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)?

2 Do you often feel TIRED, fatigued, or sleepy during the day?Has anyone OBSERVED that you have stopped breathing while sleeping?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.

3 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)60971021071121181231281331381431 4815315816316817417918418919419920420921 5220225230235240245250255261266271276611 0010611111612212713213714314815315816416 9174180185190195201206211217222227232238 2432482542592642692752802856210410911512 0126131136142147153158164169175180186191 1962022072132182242292352402462512562622 6727327828428929563107113118124130135141 1461521581631691751801861911972032082142 2022523123724224825425926527027828228729 3299304641101161221281341401451511571631 6917418O18619219720420921522122723223824 4250256262267273279285291296302308314651 1412012613213814415015616216817418018619 2198204210216222228234240246252258264270 2762822882943003063123183246611812413013 6142148155161167173179186192198204210216 2232292352412472532602662722782842912973 0330931532232833467121127134140146153159 1661721781851911982042112172232302362422 4925526126827428028729329930631231932533 1338344681251311381441511581641711771841 9019720321021622323023624324925626226927 6282289295302308315322328335341348354691 2813514214915516216917618218919620320921 6223230236243250257263270277284291297304 3113183243313383453513583657013213914615 3160167174181188195202209216222229236243 2502572642712782852922993063133203273343 4134835536236937671136143150157165172179 1861932002082152222292362432502572652722 7928629330130831532232933834335135836537 2379386721401471541621691771841911992062 1322122823524225025826527227928729430230 9316324331338346353361368375383390397731 4415115916617418218919720421221922723524 2250257265272280288295302310318325333340 3483553633713783863934014087414815516317 1179186194202210218225233241249256264272 2802872953033113193263343423503583653733 8138939640441242075152160168176184192200 2082162242322402482562642722792872953033 1131932733534335135936737538339139940741 5423431761561641721801891972052132212302 3824625426327127928729530431232032833634 4353361369377385394402410418426435443 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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