STOP-BANG Test

The STOP-BANG test is a key part of our fatigue management program. This (Yes/No) test will help identify individuals at risk of Obstructive Sleep Apnea (OSA).

Please answer the following questions to determine if you are at risk.

Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

Do you have or are being treated for High Blood Pressure?

Body Mass Index more than 35 kg/m2?

Age older than 50?

Neck size / shirt collar 16 inches / 40cm or larger? (Measured around Adams apple)

Gender = Male?

Name

First Name

Last Name

Phone

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