Obstructive Sleep Apnoea Screening Questionnaire

Suspect you might have sleep apnoea? You’re not alone. Obstructive Sleep Apnoea (OSA) affects an estimated 1 in 4 adults in New Zealand, yet many cases remain undiagnosed. At Optima Sleep, we provide a simple, online Sleep Apnoea test that will get you started on your journey to better health.

Obstructive Sleep Apnea Test

Question 1: Snoring?(Required)

Do you Snore Loudly (loud enough to be heard through closed doors or your bed-partner elbows you for snoring at night)?

Yes

Question 2: Tired?(Required)

Do you often feel Tired, Fatigued, or Sleepy during the daytime (such as falling asleep during driving or talking to someone)?

Yes

Question 3: Observed?(Required)

Has anyone Observed you Stop Breathing or Choking/Gasping during your sleep?

Yes

Question 4: Pressure?(Required)

Do you have or are being treated for High Blood Pressure?

Yes

Question 5: Body Mass Index more than 35 kg/m2?(Required)

Yes

Question 6: Age older than 50 year old?(Required)

Yes

Question 7: Neck size large?(Required)

(Measured around Adams apple) For male, is your shirt collar 17 inches/43 cm or larger? For female, is your shirt collar 16 inches/41 cm or larger?

Yes

Question 8: Gender = Male?(Required)

Yes

First Name(Required)

Last Name(Required)

Date of Birth

DD slash MM slash YYYY

Phone

Email(Required)

Get in Touch?

Check this box if you don't want us to get in touch with you.

Get your Test Results

You will receive an email of your results. We may also follow up with some relevant information in regards to your sleep health. You can unsubscribe at anytime.

CAPTCHA

Phone

This field is for validation purposes and should be left unchanged.

Tired of
Being Tired?

Find out if Obstructive Sleep Apnea (OSA) is affecting your sleep. Take our quick and free OSA test today!

Take the Test!

Optima Sleep specialises in non-invasive treatment for Obstructive Sleep Apnea (OSA) and snoring using custom Airway Sleep Devices (ASD). We provide sleep assessments, home sleep testing, device fabrication and ongoing care.

OPP - Optima Payment Plan with Stripe