Obstructive Sleep Apnea Screening Tool

Kearney Anesthesia Associates, P.C

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Yes  No
❍     ❍  Do you SNORE Loudly? (Loud enough to be heard with a door closed)
❍     ❍  Do you often feel TIRED, fatigued, or Sleepy during the day?
❍     ❍  Has anyone OBSERVED you stop breathing (gasping/choking) during your sleep?
❍     ❍  Do you have or are you being treated for high blood PRESSURE?
❍     ❍  BMI Greater than 35? *See link below.
❍     ❍  Are you older than 50 years of AGE?
❍     ❍  NECK circumference greater than 40 cm? (size 17 collar)
❍     ❍  GENDER are you a Male?

Click for BMI Calculator