Obstructive Sleep Apnoea Questionnaire

If you have been advised by the surgery to do so, please submit this form.

For more information, please visit NHS: Sleep Apnoea.

Obstructive Sleep Apnoea Questionnaire

Section

Do you snore loudly (louder than talking or loud enough to be heard through closed doors)? *
Do you often feel tired, fatigued, or sleepy during daytime? *
Has anyone observed you stop breathing during your sleep? *
Do you have or are you being treated for high blood pressure? *
eg. 1.75
eg. 60.6
Body Mass Index (BMI) more than 35? *
Age over 50? *
Neck circumference greater than 40cm / 16 inches? *
Is your gender male? *

A score of 0-2 may indicate a low risk of obstructive sleep apnoea.

A score of 3-4 may indicate an intermediate risk of obstructive sleep apnoea.

A score of 5-8 may indicate a high risk of obstructive sleep apnoea.