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Sleep Apnea Test

    EPWORTH SLEEPINESS SCALE

    How likely are you to doze off or fall asleep and not just feel tired in the following situations? EVEN if you have not been in one of these situations lately, imagine what effect it would have had on you.

    Choose the most appropriate response from the following:

    • 0 = No risk of falling asleep
    • 1 = Low risk of falling asleep
    • 2 = Moderate risk of falling asleep
    • 3 = High risk of falling asleep

    First Name

    Last Name

    Email

    Questions 0 1 2 3
    1.Reading in sitting position 0 1 2 3
    2.Watching television 0 1 2 3
    3.Sitting idle in a public place (theater, meeting, etc). 0 1 2 3
    4.Sitting as a passenger in a vehicle for a journey of one hour or more. 0 1 2 3
    5.Lie down in the afternoon when circumstances permit. 0 1 2 3
    6.Sitting while talking with someone. 0 1 2 3
    7.Sitting quietly after a meal without alcoholic drink. 0 1 2 3
    8.In a car stopped for a few minutes at a traffic light or in traffic. 0 1 2 3
    RESULTS: TOTAL:

      STOP-BANG RATING MODEL (SLEEP APNEA SYNDROME SCREENING)

      First Name

      Last Name

      Email

      S(SNORING) Do you snore loudly (louder than when you speak or loud enough to be heard through closed doors)? YES
      Yes
      NO
      No
      T(TIREDNESS) Do you often feel tired, exhausted or sleepy during the day? YES
      Yes
      NO
      No
      O(OBSERVATION) Has anyone ever noticed that you stopped breathing in your sleep? YES
      Yes
      NO
      No
      P(BLOOD PRESSURE) Have you followed or are you undergoing treatment for high blood pressure? YES
      Yes
      NO
      No
      B(BMI) BMI greater than 35 kg / m2? YES
      Yes
      NO
      No
      A(AGE) Age over 50? YES
      Yes
      NO
      No
      N(NECK CIRCUMFERENCE) Circumference at 40cm (16in)? YES
      Yes
      NO
      No
      G(GENDER) Male? YES
      Yes
      NO
      No
      RESULTS :