Sleep Apnea Quiz « Respiratory & Sleep Solutions LLC

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Take this short evaluation to see if you are at risk for having obstructive sleep apnea.

First Name*

Last Name*

Email*

Phone

What City Do You Live In?

Do You Snore?*

Is snoring so loud that it can be heard through a door or wall?*

Do you stop breathing or gasp during sleep?*

What is your collar size?*

Male - Less than 17 inches (0)

Male - Greater than 17 inches (5)

Female - Less than 14 inches (0)

Femail - Greater than 14 inches (5)

Not Sure

Do you have high blood pressure?

Yes

Not Sure

Do you occassionally doze, or fall asleep during the day when you're not busy or active?

Yes

Are you overweight?*

Yes

Not Sure

Total Score*

0-5: Low Risk

6-8: Moderate Risk

9+: High Risk

Error occured. Please confirm your data and submit again:

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