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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.


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

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