Sleep Health Questionnaire

Risk of Sleep Apnea Questionnaire

We want to help you sleep better.
To get started, answer these questions to see if you are at a higher risk of sleep apnea.

*1. Have you ever been told that you snore loudly (louder than talking or loud enough to be heard through closed doors)?	Yes No	*5. Is your BMI more than 35?	Yes No
*2. Do you often feel tired, fatigued or sleepy during the day?	Yes No	*6. Is your neck size circumference 16 inches or greater?	Yes No
*3. Has anyone told you that you stop breathing during your sleep?	Yes No	*7. Are you over 50 years old?	Yes No
*4. Do you have or are you being treated for high blood pressure?	Yes No	*8. Are you a male?	Yes No

If you answered ‘yes’ to three or more questions, your risk of sleep apnea may be high.
Would like to have someone from Fairview Sleep Centers contact you? Yes No

Thank you for your interest in Fairview Sleep Centers. If you have any questions, please contact us at 612-273-5000.


*First Name
*Last Name
*Zip Code
Email address
*Phone Number

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