Marietta Cosmetic Dentist

STOP-Bang Questionnaire

Is it possible that you have Obstructive Sleep Apnea (OSA)?
Please answer the following questions below to determine if you might be at risk.

Personal Information

Full Name *

Phone *

Email Address *

Date of Birth *

Street Address *

Apartment, suite, etc

City *

State/Province *

ZIP / Postal Code *

Country

Snoring *YesNo

Snoring?
Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Tired *YesNo

Tired?
Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Observed *YesNo

Observed?
Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

Pressure *YesNo

Pressure?
Do you have or are being treated for High Blood Pressure?

BMI *YesNo

Body Mass Index more than 35 kg/m²?

Height (in inches) *

Weight (in pounds) *

BMI

Age *YesNo

Age older than 50?

Neck *YesNo

Neck size large ? (Measured around Adams apple)
Is your shirt collar 16 inches / 40cm or larger?

Gender *YesNo

Gender = Male ?

Total Score

By submitting your screening responses, you agree that a representative from our team may contact you to discuss your results and provide information about sleep apnea treatment options, including CPAP alternatives.