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STOP-Bang (NM800077)

STOP-Bang (NM800077) - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Questionnaires



Patient Name

DOB:

MR #


NM800077 (Rev. 09/19/16) Worksheet Only – Not a Medical Record Document
UW Health uwhealth.org
(University of Wisconsin Hospitals and Clinics Authority)
STOP-BANG QUESTIONNAIRE



Please answer the following questions below to determine if you might be at risk.

Yes No Snoring?
Ο Ο Do you Snore Loudly (louder than talking or loud enough to be heard through closed doors?


Yes No Tired?
Ο Ο Do you feel Tired, Fatigued, or Sleepy during the daytime?


Yes No Observed?
Ο Ο Has anyone Observed you Stop Breathing during your sleep?


Yes No Pressure?
Ο Ο Do you have or are being treated for High Blood Pressure?


Yes No
Ο Ο Body Mass Index more than 35?


Yes No
Ο Ο Age older than 50?


Yes No Neck size large?
Ο Ο Do you have a Neck that Measures more than 16 inches / 40 cm around (measure at Adam’s Apple)?

Yes No
Ο Ο Gender = Male?







Low risk of OSA: Yes to 0-2 questions
Intermediate risk of OSA: Yes to 3-4 questions
High risk of OSA: Yes to 5-8

Adapted from Chung F et al. Anesthesiology 2008; 812-821, and Chung F et Br J
Anaesth 2012; 108: 768-775.