S

Do you snore loudly (louder than talking/are you heard through closed doors)?

Y

N

T

Do you often feel tired, fatigued, or sleepy during the day?

Y

N

O

Has anyone observed you not breathing during your sleep?

Y

N

P

Do you have, or been treated for high blood pressure?

Y

N

B

Is your body mass index more than 28?

Y

N

A

Is your age 50 or older?

Y

N

N

Is your neck circumference greater than 17in (men) or 16in (women)?

Y

N

G

Is your gender male?

Y

N