Form preview
The STOP-BANG Sleep Apnea Screening form digitizes one of the most widely validated and easy-to-administer screening tools for obstructive sleep apnea (OSA). The acronym represents eight risk factors: Snoring loudly, feeling Tired during the day, Observed apnea during sleep, high blood Pressure, BMI over 35, Age over 50, Neck circumference over 40 cm, and male Gender. Each item is scored as yes (1) or no (0), producing a total score from 0 to 8.
Risk stratification is straightforward: a score of 0-2 indicates low risk for OSA, 3-4 indicates intermediate risk, and 5-8 indicates high risk. Studies have shown the STOP-BANG has a sensitivity exceeding 90% for detecting moderate-to-severe OSA, making it an excellent first-line screening tool. The digital form includes fields for the score and provides risk-level interpretation, along with recommendations for further evaluation such as home sleep testing or in-lab polysomnography.
This template is widely applicable across clinical settings including pre-operative anesthesia assessments (where undiagnosed OSA poses significant surgical risk), primary care practices evaluating patients with hypertension or metabolic syndrome, sleep medicine referral workflows, and occupational health programs screening commercial drivers or pilots. The STOP-BANG is endorsed by the American Society of Anesthesiologists and the American Academy of Sleep Medicine as a validated OSA screening instrument.
What's included
- All eight validated STOP-BANG screening items
- Automatic score calculation and risk stratification
- OSA risk-level interpretation (low, intermediate, high)
- Recommendations for further sleep testing
- BMI and neck circumference measurement fields
- Provider notes and referral documentation
Who uses this template
- Pre-operative anesthesia sleep apnea risk assessment
- Primary care screening for patients with hypertension or obesity
- Sleep medicine referral and triage workflows
- Occupational health screening for safety-sensitive positions
All form fields
12 fields across 1 page. Customize any field after signing up.
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