CONCIERGE SLEEP MEDICINE
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Sleep Apnea Quiz PDF
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    Sleep Apnea Quiz (SAQ)  2017

    Month/Date/Year


                                SITUATION
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    If you marked Yes three or more times, you may show symptoms of Sleep Apnea, a life-threatening disorder that causes you to stop breathing repeatedly often several hundred times a night while you sleep.

    This questionnaire is meant to be a source of education to help you and your physician decide if you need help or further evaluation. It should not be used for diagnosis or treatment purposes.

    If you show symptoms of a sleep disorder for more than two weeks, please take this form to your physician.
    Sleep Study at the comfort of your home using SOMNOscreen™ plus, the smallest state of the art wireless PSG system with up to 28 channels or ApneaLink Plus, that will allow you to move freely anywhere in your home without any tech assistance. Tel: (305) 606-5332 • e-mail: info@conciergesleepmedicine.com
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