffic

Calculate the total score and see results here:

1-6: Congratulations, you are getting enough sleep!

7-8: Your score is average

9 and up: Very sleepy and should seek medical advice

*Johns, M.W. (1991). A new method for measuring daytime sleepiness: The Epworth sleepiness scale. Sleep, 14, 540-545.

Download printable copy here

If you suspect you may be suffering from Sleep Apnea, you can download this form and bring it to your doctor for consultation and sign-off.

If you are a physician and would like to refer your patient for Sleep Apnea, you can download this form and send it to us. We will arrange for a Sleep Study with your patient and inform you once the report is ready.

Download referral form here