CHUNG F. ET AL ANESTHESIOLOGY 2008 AND BJA 2012 STOP BANG QUESTIONNAIRE P (02) 4226 6980 F (02) 4226 9857 A 47 Kenny Street, Wollongong NSW 2500 M [email protected] W www.ismc.net.au ISMC DO YOU S NORE LOUDLY (LOUDER THAN TALKING OR LOUD ENOUGH TO BE HEARD THROUGH CLOSED DOORS)? DO YOU OFTEN FEEL T IRED, FATIGUED, OR SLEEPY DURING DAYTIME? AGE: WEIGHT: NAME: HEIGHT: GENDER: PATIENT INFORMATION LOW RISK OF OSA: YES 0 - 2 INTERMEDIATE RISK OF OSA: YES 3 - 4 HIGH RISK OF OSA: YES 5 - 8 YES NO YES NO HAS ANYONE O BSERVED YOU STOP BREATHING DURING YOUR SLEEP? YES NO DO YOU HAVE OR ARE YOU BEING TREATED FOR HIGH BLOOD P RESSURE? YES NO STOP B MI MORE THAN 35KG/M 2 YES NO A GE OVER 50 YEARS OLD? YES NO N ECK CIRCUMFERENCE OVER 16 INCHES (40CM)? G ENDER: MALE? YES NO YES NO BANG TOTAL SCORE: