OSA 50 Screen Questionnaire

*** This form will be submitted electronically by standard email as a password-protected pdf file directly to the practice nurse. If you wish to send your name and date of birth in a de-identified manner please write a bogus name and advise reception by phone to link to your file. ***

  • Instruction

    When you submit the questionnaire, you will see your score at the next screening with an explanation.

    Score Guide
    If you score more than 5 out of 10, consult your doctor to see if you need to investigate further as you may be at risk of Sleep Apnoea.

  • What is your waist circumference
  • Has your snoring ever bothered other people?
  • Has anyone noticed that you stop breathing during your sleep?
  • Are you over 50 years old?

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