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Sleep Apnea Screening Questionnaire

Not sure if you are suffering from Sleep Apnea? Our screening can help!

Sleep Apnea Screening Questionnaire – ‘STOP’

This a revision of the popular STOP sleep apnea screening questionnaire. The scoring system is at the bottom.

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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?


SCORE:
If YES to 0 – 2, then low risk of sleep apnea
If YES to 3 – 4 of the above, then you are at intermediate risk of having sleep apnea

STOP

Click here for a pdf copy of this questionnaire

Note: Messages sent using this form are not considered private. Please contact our office by telephone if sending highly confidential or private information.

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CHESTERBROOK DENTAL ASSOCIATES
Robert J. Dollfus III, DMD
Brooke Bowen, DMD, John B. Fitzgerald III, DMD