Apnea Risk Survey

Take Our Sleep Apnea Risk Survey

Obstructive Sleep Apnea (OSA) can negatively affect the quality of life of men and women of all ages. At its most severe, a lack of sleep caused by OSA can lead to high blood pressure, abnormal heart rhythms, heart attack or strokes.

This simple quiz can identify if you or a loved one is suffering from OSA.

First

Last

Zip

Height

feet

inches

Weight (lb)

Neck Size

Age

Gender

Referral

Where did you hear about this web site?

Health

Do you have high blood pressure?

Snoring

Do you snore often (three or more nights per week)?

Have you been told that during sleep, you frequently stop breathing or gasp for air?

Epworth Sleepiness Scale

How likely are you to doze off or fall asleep in the following situations in contrast to just feeling tired? This refers to your usual way of life in recent times. Even if you have not done some of these things recently, try to work out how they would have affected you. Use the scale below to choose the most appropriate frequency for each situation.

Sitting and reading

Watching television

Sitting, inactive, in a public place (e.g., theater, meeting)

Sitting as a passenger in a car for an hour without a break

Lying down to rest in the afternoon when circumstances permit

Sitting and talking to someone

Sitting quietly after a lunch without alcohol

Sitting in a car while stopped for a few minutes in traffic

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