STOP-BANG Questionnaire What Is Obstructive …

1 what Is Obstructive sleep Apnea (OSA)? It is when your breathing stops or slows down while you are you snore loudly or gasp for air when you sleep , or you are always tired, you may have is often present with other diseases. If OSA is overlooked, it could be bad for your health. 43 million Americans currently have OSA 50% of patients with diabetes have OSA 30% of patients with high blood pressure have OSAC omplete the Questionnaire below to know if you are at risk of OSA. Patient InformationName:Male/Female (M/F):Age (years):Height: Feet InchesBody mass index ([BMI] see reverse side):Weight (pounds):Neck or collar size (in inches; office staff can measure):STOP-BANGYESNODo you SNORE loudly (ie, louder than talking or loud enough to be heard through closed doors)?Do you often feel TIRED, fatigued, or sleepy during the day?Has anyone OBSERVED that you have stopped breathing while sleeping?

2 Do you have or are you being treated for high blood PRESSURE?BMI more than 35 kg/m2?Are you more than 50 years of AGE?Is your NECK 17 inches or greater for men (16 inches for women)?Male GENDER?YES to 3 or more questions means you are at high QuestionnaireTalk with your doctor about this Questionnaire . If you are at high risk of OSA, ask about the AccuSom Home sleep Home sleep Test An Easy, Clinically Accurate, Comfortable Solution for an OSA* DiagnosisKnow Your BMI to Help Determine Your Risk of OSATo calculate your BMI: 1. Find your height in inches in the left-hand column (use chart below to convert feet to inches) 2. Move across the row until you find your weight in pounds 3. Go up to the row labeled BMI (example height: 67 inches weight: 159 pounds BMI: 25)Body Mass Index Conversion ChartNormalOverweightObeseExtreme ObesityBMI192021222324252627282930313233 3435363738394041424344454647484950515253 54(kg/m2)Height (inches)Body Weight (pounds)

3 6097102107112118123128133138143148153158 1631681741791841891941992042092152202252 3023524024525025526126627127661100106111 1161221271321371431481531581641691741801 8519019520120621121722222723223824324825 4259264269275280285621041091151201261311 3614214715315816416917518018619119620220 7213218224229235240246251256262267273278 2842892956310711311812413013514114615215 8163169175180186191197203208214220225231 2372422482542592652702782822872932993046 411011612212813414014515115716316917418O 1861921972042092152212272322382442502562 6226727327928529129630230831465114120126 1321381441501561621681741801861921982042 1021622222823424024625225826427027628228 8294300306312318324661181241301361421481 5516116717317918619219820421021622322923 5241247253260266272278284291297303309315 3223283346712112713414014615315916617217 8185191198204211217223230236242249255261 2682742802872932993063123193253313383446 8125131138144151158164171177184190197203 2102162232302362432492562622692762822892 9530230831532232833534134835469128135142 1491551621691761821891962032092162232302 3624325025726327027728429129730431131832 4331338345351358365701321391461531601671 7418118819520220921622222923624325025726 4271278285292299306313320327334341348355 3623693767113614315015716517217918619320 0208215222229236243250257265272279286293 3013083153223293383433513583653723793867 2140147154162169177184191199206213221228 2352422502582652722792872943023093163243 3133834635336136837538339039773144151159 1661741821891972042122192272352422502572 6527228028829530231031832533334034835536 3371378386393401408741481551631711791861 9420221021822523324124925626427228028729 5303311319326334342350358365373381389396 4044124207515216016817618419220020821622 4232240248256264272279287295303311319327 3353433513593673753833913994074154234317 6156164172180189197205213221230238246254 2632712792872953043123203283363443533613 69377385394402410418426435443 Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence to Inches Conversion ChartFeet/Inches5'0"5'1"5'2"5'3"5'4"5'5" 5'6"5'7"5'8"5'9"5'10"5'11"6'0"6'1"6'2"6' 3"6'4"Inches60"61"62"63"64"65"66"67"68"6 9"70"71"72"73"74"75"76"*OSA= Obstructive sleep apnea BMI=body mass index 2014 NovaSom Inc.

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