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  • Home
  • About Us
    • Our Mission
    • Administrative Team
    • Clinical Team
    • Physical Therapy Team
    • News and Announcements >
      • Office Closures
      • MS Walk 2025
    • What's a Neurologist?
  • Our Providers
    • Craig H. Couch, MD
    • Adam D. Horvit, MD
    • Elizabeth L. Peckham, DO
    • Terry S. Peery, DO
    • Yashma R. Patel, MD
    • Parisa Khosravi, DO
    • Breanna Purdie, MSN, APRN, FNP-C
    • Karan Saini, PA
  • Services
    • Headache Center
    • Center for Sleep Medicine
    • Multiple Sclerosis Clinic
    • Epilepsy Center
    • Neuromuscular Center
    • Movement Disorder Center
    • Electrodiagnostic Center (EMG and EEG)
    • Infusion Center
    • Physical Therapy >
      • Physical Therapy Forms
  • Patient Resources
    • New Patient Scheduling
    • Patient Forms >
      • Dr. Couch Patient Forms
      • Dr. Patel / Dr. Khosravi Patient Forms
      • Dr. Horvit Patient Forms
      • Dr. Peckham Patient Forms
      • Dr. Peery Patient Forms
    • Research >
      • Clinical Trial Enrollment Form
    • Billing Information
    • Insurance Information
    • Location
    • Pay My Bill Online
    • Additional Resources
    • Our Privacy Policy
  • Contact
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  • Patient Portal
< Center for Sleep Medicine

STOP-BANG Questionnaire
A Tool to Screen Patients for Obstructive Sleep Apnea



S:  Have you been told that you SNORE?                                                                          Yes       No

T: Do you often feel TIRED, fatigued or sleepy during daytime?                                  Yes       No

O:  Has anyone OBSERVED you holding your breath while asleep?                              Yes      No
P: Do you have or are you being treated for high blood PRESSURE?                           Yes     No




B:  Is your BODY MASS INDEX greater than 28?                                                             Yes      No

A:   AGE over 50 years old?                                                                                                    Yes      No

N: NECK circumference greater than 16 inches?                                                                Yes     No

G:  Are you a MALE?                                                                                                               Yes    No

If you answered Yes to 3 or MORE questions, you are at HIGH RISK for OSA.
To schedule an appointment call 512-218-1222

REFERENCE
Chung, F., Yegneswaran, B., Liao, P., Chung, S. A., Vairavanathan, S., Islam, S., Khajehdehi, A., and Shapiro, C. M. STOP Questionnaire A Tool to Screen Obstructive Sleep Apnea. Anesthesiology 108, 812-821. 2008.
16040 Park Valley Dr, Building B, Suite 100 | Round Rock, TX 78681 | Phone (512)218-1222 | Fax (512)218-1393
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