Do you snore loudly (louder than talking)?
Yes
No
Do you often feel tired, fatigued, or sleepy during daytime?
Yes
No
Has anyone observed you stop breathing during your sleep?
Yes
No
Do you have or are you being treated for high blood pressure?
Yes
No
Is your Body Mass Index (BMI) score higher than 35?
Yes
No
Are you over 50 years old?
Yes
No
Is your neck circumference bigger than 16 inches (40cm)
Yes
No
Are you male?
Yes
No
Do any of the following apply to you?
High blood pressure
Diabetes
Heart disease
Stroke
Insomnia
Depression
Frequent nighttime urination
None of the above
Full Name
Email
*
Phone