Self Evaluation Questionnaire

This questionnaire helps estimate your risk for having obstructive sleep apnea. The higher your score, the more likely you are to have obstructive breathing in your sleep.

NOTE: This questionnaire is intended to indicate risk of sleep apnea and does not substitute for a sleep study diagnosis.

Yes No Not Sure    
Have you been told (or noticed on your own) that you snore on most nights?
Have you been told (or noticed on your own) that you stop breathing or struggle to breathe in your sleep?
Are you tired, fatigued or sleepy on most days?
Do you have acid indigestion or high blood pressure (OR use medication to control either of these conditions)?
Are you overweight?
     


At high risk? Learn more about sleep study.

If you would like to submit your results to us, please fill out your name, email address and telephone number. Then, simply click Submit and your test results will be sent to us. From there, we can advise you on further action.